Doctors Lounge - Gastroenterology Answers
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Forum Name: Gastroenterology Topics
|Veridian - Wed Dec 09, 2009 2:49 pm||
I am a 30 yr old female. In Nov. '08, after having my son, I developed an anal fissure. My doctor gave me 2% Nitro Bid to help heal it. After a couple weeks it healed. Jan. '09 I had bleeding and pain again, so I used the Nitro and it went away. After it happend a third time, in Mar. '09 I went to my doctor (a different person because we moved). He told me to make sure I drink plenty of water, eat 25-30g of fiber a day and use stool softner when needed.
I have been following my Doctor's advice. However I have had several more "flare ups" since March. (Maybe I did not eat enough fiber or drink enough water during those episodes, I'm not sure)
Is this something I will have to deal with the rest of my life? Will I just have to be super strict with my diet to ensure proper intake of fiber and to avoid painful movements? Or is there something else happening?
|Dr.M.Aroon kamath - Tue Dec 15, 2009 1:53 am||
Pregnancy associated anal fissures usually occur anteriorly(in the front of the anus (at 12 O'clock position in the lithotomy position), unlike the other common fissures that occur in the posterior part of the anus (at 6 O'clock position in the lithotomy position).
Some of the acute fissures do heal completely. Some tend to become chronic.The chronic fissures tend to heal and breakdown intermittently.
Some of the non-operative means which are available for the management of fissures are
- sitz baths
- self anal dilatations (using dilators)
- dietary modifications (including high fiber in diet)
- topical nitro-glycerine
- topical calcium channel blockers (ex, Diltiazem) etc.
Sometimes, a combination of non-operative means may work, rather than a single modality.
If one does not respond to the non-operative management for any reason (refractoriness, non-compliance), surgical option (lateral sphincterotomy) may need to be considered.
In refractory cases one should exclude inflammatory bowel disease (IBD) as well.
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