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Dx Anal Fissure Treatment:


Most anal fissures heal naturally: Dr. Weil suggests keeping the stool very soft with 'lots of vegetables, wheat bran, whole-grain breads and cereals and fruit'. Drink one rounded tablespoon of psylliim powder stirred into a glass of water or dilute juice. Drink 6-8 glasses of water per day. Add over-the-counter Colace (stool softener)and relax the sphincter with sitz-baths. Review more alternative therapies at the bottom of page: the [Editor] and [Jonathan Wright, M.D.].

The standard treatment reported by the U.S. National Institute of Health (N.I.H.) here and in Germany as stated is "Acute anal fissures should be treated conservatively by topical ointments, consisting of nitrates, calcium channel blockers and if all else fails by botulinum toxin. Treatment of chronic fissures will start conservatively but operative options are necessary in many cases. Operation of first choice is fissurectomy, including excision of fibrotic margins, curettage of the base and excision of the sentinel pile and anal polyps. Lateral internal sphincterotomy is associated with a certain degree of incontinence and needs critical long-term observation."
"A few of the newer agents investigated show promise based only upon single studies (clove oil, sildenifil and a "healer cream") but lack comparison to more established medications."

Anal Fissure

The Merck Manual Home Edition
"An anal fissure is a tear or ulcer in the lining of the anus. Anal fissures may be caused by an injury from a hard or large bowel movement or from frequent loose bowel movements. Uncommonly, they may also be caused by penetration of the anus during anal sex. Fissures cause the anal sphincter to go into spasm, which worsens pain and prevents healing. Fissures cause pain and bleeding, usually during or shortly after a bowel movement. The pain lasts for several minutes to several hours and then subsides until the next bowel movement. A doctor diagnoses a fissure by gently inspecting the anus."

Medications Used in Treatment:
1. Nitrates: Rectiv®. Can be compounded cheaply.
2. Acetylcholine Release Inhibitors: Botox®.
3. PDE5 Inhibitors: Sildenafil.

*[Editor]: Gynecologists use the same Tucks with glycerine in the folded middle and placed against the hemorrhoid to suck out the fluid as post-partum hemorrhoids are severe.
Alternatively, MediHoney may be used the same way. It can also be packed in any open sore, with the physician's approval.

[National Library of Medicine]: An interesting article suggests Medical Grade Honey be placed within a folded Tuck, for the treatment of anal fissure and hemorrhoids. The N.L.M. also reports: New research offers alternative non-surgical treatments for anal fissure. After nitroglycerin ointment, Botox and nifedipine are listed: sildenafil, L-arginine, clove oil, lignocaine, as well as sitz baths.

[Jonathan Wright, M.D.]: The use of inexpensive compounded 0.2% nitrogylcerin with 5% xylocaine shrinks the anal opening and offers topical relief at one-tenth the cost of Rectiv®. Jonathan Wright, M.D. also reports on using topical SSKI (Iodine) with DMSO to assist in the healing.

*[Editor-Case Report]: In one of our most severe case reports, a man with a 5-year history of a still-draining fistula after 5 major surgeries was able to improve healing by (1) raising his bio-available testosterone, (2) add anti-inflammatory anabolic steroids, and (3) incorporate a 6-month course of human growth hormone. Note that these complementary treatments were secured after receiving the surgeon-of-record's support and approval. Favorable outcome was noted in this unique case.

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