Role Of Diet And Nutrition In Managing Anal Fissures

Introduction

An anal fissure is a superficial tear in the skin around the anal canal. Managing anal fissures is important because they can cause significant pain, discomfort, and sometimes bleeding. If left untreated, they may cause certain complications, such as infection or inflammation. Proper management of anal fissures typically involves a combination of lifestyle changes, dietary modifications, and medical treatments.^1,2

Role of diet and nutrition in the management process

The role of diet and nutrition is well established in managing anal fissures. Because this type of management avoids the adverse effects of drugs associated with medical treatments and helps improve overall quality of life.

Causes of anal fissures

Following are some causes of anal fissures:

• Trauma — like stretching and straining 
• Chronic constipation and straining to poop
• Obstructive defecation syndrome
• Infant dyschezia
• Chronic diarrhoea
• Pregnancy and Childbirth
• Penetration
• Inflammatory bowel disease (IBD)
• Anal cancer
• Diaper rash
• sexually transmitted diseases, and
• Anal sexual intercourse^1,3

Symptoms of anal fissures

Generally, the patient experiences severe pain while defecating, and this pain may last for several minutes to several hours afterwards. The cycle of experiencing pain continues after every bowel movement, and the patient feels reluctant to have a bowel movement, leading to a cycle of worsening constipation, harder stools, and more anal pain. Approximately 70% of patients may bleed.⁴

Patients describe the pain as sharp, tearing, cutting or burning. Some people find that the pain spreads to their buttocks, thighs, or lower back.¹

Complications of anal fissures

In most of the cases, anal fissures may go without certain treatment. But if anal fissures don't heal, they can lead to further complications, such as:

• Fecal impaction
• Anal stenosis or
• Anal fistula

Differentiating between anal fissures and constipation

Anal fissures are often misdiagnosed as external or internal haemorrhoids. This is due to the similarities inherited in their symptoms, as both can cause rectal bleeding, anal pain, and anal itching. Therefore, a thorough physical exam and differential diagnosis should be performed to differentiate between the two.

Hemorrhoids and anal fissures have similar causes, and it’s easy to mistake one for the other. Both can happen when the anal region is stretched during defecation. Hemorrhoids don’t always cause pain, but 90% of fissures do. However, the pain from a fissure usually occurs in episodes, while haemorrhoids cause constant pain.^1,2

Diagnosis and treatment options

Most anal fissures go within a few days to weeks, or prescription cream is a solution to get rid of pain temporarily, like lidocaine. An anal fissure that lasts more than eight weeks is referred to as chronic fissure.

Medications

Medications for anal fissures include:

1. Nitroglycerin 

Nitroglycerin acts as a vasodilator, a medicine that dilates blood vessels. Usually applied as a cream, it can restore normal blood flow and can help the anal sphincter relax, thus decreasing tension and pain. However, it can cause headaches due to vasodilation in cerebral blood vessels, and some people have to discontinue it due to its side effects.

2. Calcium channel blockers

Diltiazem or nifedipine, is used when nitroglycerin does not work. These medications work as an alternative therapy to relax blood vessels and anal muscles. 

3. Botox

Botox is a muscle relaxant in the form of an injection. It is the last treatment option. It helps the anal sphincter muscle relax. Its effects last for about three months, giving anal mucosa and muscles enough time to heal.

4. Bulk laxatives

Not everyone with constipation requires to take medication for it, but medications can help if you have very hard poops that cause additional stress on your anal fissure. Bulk laxatives, such as Metamucil® (psyllium), draw fluid from the body into your gut to help soften the poop.¹

Diet and nutrition in anal fissure management

Various studies indicate that anal fissures result due to inappropriate diet and nutrition, and dietary interventions might reduce the incidence of these anal fissures. Appropriate diet and exercise ensure proper bowel movements, thus preventing constipation and promoting a healthy lifestyle.⁶

Take fibre-rich foods

A high-fibre diet is recommended for the management of anal fissures.¹ A fibre-rich diet includes fruits, vegetables, rice, and pasta.³ Fruits include raspberries, pears, and apples. Vegetables include broccoli and peas. Lentils, beans, and grains also have a rich fibre content. One study recommends that the adult diet contain 25 to 35 g of fibre daily.⁵

Hydration

Adequate fluid intake is also helpful in preventing the recurrence of anal fissures and is strongly encouraged. This is because having adequate body fluids prevents dehydration of gastric mucosa and keeps stools soft, easing stool passage.²

Avoid irritants

Foods to avoid include spicy foods and nuts while you have constipation or symptoms of anal fissures.¹ Many people prefer to eat spicy foods, ignoring digestive health. Spicy foods cause heartburn, and flavoured foods like garlic or onion may cause digestive problems.⁸

Dietary supplements

Psyllium-based products are the preferred fibre supplements. Unluckily, some people cannot tolerate psyllium because of developing excess gas or bloating; other fibre products are available for those people. In addition to consuming dietary fibre, patients should take fibre supplementation daily (i.e., 6 g of psyllium).

Their dosage should be increased to twice daily within a week if tolerable. Patients should drink at least two glasses of water or fluids following a dose of fibre supplement. Methylcellulose and guar gum are other fibre products for patients who cannot tolerate psyllium.⁵

Vitamins and minerals

Vitamin D deficiency causes intestinal motility disorders that can lead to chronic functional constipation. Therefore, appropriate vitamin D levels in serum should be maintained to avoid symptoms.⁹

Appropriate balance in levels of aluminium and magnesium should be maintained as magnesium helps manage constipation while aluminium causes it.¹⁰

Protein

Protein-rich foods such as lentils and beans promote good digestion and bowel movements, thus preventing anal fissures.

Healthy fats

A study found that lipid-rich foods were associated with a lower constipation score. As constipation is the most common cause of anal fissures, avoiding constipation by taking lipid-rich foods can help prevent anal fissures.⁷

FAQs

What are anal fissures, and why is it important to treat them? 

Anal fissures are minor cuts in the skin around the anus. If not treated, they can cause a lot of pain and problems.

What role does diet and nutrition play in managing anal fissures?

Diet and nutrition are crucial in managing anal fissures as they can help avoid the adverse effects of medications and improve overall quality of life. A high-fibre diet, adequate hydration, and avoiding irritants are recommended.

What are some common causes of anal fissures?

Common causes include trauma (such as stretching and straining), chronic constipation, diarrhoea, pregnancy, anal intercourse, and certain medical conditions like inflammatory bowel disease (IBD).

What are the signs of anal fissures? 

You might feel terrible pain when you poop, see bright red blood, and feel like you're being cut or burned. Some people also feel pain in their buttocks, thighs, or lower back.

How do doctors treat anal fissures? 

Most of the time, fissures get better in a few weeks. But if they don't, doctors might give you medicines like nitroglycerin, calcium channel blockers, botox injections, or laxatives. 

How can your diet help with anal fissures? 

Eating fibre-rich foods like fruits, veggies, grains, and beans is good for you. Drinking enough water and avoiding things that upset your stomach is also important. Some vitamins and minerals could help, too.

Can eating protein and good fats prevent anal fissures? 

Yes, foods with a lot of protein, like lentils and beans, can help with digestion and make it easier to poop. Good fats can also help stop constipation, which can cause fissures.

Are there any dietary supplements that can aid in managing anal fissures?

Psyllium-based products are the preferred fibre supplements, but alternatives like methylcellulose and guar gum are available for those who cannot tolerate psyllium. It's important to start with a low dose and gradually increase while staying hydrated.

Summary

Anal fissures, tears in the skin around the anal canal, cause pain, discomfort, and sometimes bleeding if left untreated. Managing them involves lifestyle changes, medical treatments, and dietary modifications. Causes include trauma, chronic constipation, diarrhoea, pregnancy, and certain diseases.

Symptoms include severe pain during bowel movements and bright red blood. Diagnosis involves physical examination, and most fissures heal within weeks. Treatment options include medications like nitroglycerin ointment and Botox injections.

Diet plays a crucial role in managing anal fissures, with a high-fibre diet recommended. Fibre-rich foods include fruits, vegetables, lentils, and grains. Adequate hydration is also important. Irritants like spicy foods should be avoided. Fibre supplements like psyllium are recommended, and vitamin D deficiency should be addressed. Protein-rich foods aid digestion, while healthy fats can prevent constipation, a common cause of fissures.