Purpose of the Diet
The diet for anal fissures is a nutritional system aimed at the prevention, reduction of symptoms and remission of anal fissures.
Remember that, as specific and correct, the diet is not always completely conclusive; in fact, for certain levels of severity, the joint application of a medical therapy becomes essential.
Figure: psyllium seed powder, particularly suitable for softening faeces in the case of fissures associated with constipation
NB . Rhagades are NOT hemorrhoids; while affecting (more or less) the same tract of intestine and, despite having various causes in common, they must be treated pharmacologically in a different way. To learn more, see the articles: drugs for the treatment of anal fissures and drugs for the treatment of hemorrhoids.
Anal fissures
Anal fissures are elementary cutaneous lesions of the anal canal, often superimposed on infectious, inflammatory (dermatitis) or, more rarely, psoriasis.
In the etiology of anal fissures, in addition to the physical stress linked to the passage of hard or irritating stools, inflammation of the anal mucosa plays a more than decisive role.
The fissures can appear to be bright red and immediately appear with traces of fresh blood (bright red) in toilet paper.
In acute form they cause a strong pain to the anus, both during and after the defecation, while the chronic ragadi bring a decidedly inferior discomfort.
Anal fissures generally occur near the anal opening, especially behind the midline; it is likely that this is due to the lack of blood perfusion and the specific shape of this area.
The depth of the anal fissures is variable, from superficial to deep, with achievement of the underlying sphincter muscle. Upon visual examination, superficial fissures may appear to be cuts so thin that they are difficult to identify; generally, they heal spontaneously in about two weeks. However, some become chronic and reach the deepest layers.
The most frequent cause of chronicity is the spasms of the internal anal sphincter, which makes defecation even more difficult and alters the flow of blood to the anal mucosa, favoring bacterial proliferation.
Causes
Most anal fissures are due to excessive stretching of the anal mucosa. In adults, this occurs mainly due to constipation and the relative passage of excessively large and hard stools; however, paradoxically, fissures can also occur in case of prolonged diarrhea, due to the irritating effect of unformed stools.
Reduced blood flow also plays an important role in the elderly.
When anal fissures are on the side and deeper, they can be related to other pathological conditions, such as carcinoma or chronic inflammatory bowel diseases (ulcerative rectal colitis, Crohn's disease); in this case diagnostic tests are required for differentiation from more serious disorders.
As with proctitis, anal fissures can also be favored by certain sexually transmitted infections, which favor tissue rupture and subsequent cracking. Some examples are: syphilis, genital herpes, chlamydia and papilloma virus.
Secondary causes of anal fissures are: trauma of birth in women, anal sexual activity and poor hygiene (especially in children).
Prevention and Care
Prevention and treatment of anal fissures are based on:
- Suitable diet
- Delicacy in defecation
- Hygiene of the anus
- Treatment of diarrhea
- Frequent diaper change in children.
Generally, in less severe cases, the diet is sufficient to make the anal fissures heal completely. In the next chapter we will analyze it more accurately.
In the event that the nutritional therapy fails or is able to soften the faeces only partially, it becomes essential to reduce the intra-abdominal pressure and the consequent excessive (or too abrupt) distension of the anus.
A very useful trick is to give the right time to the defecatory activity.
Furthermore, the use of lubricating ointments can be very useful, provided they are not aimed at treating hemorrhoids. In fact, the latter are based on vasoconstrictors and would exert an action diametrically opposite to that necessary for the healing of anal fissures.
In the most severe cases it may be necessary to use anesthetic drugs, nitroglycerin for topical use or calcium channel blockers; alternatively, localized injection of botulinum toxin is proposed (for relaxation of the anal sphincter).
Diet
As far as the diet against anal fissures is concerned, the main objective concerns the reduction of stool consistency . This result can be pursued by:
- the increase in the fiber share (especially soluble)
- increasing the share of water
- the increase in the amount of vegetable oils (if deficient).
Even without any other precaution, these three nutritional interventions are generally able to favor the evacuation, reducing the necessary efforts and increasing the speed, as well as the frequency of the sessions.
The increase in the fiber quota can also be obtained by means of supplements based on soluble molecules such as inulin and glucomannans; on the contrary, it is better to avoid osmotic and irritating laxatives such as lactulose and anthraquinones.
In addition to the modification of the fecal consistency, it is possible to obtain a further reduction of the pain symptomatology by eliminating the irritating agents from the diet. Among these, the molecules responsible for the spicy taste stand out, in particular:
- Chili capsaicin
- Black pepper piperine
- Gingerol of ginger
- Horseradish, mustard seed and wasabi isothiocyanate
- Garlic, onion, shallot, etc. allicin
The same is true for some nerves, such as:
- Ethyl alcohol of all alcoholic beverages
- Coffee caffeine
- Cocoa theobromine
- Theine of fermented teas.
ANALI fissures and diarrhea
As anticipated, anal fissures can also appear in the case of protracted diarrhea. This is attributable to the presence of:
- Contraindicated molecules such as, for example, lactose and gluten for intolerant people
- Irritating molecules (see above).
For more information, see the article dedicated to the Diet for Diarrhea
It should also be remembered that the nutritional excess of fats determines a reduction in fecal pH and, on the contrary, that of proteins increases it; both contribute to the negative selection of the intestinal bacterial flora, preferring the putrefactive flora and playing an unfavorable role in the healing of fissures.
It is therefore logical to think that even for fissures, as for other intestinal diseases, taking probiotics can be a positive attitude.
ANALI fissures in infants
Unlike adults, where dehydration is only one of several predisposing factors, dehydration is of paramount importance in infants. Parents must therefore ensure that the amount of breast milk is sufficient and that, if artificial formulas are used, the dilution ratio is correct.
The resolution of fissures in children is much faster than that of adults.
