An anal fissure can be a very troublesome problem. In my practice I suggest the following measures. Do sitz bath daily three times. Cremagel (Diltiazem 2%) should be applied in the orifice half an hour before passing the stool. Take two teaspoons of lactulose solution followed by two glasses of water during bed time. Increased uptake of green leafy vegetables, fibrous vegetables, and fruits. Quit smoking, and drinks if you do. Do cardio exercises regularly. If followed properly the fissure can heal. This region has peculiar anatomy. The fissure does not heal that easily, because the anal sphincter is tight which prevents the return of venous blood. When you do sitz bath with warm water and apply Diltiazem ointment the sphincter relaxes helping the blood to flow and go back. Thus the vascularity helps to remove inflammatory products and heal the wound. Increasing the fiber content of food helps in the formation of soft stools which do not cause the tear in mucosa while passing stools. The injury initially occurs due to constipated hard stools. Lactulose increases water entry into the large intestines and helps to form soft stools. I hope this helps. Thank you and take care.
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