1. Anal fissure is the chief cause of anal pain and bleeding, and is usually associated with a history of constipation, hard stools, straining, etc.
2. Burning, searing, or stabbing pain during defecation with persistent burning sensation for up to several hours after bowel movements are typical.
3. Attention should first be directed at correcting constipation, with the goal of achieving 1-2 soft bowel movements per day.
4. Adjunctive measures -- not a substitute for dietary measures -- may include
- sitz baths
- 0.2% nitroglycerine ointment (can cause headache)
- 0.3% nifedipine ointment BID (must be compounded)
Suggested Additional Test/Management Prior to Specialty Visit
Patient Education/Information (includes preps)
A high fiber diet can be achieved by daily use of a high fiber cereal (i.e., All-Bran, Fiber One, Bran Buds, Kashi cereals with >10 grams of fiber per serving) ½ to 1 cup of cereal daily.
by using a fiber supplement (i.e., Metamucil, Citrucel, Benefiber, etc.). A sufficient amount must be taken daily to give 10-20 grams of fiber. This usually means tablespoons not teaspoons of supplement.
The added fiber must be taken every day. It is not a cathartic. Beneficial effects take days to weeks as the colon adapts to the new diet.
Miralax is another alternative, but should be reserved for patients who cannot tolerate or are unable to manage a high fiber diet.
For patients with severe, chronic constipation, or in whom one is concerned about dysmotility, referral to the Michigan Bowel Control Program is suggested.
How to Get Results to Consultant
UMHS Patients: See CareWeb
External Patients: Hand carry Non-UM records to visit