Physiopathology of the anal fissure

The anal fissure is a lesion of the distal anal canal epithelium, often located at the posterior commissure.

The onset of an anal fissure is associated with several factors, which, if untreated, can cause chronicity. The chronicization of the anal fissure usually occurs about 6 weeks after the original lesion appears.

This lesion develops from a microtrauma in the perianal area, frequently caused by constipation or diarrhoea.

Patients suffering from anal fissure experience intense pain during defecation and a few hours later. The pain causes the physiological contraction of the sphincter muscles (hypertonia of the internal anal sphincter) aimed at limiting the exposure of the lesion. The hypertonia of the sphincter reduces the blood supply to the perianal area (local ischemia) slowing the healing of the fissure and favouring its chronicization.

It is therefore important to act on all the elements underlying the onset of the anal fissure and its subsequent chronicization. The ideal product must protect and lubricate the perianal area, preventing the formation of further fissures, relieving defecation pain and favouring the healing of the lesion.

Levorag^® emulgel: therapeutic indications

Levorag^® emulgel is a cream with emollient, lubricating and film-forming properties for the symptomatic and asymptomatic treatment of anal fissures. Levorag^® helps repair the epithelium of the mucosa and promotes regression of burning, irritation and itching.

The clinical evidence shows the efficacy of Levorag^® emulgel both in the treatment of acute anal fissures and in the treatment of chronic anal fissures with a significant pain reduction.¹

Levorag^® emulgel: mode of action and properties

Levorag^® emulgel acts on the various factors involved in the development of the anal fissure.

Thanks to its exclusive formulation, Levorag^® alleviates the symptoms of anal fissures and promotes the healing process. The ingredients of natural origin contained in Levorag® contribute to a rapid well-being and to restoring optimal physiological conditions.

Levorag^® emulgel is in fact an adjuvant for the treatment of anal fissures with:

• lubricating and film-forming properties
• emollient and moisturising properties
• soothing properties
• protective properties

Levorag^® creates a protective film on the perianal area which allows it to be preserved from external microorganisms. Its oily and soothing substances help lubricate the treated area, reduce pain and facilitate evacuation, preventing the formation of further microlesions.

• Lubricating and film-forming properties
  The oily substances contained in Levorag^® contribute to lubricating the application area, avoiding contact between the walls of the sphincter and facilitating the passage of the faeces.
  CM-Glucan and Glyceryl Stearate also contribute to creating a protective film on the treated area.
• Emollient properties
  The emollient substances found in Levorag^® help maintain skin hydration by reducing the transdermal evaporation process.
• Moisturising properties
  CM-Glucan contributes to moisturising the skin thanks to its ability to absorb water.
  Glyceryl Stearate is able to form a barrier on the skin which slows the loss of trans-epidermal water.
• Soothing properties
  The soothing substances in Levorag^® promote the reduction of inflammatory processes and the healing of microlesions, creating an environment conducive to healing the fissures and unfavourable to bacterial colonisation.
• Antioxidant properties
  The antioxidant substances in Levorag^® help to counteract oxidative phenomena and contribute to preserving skin elasticity.

Levorag^®: advantages

The combined action of all the components of Levorag^® cream emulgel enables acting on various factors of the disease. Levorag^® emulgel:

• lubricates and protects the perianal area
• preserves hydration of the epithelium
• helps relieve pain during defecation
• promotes lesion repair

Levorag^® also offers additional advantages:

• standard quantity of product and targeted delivery in the right place.
  The practical single-dose tubes with integrated cannula allow to apply a standard quantity of product with targeted delivery in the area to be treated.
• also indicated for prolonged use.
  Unlike other preparations for topical use for treating anal fissures, Levorag^® can also be used for prolonged periods.
• no side effects.
  There are no documented complications or serious side effects following the use of Levorag^®.¹
• ready and easy to use.
  Thanks to the practical single-dose tubes with built-in applicator, Levorag^® is ready and easy to use.
• maximum hygiene.
  Single-dose tubes with built-in applicator guarantee maximum hygiene.
• non-greasy and does not stain.
• it does not contain cortisone, anaesthetics, perfume and dyes. Ncikel Tested.

The practicality and simplicity of use, the targeted delivery of standard product quantities and the absence of side effects favour excellent compliance by patients^1,2, maximising the effectiveness of the treatment.

Levorag^®: posology and ingredients

Posology:

we recommend applying twice a day, ideally after stool evacuation, for at least 20 consecutive days.

Ingredients:

Aqua, dimethicone, glycerin, prunus amygdalus dulcis oil, phenyl trimethicone, borago officinalis seed oil, malva sylvestris extract, panthenol, hydrolyzed hibiscus esculentus extract, dextrin, phenoxyethanol, cetyl alcohol, glyceryl stearate, PEG-75 stearate, triethanolamine, tocopherol, acrylates/C10-30 alkyl acrylate, crosspolymer, 1,2-hexanediol, caprylyl glycol, ceteth-20, steareth-20, maltodextrin, calendula officinalis flower extract, glycyrrhiza glabra root extract, ethylhexylglycerin, sodium carboxymethyl beta-glucan, trisodium ethylenediamine disuccinate, tropolone, silica.

Levorag^® is a medical device that does not require a prescription and can be ordered and purchased in all pharmacies.

Bibliography:

1. Prospective multicenter observational trial on the safety and efficacy of LEVORAG^® Emulgel in the treatment of acute and chronic anal fissure, Altomare D.F., Digennaro R., Pecorella G., Serra G., et al., Tech Coloproctol. 2015 May; 19(5): 287-92. Epub 2015 Mar 15
2. Resultados de la encuesta de satisfacción realizada a pacientes con fisura anal tratados de forma conservadora, Arellano M. L., Prieto Nieto I., Dore M., et al., Poster XXX National Congress of Surgery 2014, Madrid