- Dietary fibre supplements
- Medical therapy of anal fissures: products for topical use
- Adjuvants in the treatment of anal fissures for topical use
- Intimate detergents for the perianal area
- THD: supplements, ointments and intimate detergents for anal fissures
Dietary fibre supplements
Faeces that are too hard or, on the contrary, liquid faeces, can cause lesions of the skin in the perianal area and favour the onset of anal fissures.
In the case of constipation, excessively hard or bulky stools make evacuation difficult and create further damage in the area affected by the fissure. Similarly, in the case of diarrhoea, liquid stools with a high level of acidity irritate the area around the anus, aggravating the symptoms of the fissure and slowing its recovery.
Bowel regularity and correct stool consistency are therefore important factors in the prevention of anal fissures or in the treatment of the disease, after its onset.
A diet rich in fibre and the intake of adequate amounts of water contribute to forming soft and easy to evacuate stools, counteracting constipation and reducing pain and spasm of the internal sphincter during defecation. By regularising intestinal transit and stool consistency, fibres also help to counteract diarrhoea and the consequent risk of local inflammation and irritation.
In the case of low-fibre diets, it is advisable to use specific dietary fibre supplements. THD offers two supplements based on natural fibres: THD Fibraid® and THD Fibraid® Gel. For further information on the THD Fibraid® line, click here.
Medical therapy of anal fissures: products for topical use
The objective of local medical therapy is to reduce the hypertonia of the internal anal sphincter and thus to facilitate the healing of the anal fissure. The most commonly used topical preparations for treating anal fissures are:
Nitro-glycerine ointments (GTN)
Studies on the pathophysiology of the anal sphincter have shown how nitric oxide helps to counteract hypertonia of the internal anal sphincter.
Nitro-glycerine based ointments (GTN), a substance capable of releasing nitric oxide, are available on the market. Nitro-glycerine based ointments cause relaxation of the internal anal sphincter, reducing hypertonia and promoting fissure healing.
Clinical evidence shows an average cure rate of 58% within the first 2 months of treatment, while the recurrence rate is between 11 and 46.2%. However, the use of these products is associated with a very frequent complication (on average in 57% of cases) which sometimes forces the interruption of the treatment: headaches.
Clinical evidence has shown how injecting botulinum toxin into the smooth internal sphincter allows to reduce the tone of the internal anal sphincter, favouring the healing of anal fissures. This active ingredient causes flaccid paralysis which tends to remain for about 3-4 months.
The healing rate of anal fissures is between 27 and 96% within 2 months of treatment. However, relapses can reach 30% of cases. The most frequently documented side effect is temporary faecal incontinence which occurs on average in 18% of patients.
Calcium channel blockers
Calcium antagonist preparations, such as nifedipine, result in a reduction of the maximum sphincter pressure at rest. In a 2011 Italian study, the healing rate of patients treated with a nifedipine cream after 6 weeks of treatment was 95%.
Side effects associated with these products include migraine headaches and the risk of overdose in cardiac and diabetic patients.
- Optimal treatment duration of glyceryl trinitrate for chronic anal fissure: results of a prospective randomized multicenter trial, G. Gagliardi, A. Pascariello, D. F. Altomare et al., Tech Coloproctol. 2010 Sep; 14(3): 241-248.
- La ragade anale” (prima parte/first part), G. Rosa et al. Riv. It. Colo-Proct., 22, 7-12, 2003
- The management of patients with primary chronic anal fissure: a position paper., D.F. Altomare et al. Tech Coloproctol (2011) 15: 135-141
- Innovations in chronic anal fissure treatment: A systematic review, Aaron Poh et al. World J Gastrointest Surg 2010 July 27; 2(7): 231-241
- A dose finding study with 0.1%, 0.2% and 0.4% glyceryl trinitrate ointment in patients with chronic anal fissures. J.H.Scholefield et al. Gut 2003; 52: 264-269
Adjuvants in the treatment of anal fissures for topical use
Today, adjuvants for topical use which allow the anal fissure to be treated without the side effects of nitro-glycerine, botulinum toxin and calcium channel blockers, are available.
For the treatment of acute and chronic anal fissure, THD offers Levorag® emulgel, a Class IIA medical device.
Thanks to its composition Levorag® emulgel:
lubricates, soothes and protects the treated area.
contributes to repairing the epithelium, creating a favourable environment for healing the fissures and hostile to bacterial attack.
relieves pain during defecation.
contributes to restoring optimal physiological conditions and consequently to reducing the hypertonia of the internal sphincter.
For further information on Levorag®, click here.
Intimate detergents for the perianal area
In the presence of fissures, a careful hygiene of the perianal area helps to avoid the onset of local inflammations which can slow down healing. The use of an intimate detergent specific for the perianal region after each evacuation allows supporting the action of local topical treatments or of systemic therapies.
However, intimate detergents which are too aggressive can alter the skin's hydrolipidic film, slowing down the healing of the lesion. In the presence of anal fissures, the ideal intimate detergent must:
- soothe and moisturise
For intimate hygiene of the perianal area in the case of fissures, it is therefore advisable to use a delicate and moisturising intimate detergent with anti-bacterial substances and physiological pH.
THD research has created THD Deliclin® Soap, a specific intimate detergent for the perianal region, useful in the presence of fissures. THD Deliclin® Soap cleanses, disinfects, moisturises and soothes the skin in the perianal region. For further information on THD Deliclin® Soap, click here.
THD: supplements, ointments and intimate detergents for anal fissures
THD offers an integrated approach to the prevention and treatment of anal fissures with a complete line of supplements, intimate detergents and adjuvants for topical use: