Quel est le traitement de première intention de la fissure anale ?
La prise en charge de première intention de la fissure anale est conservative. L'approche s'attaque à la fois à l'inconfort immédiat de la douleur aiguë et au mode de transit sous-jacent qui favorise la formation de la fissure et empêche la cicatrisation.
Objectif thérapeutique
Selles de consistance molle évacuées sans effort.
References
DOI: 10.1111/codi.167
- Patients should be encouraged to aim for stool consistency which is soft and passed without straining.
- This can be achieved using a combination of lifestyle measures (increased physical activity, weight loss, if appropriate, and adequate hydration), dietary changes (at least 30 g of fibre per day) and laxatives.
- This can be in the form of acute sharp pain which may be treated with topical anaesthetic agents such as lidocaine.
- In addition, patients may also experience a burning, dull perianal discomfort which may last for several hours after defaecation and may be offered nonopioid analgesics such as paracetamol with further escalation as appropriate.
- Advice includes not ignoring the urge to defaecate and avoiding prolonged sitting on the toilet or straining.