"First, do no harm"
Sir William Osler (1849-1919)
Canadian-born physician |
"The most exciting phrase to hear in science, the one that heralds new discoveries, is not "Eureka" (I've found it!), but "That's funny..."
Isaac Asimov |
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Anal Fissure -
A New Look At Cause And Treatment
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The Old Theories (and treatments) Just Don't Hold Up
My theory of the causation of anal fissure differs considerably from classical medical teaching. It is based upon thousands of clinical observations using wheatgrass as a therapeutic agent which suggests that it works as a topical immunomodulator or "tissue normaliser".
The exact cause of anal fissure is unknown. When I was a medical student in the 60's, it was thought to be due to a tear in the anal canal, most likely from the trauma of passing a hard or large stool. One of the reasons it was thought to persist was that the fissure caused spasm of a muscle inside the anus which in turn reduced the blood supply to the anal canal. This is thought to complicate the healing process. But how is it that babies may be born with anal fissure yet they're not constipated? Why do so many chronically constipated patients have chronic anal fissures they had no idea existed because no doctor had ever examined their anal canal? Many people with fissures have never been constipated.
So
how is it, that by curing anal fissures with my wheatgrass extract, (80-90 percent success rate) I am often able to rid the patient of constipation they have suffered for years? In other words, fix the fissure - fix the constipation.
Constipation - Cause Or Effect?
I believe that constipation probably has little to do with causing anal fissure. More likely, the fissure occurs first and the constipation follows. I have seen numerous severely constipated patients who have had all manner of investigations and treatments, but their doctor has never checked to see if an anal fissure was present. This is a very simple examination.
Let us suppose that mechanical factors such as constipation are not causes of anal fissure, but aggravating factors. That is, the fissure exists for other reasons, but constipation, stress (e.g. domestic violence causing stress to the fetus) and other factors either makes the symptoms worse or just perpetuates the problem. Then what is the cause?
It is possible that anal fissure is due to auto-immunity. For some reason, auto-immune antibodies attack and damage the (usually posterior) margin of the anal canal. This results in an inflammatory response by these tissues i.e. they become red, swollen and painful, the skin and mucous membrane breaks down and the fissure opens. At time of defecation, the anal sphincter reflexly goes into spasm and fecal retention occurs leading to constipation. Then, unless some way is found to heal the fissure, or the body repairs itself, the fissure becomes chronic. The anal verge being unable to "rest" for any length of time because of the need for bowel evacuation, the fissure remains open. The constipation that develops because of the fissure aggravates and perpetuates the problem.
Healing The Fissure
So what do we do to get rid of these fissures? Well, we cut them, we inject them with toxins, we insert all sorts of creams and gels into the anal canal to try and relieve the pain, we sit in hot baths and so on. All current treatments are either of limited efficacy or complicated by unpleasant side effects. In particular, glyceryl trinitrate (GTN) can produce quite severe headaches in many users, (see table below), and claims of efficacy vary widely. So far, most of the patients I have treated for AF with wheatgrass that have returned for follow up have either had a dramatic improvement in symptoms (pain, bleeding, constipation) within a couple of weeks or healed completely. All it required was a small amount of wheatgrass extract applied just inside the anal canal once or twice a day, using a cotton bud.
How does wheatgrass heal anal fissure? Well, if one thinks of wheatgrass as a topical immunomodulator or immune-enhancer, it is reasonable to expect it to reduce the effects of an auto-immune induced fissure by somehow "normalising" the abnormal or pathologically affected anal tissue.
>>Case history and further discussion
Please email me if you would like more information.
Anal Fissure - Some Treatment Comparisons |
Treatment
Modality |
Effectiveness |
Cost |
Adverse Effects |
Wheatgrass Cream.
Either make up your own mixture or purchase commercial product. Search on e.g. "wheatgrass fissure". Apply twice daily. |
Very high. Safe. Hundreds of successful treatments/very few treatment failures in 10 years. Expect symptomatic relief within one to two weeks in most cases. |
Very low. |
Nil recorded or observed. No contraindications or precautions required.
Safe in pregnancy, breastfeeding. |
| Anal dilatation and/or lateral sphincterotomy |
95% prolonged symptomatic improvement |
High |
Can cause irreversible incontinence of flatus and stool |
| Glyceryl trinitrate (Rectogesic in Australia - Anogesic in USA)) |
70% healed in 6 weeks |
30gm. AUD$50. Three times a day application |
Up to 80% have headaches, 1 in 13 have anal burning. Dizziness. Interacts with alcohol, other nitrates. Contraindications:severe anemia, glaucoma, hypotension, raised intracranial pressure, pregnancy, breast feeding |
| Botulinum toxin (by anal injection) |
96% heal within 2 months. On average 2.8 treatments required per fissure |
High. A 100U vial costs approx. US$325 plus procedural costs etc. |
?Can cause irreversible incontinence of flatus and stool. Debate continues. |
| Xyloproct, Scheriproct, Ultraproct, Hemocane,Proctosedyl |
Doubtful efficacy |
Low to medium |
Contraindications and precautions e.g. pregnancy |
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