Evidence supporting the use of: Psyllium
For the health condition: Anal Fistula or Fissure

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Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Psyllium, a soluble fiber derived from the seeds of Plantago ovata, is commonly recommended as an adjunctive treatment for anal fissures and, to a lesser extent, anal fistulas. The primary rationale is its well-established ability to soften stools and increase their bulk, thereby reducing straining and minimizing trauma to the anal mucosa during defecation. Reduced trauma may facilitate healing of fissures and prevent recurrence. Several randomized controlled trials and meta-analyses have demonstrated that fiber supplementation, including psyllium, leads to significant improvement in symptoms, healing rates, and pain reduction in patients with acute and chronic anal fissures. For example, a meta-analysis published in the Diseases of the Colon & Rectum journal (2005) concluded that dietary fiber is effective for healing and symptom relief in anal fissure management.

For anal fistulas, direct evidence supporting psyllium's efficacy is limited. However, softening stools to reduce local trauma and promote easier bowel movements is generally considered beneficial for patient comfort and to prevent further irritation, even if it does not directly treat the fistula itself. Guidelines from colorectal societies often include fiber supplementation as a conservative measure in the management of both conditions. While psyllium does not cure anal fissulas or fissures, its use is scientifically justified as a supportive therapy to optimize healing conditions and prevent symptom exacerbation.

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