Evidence supporting the use of: Fiber (unspecified)
For the health condition: Anal Fistula or Fissure

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Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Synopsis: Dietary fiber is scientifically validated as a supportive treatment for anal fissures and, to a lesser extent, for anal fistulas. High-fiber diets are recommended in multiple clinical guidelines and supported by randomized controlled trials, particularly for anal fissures. Fiber increases stool bulk and softness, which reduces straining and trauma during defecation. This, in turn, decreases pain and promotes healing of anal fissures. A 2013 Cochrane review found that fiber supplementation increased the likelihood of fissure healing compared to placebo, and reduced the recurrence rate. The same body of evidence supports its use in chronic constipation, a common contributing factor to both fissures and (indirectly) to fistulas.

For anal fistulas, the evidence is less robust, but fiber is still commonly recommended to ensure soft stools and minimize trauma to the healing tissue, especially post-surgical intervention. While fiber does not directly treat the fistula tract, it supports overall anorectal health and reduces symptoms such as pain and bleeding. Fiber is included as part of standard conservative management in both conditions by authoritative sources such as the American Society of Colon and Rectal Surgeons and NICE guidelines.

In summary, the recommendation to use fiber for anal fissure is strongly supported by clinical evidence, while its role in fistula management is more supportive and based on expert consensus and pathophysiological rationale.

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