Anal fissures have a tendency for recurrence or chronicity. Katsinelos et al. (2006) observed 16% recurrences, and Jensen (1987) 25%. Therefore, strategies to avoid such developments should be designed. In a double-blind, placebo-controlled study concerning 90 patients with acute anal fissure, Jensen (1987) was able to prove that after the administration of 5 g of unprocessed bran (three times daily over a year), a recurrence affected only 16% of the cases. The placebo group, however, showed 68% recurrences. Bran absorbs four times its weight in water, and thus effects a voluminous stool which leads to a physiological dilatation of the anus during its passage. Contrary to bran, Plantago ovata (flee seed husks; Mucofalk^®) increases substantially in volume, so that its administration promises an even better therapeutic effect.

Moreover, Katsinelos et al. (2006) were able to show that 0.5% nifedepine ointment significantly reduced the tendency for recurrence of acute anal fissure or its transition to a chronic anal fissure.

Quality of Life (QOL) is a complex health-related concept which still lacks a universally binding definition. In medicine, this term has been gaining increasing importance for some years now, especially under therapeutic aspects, for instance, in palliative cancer therapy. However, this concept does not guarantee survival, but it can improve or at least maintain more or less the quality of life until death.

Quality of life can be quantified on the basis of data drawn from three different health questionnaires:

In 1995, Eypasch and coworkers developed the GastroIntestinal Quality of Life Index (GIQLI). The questionnaire lists symptoms and factual as well as emotional and social dysfunctions which are associated with a gastrointestinal disorder or are related to a corresponding treatment.

Points between 0 and 4 are allotted to each of the 36 questions. The quality of life status is equivalent to the sum of points scored, that is, 144 points in the best and 0 points in the worst case.