What are the discharge instructions for a 31-year-old female with an anal fissure prescribed lidocaine (lidocaine) jelly?

Discharge Instructions for Anal Fissure Patient Using Lidocaine Jelly

For a 31-year-old female with anal fissure prescribed lidocaine jelly, instruct her to apply the medication topically to the anal area twice daily for pain relief, avoid applying to broken skin, and combine this with increased fiber intake (30-40g daily) and adequate hydration (at least 8 glasses of water daily) to promote healing. 1

Medication Application Instructions

• Apply a small amount of lidocaine jelly to the anal area twice daily, particularly before bowel movements to reduce pain
• Wash hands thoroughly before and after application
• Use only externally around the anus - avoid inserting deep into the rectum
• Do not apply to severely cut, irritated, or swollen skin 2
• A temporary burning sensation may occur upon application but should disappear within several days 2
• Do not cover the area with bandages or apply heat (such as heating pads) to the area 2
• Avoid contact with eyes and other mucous membranes 2

Dietary and Lifestyle Modifications

• Increase dietary fiber intake to 30-40g daily (through fruits, vegetables, whole grains) 1
• Drink at least 8 glasses of water daily to soften stool 1
• Consider a fiber supplement if dietary changes are insufficient
• Avoid straining during bowel movements
• Take warm sitz baths for 10-15 minutes 2-3 times daily, especially after bowel movements
• Use unscented, soft toilet paper or moistened wipes after bowel movements
• Avoid prolonged sitting and tight-fitting clothing

Pain Management

• Supplement lidocaine with oral pain medications like paracetamol or ibuprofen as needed 1
• Apply lidocaine jelly 15-20 minutes before bowel movements to reduce pain during defecation
• Continue warm sitz baths for additional pain relief

When to Seek Medical Attention

Instruct the patient to discontinue use and contact her doctor if:

• Condition worsens or symptoms persist for more than 7 days 2
• Redness, irritation, or signs of skin injury (pain, swelling, blistering) develop 2
• Symptoms clear up but recur within a few days 2
• Severe pain, bleeding, or fever occurs
• She experiences any systemic symptoms like dizziness or heart palpitations

Expected Treatment Course

• Pain relief should begin shortly after application of lidocaine
• Inform the patient that lidocaine provides temporary pain relief but is not curative alone
• Complete healing typically requires at least 6 weeks of consistent treatment 1
• If symptoms do not improve after 4-6 weeks, additional treatments like topical calcium channel blockers may be considered 1

Important Cautions

• Keep medication out of reach of children 2
• If pregnant or breastfeeding, consult healthcare provider before use 2
• If accidentally swallowed, contact Poison Control Center immediately (1-800-222-1222) 2
• Lidocaine jelly provides symptomatic relief but is not a definitive treatment for anal fissures - adherence to dietary and lifestyle modifications is essential for healing 1, 3
• Do not use for more than directed without consulting your doctor 2

Follow-up Instructions

• Schedule a follow-up appointment in 4-6 weeks to assess healing
• Consider additional treatments if symptoms persist, such as topical calcium channel blockers (nifedipine or diltiazem), which have healing rates of 65-95% 1
• Surgical options may be considered if no improvement after 8 weeks of conservative treatment 1