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    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/cremas-y-pomadas/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomadas-e-cremes/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/creams-and-ointments/"/>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/understanding-fissures/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.6</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/understanding-fissures/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/entender-la-fisura/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/understanding-fissures/"/>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/acute-vs-chronic-anal-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/acute-vs-chronic-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-anal-aguda-o-cronica/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/acute-vs-chronic-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/acute-vs-chronic-fissure/en/hero-1600.jpg</image:loc><image:title>Infographic introducing the guide on acute versus chronic anal fissure and the 6 to 8 week line</image:title><image:caption>After 6 to 8 weeks, a fissure is held open by the sphincter and scar: the treatment has to change.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/acute-vs-chronic-fissure/en/fig-1.jpg</image:loc><image:title>Cross-section drawing of the anal canal with a chronic fissure, showing the sentinel pile at the outer end, a hypertrophied papilla at the inner end and visible internal sphincter fibers</image:title><image:caption>The signs of chronicity: sentinel pile, hypertrophied papilla and sphincter fibers at the base of the wound. Based on ASCRS 2023.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/acute-vs-chronic-fissure/en/fig-2.jpg</image:loc><image:title>Timeline of an anal fissure from the first tear through the 6 to 8 week line to ointment, botulinum toxin and sphincterotomy</image:title><image:caption>From acute to chronic: what to do at each stage, based on ASCRS 2023, Jensen 1986 and the Cochrane review.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/anterior-anal-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anterior-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-anal-anterior/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anterior-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/anterior-fissure-women/en/hero-1600.jpg</image:loc><image:title>Infographic on anterior anal fissures in women and how they differ from the typical posterior fissure</image:title><image:caption>Anterior fissures sit at the front of the anal canal and are linked to childbirth and the pelvic floor.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/anterior-fissure-women/en/fig-1.jpg</image:loc><image:title>Diagram of the anal canal seen as a clock: posterior position where most fissures occur, anterior position more frequent in women and after childbirth, and lateral position that requires tests for other causes</image:title><image:caption>Where a fissure sits gives clues to its cause. Anterior fissures are more frequent in women; lateral ones need further tests. Based on ACPGBI 2023 and ASCRS 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/best-cream-for-anal-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/best-cream-for-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/crema-para-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-para-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/best-cream-for-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/best-cream-anal-fissure/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base over a peach background, next to the title of the guide on anal fissure creams</image:title><image:caption>The cream that closes a fissure is the one that relaxes the sphincter, used for 6 to 8 weeks.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/best-cream-anal-fissure/en/fig-1.jpg</image:loc><image:title>Decision tree: which cream to use depending on whether the anal fissure is recent, painful or chronic</image:title><image:caption>Choosing a cream by fissure type, based on ASCRS 2023 and ACPGBI 2023 guidelines.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/compounded-fissure-cream/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/compounded-fissure-cream/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/formula-magistral-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-manipulada-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/compounded-fissure-cream/"/>
    <image:image><image:loc>https://fisurin.com/img/compounded-fissure-cream/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a peach background next to the title of the guide on compounded fissure creams</image:title><image:caption>A compounded fissure cream is made for one patient, on prescription, in a local pharmacy.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/compounded-fissure-cream/en/fig-1.jpg</image:loc><image:title>Five numbered steps showing how a patient gets a compounded fissure cream, from diagnosis to prescription, preparation, use and review</image:title><image:caption>How a compounded fissure cream reaches you: diagnosis, prescription, preparation in a licensed pharmacy, 6 to 8 weeks of use and review.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/diltiazem-cream-anal-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/diltiazem-cream-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/crema-de-diltiazem/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/diltiazem-pomada/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/diltiazem-cream-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/diltiazem-cream-fissure/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a peach background next to the title of the guide on diltiazem 2% cream for anal fissure</image:title><image:caption>Diltiazem 2 % heals fissures about as often as nitroglycerin, with fewer headaches and fewer recurrences.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/diltiazem-cream-fissure/en/fig-1.jpg</image:loc><image:title>Bar chart comparing headache and recurrence risk with diltiazem versus nitroglycerin, with nitroglycerin set at 1.0</image:title><image:caption>Diltiazem against nitroglycerin in 7 randomized trials (481 patients): same healing, fewer headaches and recurrences (Sajid, 2013).</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/anal-fissure-crohns-disease/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-crohns-disease/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-anal-crohn/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-crohns-disease/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-and-ibd/en/hero-1600.jpg</image:loc><image:title>Infographic on anal fissures in Crohn’s disease and inflammatory bowel disease</image:title><image:caption>In Crohn’s disease, the fissure is treated together with the bowel inflammation.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-and-ibd/en/fig-1.jpg</image:loc><image:title>Comparison table between an ordinary anal fissure and a Crohn’s disease fissure by location, pain, appearance, surrounding skin and first step</image:title><image:caption>How surgeons tell an ordinary fissure from a Crohn’s fissure. Only biopsy and the full clinical picture confirm it (ASCRS 2023; Abreu Marques 2025).</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/anal-fissure-bleeding/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-bleeding/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/sangrado-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-bleeding/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-bleeding/en/hero-1600.jpg</image:loc><image:title>Infographic illustrating bleeding from an anal fissure and when it needs medical attention</image:title><image:caption>A fissure bleeds a little, bright red and with pain; dark blood, blood mixed with stool or bleeding after 45 need a doctor.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-bleeding/en/fig-1.jpg</image:loc><image:title>Traffic light of anal fissure bleeding: green for typical small bright red bleeding, yellow for bleeding that needs a check-up, red for warning signs that need a colonoscopy or emergency care</image:title><image:caption>How to read rectal bleeding when you have a fissure. Based on ASCRS 2023 and ACPGBI 2023; it does not replace an examination.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/anal-fissure-causes/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-causes/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/causas-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-causes/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-causes/en/hero-1600.jpg</image:loc><image:title>Infographic about the causes of anal fissure: constipation, diarrhea, childbirth and sphincter spasm</image:title><image:caption>A fissure starts with a tear and stays open because of sphincter spasm; treatment has to address both.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-causes/en/fig-1.jpg</image:loc><image:title>Cycle diagram: the tear causes pain, pain causes sphincter spasm, spasm reduces blood flow, and poor blood flow keeps the tear open</image:title><image:caption>The fissure cycle: the tight internal sphincter reduces blood flow and keeps the tear from healing. Based on ASCRS 2023 and ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/anal-fissure-in-children/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-in-children/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-anal-en-ninos/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/fissura-anal-em-crianca/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-in-children/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-children/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base over a peach background, next to the title of the guide on anal fissure in children</image:title><image:caption>In children, the stool softener is the treatment; creams protect and soothe.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-children/en/fig-1.jpg</image:loc><image:title>Five numbered steps to treat an anal fissure in a child: see the pediatrician, soften the stool, fiber and fluids, toilet routine, barrier cream</image:title><image:caption>The order that works in children: stool first, cream second. Based on Alshehri 2020 and ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/how-to-apply-fissure-cream/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/how-to-apply-fissure-cream/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/como-aplicar-pomada-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/como-passar-pomada-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/how-to-apply-fissure-cream/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-how-to-apply/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base next to the title of the guide on how to apply anal fissure cream</image:title><image:caption>A pea-sized amount, 1 cm inside, two to three times a day for six to eight weeks.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-how-to-apply/en/fig-1.jpg</image:loc><image:title>Five numbered steps for applying an anal fissure cream: prepare, measure a pea-sized amount, position, apply 1 cm inside, repeat for 6 to 8 weeks</image:title><image:caption>The application routine we teach in clinic, consistent with the 6 to 8 week regimen in ASCRS 2023 and ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/fissure-cream-not-working/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-cream-not-working/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/crema-fisura-no-funciona/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-fissura-nao-funciona/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fissure-cream-not-working/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-not-working/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base next to the title of the guide on what to do when fissure cream is not working</image:title><image:caption>Before changing cream, check stools, doses, technique and diagnosis.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-not-working/en/fig-1.jpg</image:loc><image:title>Decision tree for a fissure that is not better after four weeks of cream: check stools, doses and technique, diagnosis, then consider botox or surgery</image:title><image:caption>What to review, in order, when a fissure cream seems not to work. Based on ASCRS 2023 and ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/anal-fissure-cream-pregnancy/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-cream-pregnancy/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/crema-fisura-anal-embarazo/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-fissura-gravidez/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-cream-pregnancy/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-pregnancy/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base over a peach background, next to the title of the guide on anal fissure creams in pregnancy</image:title><image:caption>In pregnancy, soft stools come first; any sphincter-relaxing cream is decided by your doctor.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-pregnancy/en/fig-1.jpg</image:loc><image:title>Traffic light for anal fissure in pregnancy: safe first steps in green, treatments to decide with your doctor in amber, warning signs in red</image:title><image:caption>What to start with, what to ask about and when to get checked, based on ACPGBI 2023 and the Poskus 2014 cohort.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/fissure-cream-side-effects/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-cream-side-effects/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/efectos-secundarios-pomada-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/efeitos-colaterais-pomada-fissura/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fissure-cream-side-effects/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-side-effects/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base next to the title of the guide on side effects of anal fissure creams</image:title><image:caption>Headache is mainly a nitroglycerin problem; nifedipine and diltiazem cause mostly local burning or itching.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-side-effects/en/fig-1.jpg</image:loc><image:title>Comparison table of side effects of nitroglycerin, nifedipine or diltiazem, lidocaine and hydrocortisone creams for anal fissure, with headache risk and how to manage each</image:title><image:caption>Main side effects by type of fissure cream and how to handle them. Based on Cochrane CD003431, Sajid 2013 and ASCRS 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/gel-vs-ointment-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/gel-vs-ointment-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/gel-o-pomada-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/gel-ou-pomada-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/gel-vs-ointment-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-gel-vs-ointment/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base over a peach background, next to the title of the guide comparing gels, creams, ointments and pastes for anal fissure</image:title><image:caption>The base changes comfort; the active ingredient decides whether a fissure closes.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-gel-vs-ointment/en/fig-1.jpg</image:loc><image:title>Comparison table of gel, cream, ointment and paste for anal fissure: base, greasiness, staining, how long it stays and typical use</image:title><image:caption>How gels, creams, ointments and pastes differ in daily use around a fissure. No trial has shown one vehicle heals better than another.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/anal-fissure-women-men/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-women-men/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-anal-mujeres-hombres/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-women-men/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-in-men-vs-women/en/hero-1600.jpg</image:loc><image:title>Infographic comparing anal fissure in women, men, children and older adults</image:title><image:caption>Same mechanism, different context: sex and age change the cause and the treatment choices.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-in-men-vs-women/en/fig-1.jpg</image:loc><image:title>Comparison table of anal fissure in women, men, children and older adults by usual site, main trigger, sphincter and key caution</image:title><image:caption>How anal fissure changes with sex and age (ACPGBI 2023; Poskus 2014; Alshehri 2020).</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/anal-fissure-itching/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-itching/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/picazon-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-itching/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-itching/en/hero-1600.jpg</image:loc><image:title>Infographic on itching around an anal fissure and how to care for the skin</image:title><image:caption>Fissure itching usually comes from healing skin, moisture, cream reactions or over-cleaning.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-itching/en/fig-1.jpg</image:loc><image:title>Checklist of what to do and what to avoid when an anal fissure itches: water and patting dry, zinc barrier, cotton underwear, no perfumed wipes, no scrubbing, no steroids beyond 7 days</image:title><image:caption>Daily skin care for an itchy fissure. Hydrocortisone never longer than 7 days.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/lateral-anal-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/lateral-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-anal-lateral/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/lateral-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-location-lateral/en/hero-1600.jpg</image:loc><image:title>Infographic on lateral and multiple anal fissures and their possible causes</image:title><image:caption>A fissure off the midline is a reason to examine, not to try another cream.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-location-lateral/en/fig-1.jpg</image:loc><image:title>Clock-face diagram of the anal opening showing the usual back-midline fissure, the front-midline fissure and an atypical lateral fissure</image:title><image:caption>Typical fissures sit in the back or front midline; a lateral one calls for examination and, if needed, biopsy (ASCRS 2023, ACPGBI 2023).</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/fissure-pain-after-bowel-movement/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-pain-after-bowel-movement/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/dolor-despues-de-defecar/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fissure-pain-after-bowel-movement/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-pain-after-bowel-movement/en/hero-1600.jpg</image:loc><image:title>Infographic explaining why anal fissure pain lasts for hours after a bowel movement</image:title><image:caption>The pain that lingers after the stool is sphincter spasm; relaxing the muscle is what eases it.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-pain-after-bowel-movement/en/fig-1.jpg</image:loc><image:title>Five numbered steps to ease anal fissure pain after a bowel movement: sitz bath, gentle cleaning, ointment, rest and soft stools</image:title><image:caption>What to do after a painful bowel movement: relax the sphincter, protect the tear and prevent the next one. Based on ASCRS 2023 and ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/anal-fissure-symptoms-checklist/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-symptoms-checklist/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/sintomas-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-symptoms-checklist/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-symptoms-checklist/en/hero-1600.jpg</image:loc><image:title>Infographic with the main anal fissure symptoms: pain during the bowel movement, lingering pain and bright red blood</image:title><image:caption>Cutting pain during the stool, pain that lingers and a little bright red blood: the three signs of a fissure.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-symptoms-checklist/en/fig-1.jpg</image:loc><image:title>Checklist of anal fissure symptoms with typical signs ticked and warning signs that point to another problem crossed out</image:title><image:caption>Typical fissure symptoms (ticked) and signs that do not fit a fissure and need a doctor (crossed). Educational, not a diagnosis. Based on ASCRS 2023 and NHS.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/fissure-vs-fistula-abscess/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-vs-fistula-abscess/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-fistula-o-absceso/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fissure-vs-fistula-abscess/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-vs-fistula-abscess/en/hero-1600.jpg</image:loc><image:title>Infographic showing the difference between an anal fissure, an anal abscess and an anal fistula</image:title><image:caption>A tear, an infection and a tunnel: three problems in the same place, with different symptoms and treatments.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-vs-fistula-abscess/en/fig-1.jpg</image:loc><image:title>Traffic light: fissure symptoms in green, fistula signs in yellow and abscess warning signs in red</image:title><image:caption>How urgent is it? Fissure symptoms can be assessed at a scheduled visit; signs of a fistula need a surgeon; signs of an abscess need a doctor the same day. Based on ASCRS 2023 and ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/fissure-or-hemorrhoids/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-or-hemorrhoids/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-o-hemorroides/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fissure-or-hemorrhoids/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-vs-hemorrhoids/en/hero-1600.jpg</image:loc><image:title>Infographic comparing an anal fissure and hemorrhoids by pain, bleeding and lump</image:title><image:caption>Pain with every stool points to a fissure; painless bleeding or a lump that comes and goes points to hemorrhoids.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-vs-hemorrhoids/en/fig-1.jpg</image:loc><image:title>Comparison table of anal fissure and hemorrhoids rating pain during the stool, pain afterwards, amount of bleeding and type of lump</image:title><image:caption>The pain rule at a glance: dots show how strongly each sign appears. Based on ASCRS 2023, ACPGBI 2023 and NHS.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/fisurin-vs-nifedipine-ointment/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fisurin-vs-nifedipine-ointment/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisurin-vs-pomada-nifedipino/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/fisurin-ou-nifedipina-manipulada/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fisurin-vs-nifedipine-ointment/"/>
    <image:image><image:loc>https://fisurin.com/img/fisurin-vs-nifedipine-pharmacy/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base over a peach background, next to the title of the comparison between FISURIN and a pharmacy nifedipine ointment</image:title><image:caption>Same sphincter relaxant; different base, anesthetic, protocol and availability.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fisurin-vs-nifedipine-pharmacy/en/fig-1.jpg</image:loc><image:title>Comparison of FISURIN and a typical compounded nifedipine ointment: active ingredient, lidocaine, base, protocol, follow-up and availability</image:title><image:caption>What FISURIN and a pharmacy nifedipine ointment share and where they differ. No trial has compared the two products directly.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/what-is-fisurin/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/what-is-fisurin/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/que-es-fisurin/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/o-que-e-fisurin/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/what-is-fisurin/"/>
    <image:image><image:loc>https://fisurin.com/img/fisurin-what-it-is/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base over a peach background, next to the title of the guide explaining what FISURIN is</image:title><image:caption>Nifedipine plus lidocaine in a steroid-free hydrogel, with a 6-week protocol.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fisurin-what-it-is/en/fig-1.jpg</image:loc><image:title>Timeline of the FISURIN 6-week protocol: consultation, weeks 1 to 2, weeks 3 to 4 with check-up, weeks 5 to 6 and decision at week 8</image:title><image:caption>The FISURIN protocol week by week, as given to patients at Clínica Proctológica de Lima. Closure is confirmed by the surgeon.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/hemorrhoid-cream-for-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/hemorrhoid-cream-for-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/crema-hemorroides-para-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-de-hemorroida-para-fissura/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/hemorrhoid-cream-for-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/hemorrhoid-cream-for-fissure/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a peach background next to the title of the guide on why hemorrhoid creams do not close an anal fissure</image:title><image:caption>Hemorrhoid creams act on veins and skin; a fissure needs the sphincter relaxed.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/hemorrhoid-cream-for-fissure/en/fig-1.jpg</image:loc><image:title>Comparison chart rating a typical hemorrhoid cream and a sphincter-relaxing ointment on relaxing the sphincter, blood flow to the fissure, pain relief, safe duration and evidence</image:title><image:caption>Hemorrhoid cream versus sphincter-relaxing ointment for an anal fissure. Based on ASCRS 2023, ACPGBI 2023 and Antropoli 1999.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/hydrocortisone-cream-anal-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/hydrocortisone-cream-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/hidrocortisona-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/hidrocortisona-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/hydrocortisone-cream-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/hydrocortisone-fissure/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a peach background next to the title of the guide on hydrocortisone cream for anal fissure</image:title><image:caption>Hydrocortisone soothes the skin around a fissure, but only for a few days and never more than 7.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/hydrocortisone-fissure/en/fig-1.jpg</image:loc><image:title>Traffic light chart showing when hydrocortisone is acceptable, when to be careful and when to stop and see a doctor for an anal fissure</image:title><image:caption>Hydrocortisone in a fissure: a short helper in green situations, never a long-term treatment. Based on ASCRS 2023 and ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/lidocaine-cream-for-anal-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/lidocaine-cream-for-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/lidocaina-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/lidocaina-pomada-fissura/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/lidocaine-cream-for-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/lidocaine-cream-fissure/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a peach background next to the title of the guide on lidocaine cream for anal fissure</image:title><image:caption>Lidocaine numbs the tear; only relaxing the sphincter lets it heal.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/lidocaine-cream-fissure/en/fig-1.jpg</image:loc><image:title>Checklist for using lidocaine cream on an anal fissure: what to do, such as applying a thin layer before bowel movements, and what to avoid, such as using it for weeks as the only treatment</image:title><image:caption>How to use lidocaine on a fissure safely, and the mistakes to avoid. Based on ASCRS 2023 and the trials of Jensen (1986) and Perrotti (2002).</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/natural-remedies-anal-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/natural-remedies-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/remedios-naturales-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/remedio-caseiro-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/natural-remedies-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/natural-fissure-ointments/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base over a peach background, next to the title of the guide on natural remedies for anal fissure</image:title><image:caption>Natural ointments can lubricate and protect; soft stools and, if chronic, a sphincter relaxant close the fissure.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/natural-fissure-ointments/en/fig-1.jpg</image:loc><image:title>Comparison table of aloe vera, calendula, coconut oil, honey, shea butter and essential oils for anal fissure: evidence, possible use and main risk</image:title><image:caption>None of these products has solid trials showing it closes a chronic fissure; some can lubricate or protect. Assessment by colorectal surgeons in light of ASCRS 2023 and ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/nifedipine-cream-anal-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/nifedipine-cream-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/pomada-de-nifedipino/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-de-nifedipina/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/nifedipine-cream-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-cream-fissure/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a peach background next to the title of the guide on nifedipine cream for anal fissure</image:title><image:caption>Nifedipine cream relaxes the internal sphincter; healing needs 6 to 8 weeks of regular use.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-cream-fissure/en/fig-1.jpg</image:loc><image:title>Timeline of a nifedipine cream course for chronic anal fissure from day 1 to week 8, with what to expect at each stage</image:title><image:caption>What to expect over an 8-week course of nifedipine cream, based on Perrotti 2002, the Cochrane review and ASCRS 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/nifedipine-vs-diltiazem-vs-nitroglycerin/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/nifedipine-vs-diltiazem-vs-nitroglycerin/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/nifedipino-vs-diltiazem-vs-nitroglicerina/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/nifedipina-diltiazem-ou-nitroglicerina/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/nifedipine-vs-diltiazem-vs-nitroglycerin/"/>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-vs-diltiazem-vs-nitroglycerin/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a peach background next to the title comparing nifedipine, diltiazem and nitroglycerin ointments</image:title><image:caption>Three ointments, similar healing, very different tolerance.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-vs-diltiazem-vs-nitroglycerin/en/fig-1.jpg</image:loc><image:title>Comparison chart of nifedipine, diltiazem and nitroglycerin ointments by healing, headache, usual use, main drawback and typical access</image:title><image:caption>The three sphincter-relaxing ointments compared. Healing is similar; headache and access make the difference. Sources: Cochrane CD003431; Sajid 2013; ASCRS 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/nitroglycerin-ointment-anal-fissure/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/nitroglycerin-ointment-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/nitroglicerina-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/nitroglicerina-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/nitroglycerin-ointment-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/nitroglycerin-ointment-fissure/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a peach background next to the title of the guide on nitroglycerin ointment for anal fissure</image:title><image:caption>Nitroglycerin relaxes the sphincter, but headache is the price for up to half of patients.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/nitroglycerin-ointment-fissure/en/fig-1.jpg</image:loc><image:title>Bar chart: healing with nitroglycerin 48.9 % versus placebo 35.5 %, recurrence about 50 %, headache in up to half of patients, healing at 2 months 60 % with nitroglycerin versus 96 % with botulinum toxin</image:title><image:caption>Nitroglycerin ointment in numbers: modest healing, frequent recurrence and frequent headache. Sources: Cochrane CD003431; Brisinda, NEJM 1999.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/otc-anal-fissure-creams/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/otc-anal-fissure-creams/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/pomada-fisura-anal-sin-receta/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-fissura-anal-sem-receita/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/otc-anal-fissure-creams/"/>
    <image:image><image:loc>https://fisurin.com/img/otc-fissure-creams-compared/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a peach background next to the title of the guide comparing over-the-counter anal fissure creams</image:title><image:caption>Over-the-counter creams relieve fissure symptoms; only prescription sphincter relaxants have evidence for closing a chronic fissure.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/otc-fissure-creams-compared/en/fig-1.jpg</image:loc><image:title>Comparison chart rating five groups of over-the-counter fissure creams for pain relief, skin protection and closing a chronic fissure</image:title><image:caption>What each over-the-counter ingredient does for a fissure. None relaxes the sphincter; based on Jensen 1986, ASCRS 2023 and ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/rectogesic-vs-alternatives/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/rectogesic-vs-alternatives/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/rectogesic-o-alternativas/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/rectogesic-vs-alternatives/"/>
    <image:image><image:loc>https://fisurin.com/img/rectogesic-vs-alternatives/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a peach background next to the title of the guide comparing Rectogesic with its alternatives</image:title><image:caption>Rectogesic works about as well as diltiazem or nifedipine; the difference is headache and access.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/rectogesic-vs-alternatives/en/fig-1.jpg</image:loc><image:title>Decision tree: whether to keep using Rectogesic or switch to diltiazem or nifedipine, depending on headache, other medicines and response after 8 weeks</image:title><image:caption>Keep going with Rectogesic or switch? A practical guide based on ASCRS 2023, ACPGBI 2023 and the Cochrane review.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/en/learn/sentinel-pile/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/sentinel-pile/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/plicoma-centinela/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/sentinel-pile/"/>
    <image:image><image:loc>https://fisurin.com/img/sentinel-pile/en/hero-1600.jpg</image:loc><image:title>Infographic about the sentinel pile, the skin tag at the outer end of a chronic anal fissure</image:title><image:caption>A sentinel pile marks a fissure that has been open for weeks; the treatment target is the fissure, not the tag.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/sentinel-pile/en/fig-1.jpg</image:loc><image:title>Cross-section of the anal canal with a chronic fissure, showing the sentinel pile at its outer end, the hypertrophied papilla at its inner end and exposed sphincter fibers</image:title><image:caption>The sentinel pile is one of the signs of a chronic fissure, together with the hypertrophied papilla and visible internal sphincter fibers. Based on ASCRS 2023 and ACPGBI 2023.</image:caption></image:image>
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    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
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    <image:image><image:loc>https://fisurin.com/img/what-is-anal-fissure/en/hero-1600.jpg</image:loc><image:title>Infographic introducing the guide on what an anal fissure is, with a simplified drawing of the anal canal</image:title><image:caption>An anal fissure is a small tear with a large effect: the sphincter spasm keeps it open.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/what-is-anal-fissure/en/fig-1.jpg</image:loc><image:title>Cross-section drawing of the anal canal showing the rectum, the internal and external anal sphincters, the anoderm and an acute fissure in the lower canal</image:title><image:caption>Where the tear is: an acute fissure in the anoderm, just over the internal sphincter whose spasm keeps it from healing. Based on ASCRS 2023.</image:caption></image:image>
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    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
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    <image:image><image:loc>https://fisurin.com/img/zinc-oxide-fissure/en/hero-1600.jpg</image:loc><image:title>FISURIN jar on a wooden base over a peach background, next to the title of the guide on zinc oxide and barrier creams for anal fissure</image:title><image:caption>Zinc oxide protects the skin around a fissure; the sphincter needs a different treatment.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/zinc-oxide-fissure/en/fig-1.jpg</image:loc><image:title>Checklist of what to do and what to avoid when using a zinc oxide barrier cream with an anal fissure</image:title><image:caption>How to use a zinc oxide barrier cream around a fissure, and the common mistakes, based on ASCRS 2023 and ACPGBI 2023 guidance.</image:caption></image:image>
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    <lastmod>2026-11-01</lastmod>
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  <url>
    <loc>https://fisurin.com/es/guia/fisura-anal-aguda-o-cronica/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/acute-vs-chronic-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-anal-aguda-o-cronica/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/acute-vs-chronic-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/acute-vs-chronic-fissure/es/hero-1600.jpg</image:loc><image:title>Infografía que presenta la guía sobre fisura anal aguda frente a crónica y la línea de las 6 a 8 semanas</image:title><image:caption>Pasadas 6 a 8 semanas, a la fisura la mantienen abierta el esfínter y la cicatriz: el tratamiento tiene que cambiar.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/acute-vs-chronic-fissure/es/fig-1.jpg</image:loc><image:title>Dibujo en corte del canal anal con una fisura crónica: plicoma centinela en el extremo externo, papila hipertrófica en el interno y fibras del esfínter interno a la vista</image:title><image:caption>Las señales de cronicidad: plicoma centinela, papila hipertrófica y fibras del esfínter en el fondo de la herida. Basado en ASCRS 2023.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/acute-vs-chronic-fissure/es/fig-2.jpg</image:loc><image:title>Línea de tiempo de una fisura anal desde el desgarro inicial, pasando por la línea de las 6 a 8 semanas, hasta la pomada, la toxina botulínica y la esfinterotomía</image:title><image:caption>De aguda a crónica: qué hacer en cada etapa, según ASCRS 2023, Jensen 1986 y la revisión Cochrane.</image:caption></image:image>
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    <loc>https://fisurin.com/es/guia/fisura-anal-anterior/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anterior-anal-fissure/"/>
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    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anterior-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/anterior-fissure-women/es/hero-1600.jpg</image:loc><image:title>Infografía sobre la fisura anal anterior en mujeres y en qué se diferencia de la fisura posterior típica</image:title><image:caption>La fisura anterior está en la parte delantera del canal anal y se relaciona con el parto y el suelo pélvico.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/anterior-fissure-women/es/fig-1.jpg</image:loc><image:title>Esquema del canal anal visto como un reloj: posición posterior, donde está la mayoría de fisuras; posición anterior, más frecuente en mujeres y tras el parto; y posición lateral, que pide estudiar otras causas</image:title><image:caption>La posición de la fisura orienta sobre su causa. Las anteriores son más frecuentes en mujeres; las laterales piden más estudios. Basado en ACPGBI 2023 y ASCRS 2023.</image:caption></image:image>
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  <url>
    <loc>https://fisurin.com/es/guia/crema-para-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/best-cream-for-anal-fissure/"/>
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    <image:image><image:loc>https://fisurin.com/img/best-cream-anal-fissure/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera con fondo melocotón, junto al título de la guía sobre cremas para fisura anal</image:title><image:caption>La crema que cierra una fisura es la que relaja el esfínter, usada durante 6 a 8 semanas.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/best-cream-anal-fissure/es/fig-1.jpg</image:loc><image:title>Árbol de decisión: qué crema usar según la fisura anal sea reciente, muy dolorosa o crónica</image:title><image:caption>Cómo elegir la crema según el tipo de fisura, a partir de las guías ASCRS 2023 y ACPGBI 2023.</image:caption></image:image>
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  <url>
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    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/compounded-fissure-cream/"/>
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    <image:image><image:loc>https://fisurin.com/img/compounded-fissure-cream/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre fondo melocotón junto al título de la guía sobre fórmulas magistrales para la fisura anal</image:title><image:caption>Una fórmula magistral para fisura se prepara para un paciente, con receta, en una farmacia de su país.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/compounded-fissure-cream/es/fig-1.jpg</image:loc><image:title>Cinco pasos numerados que muestran cómo se consigue una fórmula magistral para fisura anal: diagnóstico, receta, preparación, uso y control</image:title><image:caption>Cómo llega a ti una fórmula magistral para fisura: diagnóstico, receta, preparación en farmacia autorizada, 6 a 8 semanas de uso y control.</image:caption></image:image>
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  <url>
    <loc>https://fisurin.com/es/guia/crema-de-diltiazem/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/diltiazem-cream-anal-fissure/"/>
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    <image:image><image:loc>https://fisurin.com/img/diltiazem-cream-fissure/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre fondo melocotón junto al título de la guía sobre la crema de diltiazem al 2 % para la fisura anal</image:title><image:caption>El diltiazem al 2 % cicatriza la fisura con una frecuencia parecida a la nitroglicerina, con menos cefalea y menos recaídas.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/diltiazem-cream-fissure/es/fig-1.jpg</image:loc><image:title>Gráfico de barras que compara el riesgo de dolor de cabeza y de recaída con diltiazem frente a nitroglicerina, con la nitroglicerina como referencia 1,0</image:title><image:caption>Diltiazem frente a nitroglicerina en 7 ensayos aleatorizados (481 pacientes): misma cicatrización, menos cefalea y menos recaídas (Sajid, 2013).</image:caption></image:image>
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  <url>
    <loc>https://fisurin.com/es/guia/fisura-anal-crohn/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-crohns-disease/"/>
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    <image:image><image:loc>https://fisurin.com/img/fissure-and-ibd/es/hero-1600.jpg</image:loc><image:title>Infografía sobre la fisura anal en la enfermedad de Crohn y la enfermedad inflamatoria intestinal</image:title><image:caption>En el Crohn, la fisura se trata junto con la inflamación intestinal.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-and-ibd/es/fig-1.jpg</image:loc><image:title>Tabla comparativa entre una fisura anal común y una fisura por enfermedad de Crohn según ubicación, dolor, aspecto, piel de alrededor y primer paso</image:title><image:caption>Cómo distingue el cirujano una fisura común de una fisura por Crohn. Solo la biopsia y el cuadro completo lo confirman (ASCRS 2023; Abreu Marques 2025).</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/sangrado-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-bleeding/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/sangrado-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-bleeding/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-bleeding/es/hero-1600.jpg</image:loc><image:title>Infografía sobre el sangrado de una fisura anal y cuándo requiere atención médica</image:title><image:caption>Una fisura sangra poco, rojo brillante y con dolor; sangre oscura, mezclada con las heces o después de los 45 pide consulta.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-bleeding/es/fig-1.jpg</image:loc><image:title>Semáforo del sangrado por fisura anal: verde para el sangrado típico, escaso y rojo brillante; amarillo para el que pide control médico; rojo para las señales que requieren colonoscopia o urgencias</image:title><image:caption>Cómo leer el sangrado rectal cuando tienes una fisura. Basado en las guías ASCRS 2023 y ACPGBI 2023; no reemplaza el examen médico.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/causas-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-causes/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/causas-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-causes/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-causes/es/hero-1600.jpg</image:loc><image:title>Infografía sobre las causas de la fisura anal: estreñimiento, diarrea, parto y espasmo del esfínter</image:title><image:caption>La fisura empieza con un desgarro y sigue abierta por el espasmo del esfínter; el tratamiento debe atacar ambas cosas.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-causes/es/fig-1.jpg</image:loc><image:title>Diagrama circular: el desgarro produce dolor, el dolor produce espasmo del esfínter, el espasmo reduce la sangre y la falta de sangre mantiene abierto el desgarro</image:title><image:caption>El círculo de la fisura: el esfínter interno tenso reduce el flujo de sangre e impide que el desgarro cicatrice. Basado en ASCRS 2023 y el consenso español AECP 2018.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/fisura-anal-en-ninos/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-in-children/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-anal-en-ninos/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/fissura-anal-em-crianca/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-in-children/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-children/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera con fondo melocotón, junto al título de la guía sobre fisura anal en niños</image:title><image:caption>En los niños, el ablandador de heces es el tratamiento; las cremas protegen y alivian.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-children/es/fig-1.jpg</image:loc><image:title>Cinco pasos numerados para tratar la fisura anal en un niño: pediatra, ablandar las heces, fibra y líquidos, rutina de baño y crema barrera</image:title><image:caption>El orden que funciona en niños: primero la deposición, después la crema. Según Alshehri 2020 y la guía ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/como-aplicar-pomada-fisura/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/how-to-apply-fissure-cream/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/como-aplicar-pomada-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/como-passar-pomada-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/how-to-apply-fissure-cream/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-how-to-apply/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera junto al título de la guía sobre cómo aplicar la pomada para fisura anal</image:title><image:caption>Un guisante de pomada, 1 cm por dentro, dos o tres veces al día durante seis a ocho semanas.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-how-to-apply/es/fig-1.jpg</image:loc><image:title>Cinco pasos numerados para aplicar una pomada para fisura anal: preparar, medir un guisante, postura, aplicar 1 cm por dentro y repetir 6 a 8 semanas</image:title><image:caption>La rutina de aplicación que enseñamos en la consulta, coherente con el esquema de 6 a 8 semanas de ASCRS 2023 y ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/crema-fisura-no-funciona/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-cream-not-working/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/crema-fisura-no-funciona/"/>
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    <image:image><image:loc>https://fisurin.com/img/fissure-cream-not-working/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera junto al título de la guía sobre qué hacer cuando la crema para fisura no funciona</image:title><image:caption>Antes de cambiar de crema, revisa heces, dosis, técnica y diagnóstico.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-not-working/es/fig-1.jpg</image:loc><image:title>Árbol de decisión para una fisura que no mejora tras cuatro semanas de pomada: revisar heces, dosis y técnica, diagnóstico y luego toxina botulínica o cirugía</image:title><image:caption>Qué revisar, en orden, cuando una pomada para fisura parece no funcionar. Basado en ASCRS 2023 y ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/crema-fisura-anal-embarazo/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-cream-pregnancy/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/crema-fisura-anal-embarazo/"/>
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    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-cream-pregnancy/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-pregnancy/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera con fondo melocotón, junto al título de la guía sobre cremas para fisura anal en el embarazo</image:title><image:caption>En el embarazo, primero las heces blandas; cualquier pomada relajante del esfínter la decide tu médico.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-pregnancy/es/fig-1.jpg</image:loc><image:title>Semáforo de la fisura anal en el embarazo: primeros pasos seguros en verde, tratamientos a decidir con el médico en ámbar y señales de alarma en rojo</image:title><image:caption>Con qué empezar, qué consultar y cuándo hacerse revisar, según la guía ACPGBI 2023 y la cohorte de Poskus 2014.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/efectos-secundarios-pomada-fisura/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-cream-side-effects/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/efectos-secundarios-pomada-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/efeitos-colaterais-pomada-fissura/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fissure-cream-side-effects/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-side-effects/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera junto al título de la guía sobre efectos secundarios de las pomadas para fisura anal</image:title><image:caption>El dolor de cabeza es sobre todo cosa de la nitroglicerina; el nifedipino y el diltiazem dan más bien ardor o picor local.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-side-effects/es/fig-1.jpg</image:loc><image:title>Tabla comparativa de efectos secundarios de las pomadas de nitroglicerina, nifedipino o diltiazem, lidocaína e hidrocortisona para fisura anal, con riesgo de cefalea y cómo manejarlos</image:title><image:caption>Principales efectos secundarios por tipo de pomada para fisura y cómo manejarlos. Basado en Cochrane CD003431, Sajid 2013 y ASCRS 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/gel-o-pomada-fisura/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/gel-vs-ointment-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/gel-o-pomada-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/gel-ou-pomada-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/gel-vs-ointment-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-gel-vs-ointment/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera con fondo melocotón, junto al título de la guía que compara gel, crema, pomada y pasta para la fisura anal</image:title><image:caption>La base cambia la comodidad; el principio activo decide si la fisura cierra.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-gel-vs-ointment/es/fig-1.jpg</image:loc><image:title>Tabla comparativa de gel, crema, pomada y pasta para la fisura anal: base, grasa, manchas, duración sobre la piel y uso típico</image:title><image:caption>Cómo se diferencian gel, crema, pomada y pasta en el uso diario alrededor de la fisura. Ningún ensayo ha demostrado que un vehículo cierre mejor que otro.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/fisura-anal-mujeres-hombres/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-women-men/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-anal-mujeres-hombres/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-women-men/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-in-men-vs-women/es/hero-1600.jpg</image:loc><image:title>Infografía que compara la fisura anal en mujeres, hombres, niños y adultos mayores</image:title><image:caption>El mismo mecanismo en otro contexto: el sexo y la edad cambian la causa y las decisiones de tratamiento.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-in-men-vs-women/es/fig-1.jpg</image:loc><image:title>Tabla comparativa de la fisura anal en mujeres, hombres, niños y adultos mayores según sitio habitual, desencadenante, esfínter y precaución clave</image:title><image:caption>Cómo cambia la fisura anal con el sexo y la edad (ACPGBI 2023; Poskus 2014; Alshehri 2020).</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/picazon-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-itching/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/picazon-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-itching/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-itching/es/hero-1600.jpg</image:loc><image:title>Infografía sobre la picazón alrededor de una fisura anal y el cuidado de la piel</image:title><image:caption>La picazón de la fisura suele venir de la piel que cicatriza, la humedad, reacciones a cremas o la limpieza excesiva.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-itching/es/fig-1.jpg</image:loc><image:title>Lista de qué hacer y qué evitar cuando pica una fisura anal: agua y secar a toques, barrera de zinc, ropa de algodón; sin toallitas perfumadas, sin frotar, sin corticoide más de 7 días</image:title><image:caption>Cuidado diario de la piel cuando la fisura pica. Hidrocortisona nunca más de 7 días.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/fisura-anal-lateral/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/lateral-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-anal-lateral/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/lateral-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-location-lateral/es/hero-1600.jpg</image:loc><image:title>Infografía sobre las fisuras anales laterales y múltiples y sus posibles causas</image:title><image:caption>Una fisura fuera de la línea media es motivo para examinar, no para probar otra crema.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-location-lateral/es/fig-1.jpg</image:loc><image:title>Esquema del ano como esfera de reloj con la fisura habitual en la línea media posterior, la fisura anterior y una fisura lateral atípica</image:title><image:caption>Las fisuras típicas están en la línea media posterior o anterior; una lateral pide examen y, si hace falta, biopsia (ASCRS 2023, ACPGBI 2023).</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/dolor-despues-de-defecar/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-pain-after-bowel-movement/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/dolor-despues-de-defecar/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fissure-pain-after-bowel-movement/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-pain-after-bowel-movement/es/hero-1600.jpg</image:loc><image:title>Infografía que explica por qué el dolor de la fisura anal dura horas después de defecar</image:title><image:caption>El dolor que sigue después de la deposición es el espasmo del esfínter; relajar el músculo es lo que lo calma.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-pain-after-bowel-movement/es/fig-1.jpg</image:loc><image:title>Cinco pasos numerados para aliviar el dolor de la fisura después de defecar: baño de asiento, limpieza suave, pomada, reposo y heces blandas</image:title><image:caption>Qué hacer después de una deposición dolorosa: relajar el esfínter, proteger el desgarro y preparar la siguiente. Basado en ASCRS 2023 y ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/sintomas-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/anal-fissure-symptoms-checklist/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/sintomas-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-symptoms-checklist/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-symptoms-checklist/es/hero-1600.jpg</image:loc><image:title>Infografía con los síntomas principales de la fisura anal: dolor al evacuar, dolor que persiste y sangre roja brillante</image:title><image:caption>Dolor cortante al evacuar, dolor que se queda y un poco de sangre roja brillante: las tres señales de la fisura.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-symptoms-checklist/es/fig-1.jpg</image:loc><image:title>Lista de síntomas de fisura anal con las señales típicas marcadas y las señales de alarma que apuntan a otro problema tachadas</image:title><image:caption>Síntomas típicos de fisura (marcados) y señales que no encajan con una fisura y requieren consulta (tachadas). Educativo, no es un diagnóstico. Basado en ASCRS 2023 y NHS.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/fisura-fistula-o-absceso/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-vs-fistula-abscess/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-fistula-o-absceso/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fissure-vs-fistula-abscess/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-vs-fistula-abscess/es/hero-1600.jpg</image:loc><image:title>Infografía que muestra la diferencia entre fisura anal, absceso anal y fístula anal</image:title><image:caption>Un desgarro, una infección y un túnel: tres problemas en el mismo lugar, con síntomas y tratamientos distintos.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-vs-fistula-abscess/es/fig-1.jpg</image:loc><image:title>Semáforo: síntomas de fisura en verde, señales de fístula en amarillo y señales de alarma de absceso en rojo</image:title><image:caption>¿Qué tan urgente es? Los síntomas de fisura pueden verse en una cita programada; las señales de fístula necesitan un cirujano; las de absceso, un médico el mismo día. Basado en ASCRS 2023 y ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/fisura-o-hemorroides/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-or-hemorrhoids/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisura-o-hemorroides/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fissure-or-hemorrhoids/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-vs-hemorrhoids/es/hero-1600.jpg</image:loc><image:title>Infografía que compara la fisura anal y las hemorroides por dolor, sangrado y bulto</image:title><image:caption>El dolor en cada deposición apunta a una fisura; el sangrado sin dolor o un bulto que sale y entra apunta a hemorroides.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-vs-hemorrhoids/es/fig-1.jpg</image:loc><image:title>Tabla comparativa de fisura anal y hemorroides que puntúa el dolor al evacuar, el dolor después, el sangrado y el tipo de bulto</image:title><image:caption>La regla del dolor de un vistazo: los puntos indican cuánto aparece cada señal. Basado en ASCRS 2023, ACPGBI 2023 y NHS.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/fisurin-vs-pomada-nifedipino/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fisurin-vs-nifedipine-ointment/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisurin-vs-pomada-nifedipino/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/fisurin-ou-nifedipina-manipulada/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fisurin-vs-nifedipine-ointment/"/>
    <image:image><image:loc>https://fisurin.com/img/fisurin-vs-nifedipine-pharmacy/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera con fondo melocotón, junto al título de la comparación entre FISURIN y una pomada de nifedipino de farmacia</image:title><image:caption>Mismo relajante del esfínter; distinta base, anestésico, protocolo y disponibilidad.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fisurin-vs-nifedipine-pharmacy/es/fig-1.jpg</image:loc><image:title>Comparación de FISURIN y una pomada magistral de nifedipino típica: principio activo, lidocaína, base, protocolo y disponibilidad</image:title><image:caption>Qué comparten FISURIN y una pomada de nifedipino de farmacia y en qué se diferencian. Ningún ensayo comparó los dos productos directamente.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/que-es-fisurin/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/what-is-fisurin/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/que-es-fisurin/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/o-que-e-fisurin/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/what-is-fisurin/"/>
    <image:image><image:loc>https://fisurin.com/img/fisurin-what-it-is/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera con fondo melocotón, junto al título de la guía que explica qué es FISURIN</image:title><image:caption>Nifedipino más lidocaína en un hidrogel sin corticoides, con un protocolo de 6 semanas.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fisurin-what-it-is/es/fig-1.jpg</image:loc><image:title>Línea de tiempo del protocolo de 6 semanas de FISURIN: consulta, semanas 1 a 2, semanas 3 a 4 con control, semanas 5 a 6 y decisión en la semana 8</image:title><image:caption>El protocolo de FISURIN semana a semana, tal como lo reciben los pacientes de la Clínica Proctológica de Lima. El cierre lo confirma el cirujano.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/crema-hemorroides-para-fisura/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/hemorrhoid-cream-for-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/crema-hemorroides-para-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-de-hemorroida-para-fissura/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/hemorrhoid-cream-for-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/hemorrhoid-cream-for-fissure/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre fondo melocotón junto al título de la guía sobre por qué las cremas de hemorroides no cierran una fisura anal</image:title><image:caption>Las cremas para hemorroides actúan sobre venas y piel; la fisura necesita relajar el esfínter.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/hemorrhoid-cream-for-fissure/es/fig-1.jpg</image:loc><image:title>Tabla comparativa que puntúa una crema para hemorroides típica y una pomada relajante del esfínter en relajar el esfínter, riego de la fisura, alivio del dolor, duración segura y evidencia</image:title><image:caption>Crema para hemorroides frente a pomada relajante del esfínter en la fisura anal. Basado en ASCRS 2023, ACPGBI 2023 y Antropoli 1999.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/hidrocortisona-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/hydrocortisone-cream-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/hidrocortisona-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/hidrocortisona-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/hydrocortisone-cream-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/hydrocortisone-fissure/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre fondo melocotón junto al título de la guía sobre hidrocortisona en la fisura anal</image:title><image:caption>La hidrocortisona alivia la piel alrededor de la fisura, pero solo unos días y nunca más de 7.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/hydrocortisone-fissure/es/fig-1.jpg</image:loc><image:title>Semáforo que muestra cuándo la hidrocortisona es aceptable, cuándo hay que tener cuidado y cuándo suspenderla y consultar en una fisura anal</image:title><image:caption>Hidrocortisona en la fisura: apoyo breve en las situaciones verdes, nunca tratamiento prolongado. Basado en las guías ASCRS 2023 y ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/lidocaina-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/lidocaine-cream-for-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/lidocaina-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/lidocaina-pomada-fissura/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/lidocaine-cream-for-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/lidocaine-cream-fissure/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN con fondo melocotón junto al título de la guía sobre lidocaína para la fisura anal</image:title><image:caption>La lidocaína adormece la herida; solo relajar el esfínter deja que cicatrice.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/lidocaine-cream-fissure/es/fig-1.jpg</image:loc><image:title>Lista de verificación para usar lidocaína en una fisura anal: qué hacer, como aplicar una capa fina antes de evacuar, y qué evitar, como usarla semanas como único tratamiento</image:title><image:caption>Cómo usar la lidocaína en una fisura con seguridad y los errores que conviene evitar. Basado en ASCRS 2023 y en los ensayos de Jensen (1986) y Perrotti (2002).</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/remedios-naturales-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/natural-remedies-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/remedios-naturales-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/remedio-caseiro-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/natural-remedies-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/natural-fissure-ointments/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera con fondo melocotón, junto al título de la guía sobre remedios naturales para la fisura anal</image:title><image:caption>Las pomadas naturales lubrican y protegen; las heces blandas y, si es crónica, un relajante del esfínter cierran la fisura.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/natural-fissure-ointments/es/fig-1.jpg</image:loc><image:title>Tabla comparativa de aloe vera, caléndula, aceite de coco, miel, manteca de karité y aceites esenciales en la fisura anal: evidencia, uso posible y riesgo principal</image:title><image:caption>Ninguno de estos productos tiene ensayos sólidos de que cierre una fisura crónica; algunos lubrican o protegen. Valoración de cirujanos colorrectales a la luz de ASCRS 2023 y ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/pomada-de-nifedipino/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/nifedipine-cream-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/pomada-de-nifedipino/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-de-nifedipina/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/nifedipine-cream-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-cream-fissure/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre fondo melocotón junto al título de la guía sobre la pomada de nifedipino para la fisura anal</image:title><image:caption>La pomada de nifedipino relaja el esfínter interno; la cicatrización necesita 6 a 8 semanas de uso regular.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-cream-fissure/es/fig-1.jpg</image:loc><image:title>Línea de tiempo de un ciclo de pomada de nifedipino para fisura anal crónica desde el día 1 hasta la semana 8, con qué esperar en cada etapa</image:title><image:caption>Qué esperar en un ciclo de 8 semanas de pomada de nifedipino, según Perrotti 2002, la revisión Cochrane y la guía ASCRS 2023.</image:caption></image:image>
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  <url>
    <loc>https://fisurin.com/es/guia/nifedipino-vs-diltiazem-vs-nitroglicerina/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/nifedipine-vs-diltiazem-vs-nitroglycerin/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/nifedipino-vs-diltiazem-vs-nitroglicerina/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/nifedipina-diltiazem-ou-nitroglicerina/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/nifedipine-vs-diltiazem-vs-nitroglycerin/"/>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-vs-diltiazem-vs-nitroglycerin/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN con fondo melocotón junto al título que compara las pomadas de nifedipino, diltiazem y nitroglicerina</image:title><image:caption>Tres pomadas, cicatrización parecida, tolerancia muy distinta.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-vs-diltiazem-vs-nitroglycerin/es/fig-1.jpg</image:loc><image:title>Tabla comparativa de las pomadas de nifedipino, diltiazem y nitroglicerina según cicatrización, dolor de cabeza, uso habitual, principal inconveniente y forma de conseguirlas</image:title><image:caption>Las tres pomadas relajantes del esfínter comparadas: la cicatrización es parecida; la cefalea y el acceso marcan la diferencia. Fuentes: Cochrane CD003431; Sajid 2013; ASCRS 2023.</image:caption></image:image>
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    <loc>https://fisurin.com/es/guia/nitroglicerina-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/nitroglycerin-ointment-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/nitroglicerina-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/nitroglicerina-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/nitroglycerin-ointment-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/nitroglycerin-ointment-fissure/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN con fondo melocotón junto al título de la guía sobre nitroglicerina para la fisura anal</image:title><image:caption>La nitroglicerina relaja el esfínter, pero el dolor de cabeza es el precio hasta en la mitad de los pacientes.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/nitroglycerin-ointment-fissure/es/fig-1.jpg</image:loc><image:title>Gráfico de barras: cicatrización con nitroglicerina 48,9 % frente a placebo 35,5 %, recaída cerca del 50 %, dolor de cabeza hasta en la mitad, cicatrización a 2 meses 60 % con nitroglicerina frente a 96 % con toxina botulínica</image:title><image:caption>La nitroglicerina en cifras: cicatrización modesta, recaídas frecuentes y dolor de cabeza frecuente. Fuentes: Cochrane CD003431; Brisinda, NEJM 1999.</image:caption></image:image>
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  <url>
    <loc>https://fisurin.com/es/guia/pomada-fisura-anal-sin-receta/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/otc-anal-fissure-creams/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/pomada-fisura-anal-sin-receta/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-fissura-anal-sem-receita/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/otc-anal-fissure-creams/"/>
    <image:image><image:loc>https://fisurin.com/img/otc-fissure-creams-compared/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre fondo melocotón junto al título de la guía que compara pomadas para fisura anal sin receta</image:title><image:caption>Las pomadas sin receta alivian los síntomas de la fisura; solo los relajantes del esfínter con receta tienen evidencia para cerrar una fisura crónica.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/otc-fissure-creams-compared/es/fig-1.jpg</image:loc><image:title>Tabla comparativa que puntúa cinco familias de pomadas sin receta para la fisura según alivio del dolor, protección de la piel y cierre de la fisura crónica</image:title><image:caption>Qué hace cada ingrediente de venta libre en la fisura. Ninguno relaja el esfínter; según Jensen 1986, ASCRS 2023 y el consenso AECP 2018.</image:caption></image:image>
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  <url>
    <loc>https://fisurin.com/es/guia/rectogesic-o-alternativas/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/rectogesic-vs-alternatives/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/rectogesic-o-alternativas/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/rectogesic-vs-alternatives/"/>
    <image:image><image:loc>https://fisurin.com/img/rectogesic-vs-alternatives/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre fondo melocotón junto al título de la guía que compara Rectogesic con sus alternativas</image:title><image:caption>Rectogesic funciona más o menos como el diltiazem o el nifedipino; la diferencia está en la cefalea y el acceso.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/rectogesic-vs-alternatives/es/fig-1.jpg</image:loc><image:title>Árbol de decisión: seguir con Rectogesic o cambiar a diltiazem o nifedipino según el dolor de cabeza, otros medicamentos y la respuesta a las 8 semanas</image:title><image:caption>¿Sigo con Rectogesic o cambio? Guía práctica basada en el consenso AECP 2018, ASCRS 2023 y la revisión Cochrane.</image:caption></image:image>
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  <url>
    <loc>https://fisurin.com/es/guia/plicoma-centinela/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/sentinel-pile/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/plicoma-centinela/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/sentinel-pile/"/>
    <image:image><image:loc>https://fisurin.com/img/sentinel-pile/es/hero-1600.jpg</image:loc><image:title>Infografía sobre el plicoma centinela, el colgajo de piel en el extremo externo de una fisura anal crónica</image:title><image:caption>El plicoma centinela señala una fisura que lleva semanas abierta; lo que se trata es la fisura, no el plicoma.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/sentinel-pile/es/fig-1.jpg</image:loc><image:title>Corte del canal anal con una fisura crónica: plicoma centinela en el extremo externo, papila hipertrófica en el interno y fibras del esfínter expuestas</image:title><image:caption>El plicoma centinela es una de las señales de la fisura crónica, junto con la papila hipertrófica y las fibras visibles del esfínter interno. Basado en ASCRS 2023 y ACPGBI 2023.</image:caption></image:image>
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  <url>
    <loc>https://fisurin.com/es/guia/que-es-una-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/what-is-an-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/que-es-una-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/what-is-an-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/what-is-anal-fissure/es/hero-1600.jpg</image:loc><image:title>Infografía que presenta la guía sobre qué es una fisura anal, con un dibujo simplificado del canal anal</image:title><image:caption>La fisura anal es un desgarro pequeño con un efecto grande: el espasmo del esfínter la mantiene abierta.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/what-is-anal-fissure/es/fig-1.jpg</image:loc><image:title>Dibujo en corte del canal anal con el recto, los esfínteres anales interno y externo, el anodermo y una fisura aguda en la parte baja del canal</image:title><image:caption>Dónde está el desgarro: una fisura aguda en el anodermo, justo sobre el esfínter interno cuyo espasmo le impide cicatrizar. Basado en ASCRS 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/es/guia/oxido-de-zinc-fisura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/zinc-oxide-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/oxido-de-zinc-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/oxido-de-zinco-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/zinc-oxide-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/zinc-oxide-fissure/es/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre una base de madera con fondo melocotón, junto al título de la guía sobre óxido de zinc y cremas barrera en la fisura anal</image:title><image:caption>El óxido de zinc protege la piel alrededor de la fisura; el esfínter necesita otro tratamiento.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/zinc-oxide-fissure/es/fig-1.jpg</image:loc><image:title>Lista de qué hacer y qué evitar al usar una crema barrera de óxido de zinc con una fisura anal</image:title><image:caption>Cómo usar una crema barrera de óxido de zinc alrededor de la fisura y los errores frecuentes, según las guías ASCRS 2023 y ACPGBI 2023.</image:caption></image:image>
  </url>
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    <lastmod>2026-11-01</lastmod>
    <priority>1.0</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/"/>
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    <xhtml:link rel="alternate" hreflang="de" href="https://fisurin.com/de/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/"/>
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  <url>
    <loc>https://fisurin.com/pt/fissura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.9</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="fr" href="https://fisurin.com/fr/fissure-anale/"/>
    <xhtml:link rel="alternate" hreflang="it" href="https://fisurin.com/it/ragade-anale/"/>
    <xhtml:link rel="alternate" hreflang="de" href="https://fisurin.com/de/analfissur/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/anal-fissure/"/>
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    <loc>https://fisurin.com/pt/fissura-anal/sintomas/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/anal-fissure/symptoms/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/fisura-anal/sintomas/"/>
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    <xhtml:link rel="alternate" hreflang="fr" href="https://fisurin.com/fr/fissure-anale/symptomes/"/>
    <xhtml:link rel="alternate" hreflang="it" href="https://fisurin.com/it/ragade-anale/sintomi/"/>
    <xhtml:link rel="alternate" hreflang="de" href="https://fisurin.com/de/analfissur/symptome/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/anal-fissure/symptoms/"/>
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    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/anal-fissure/causes/"/>
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    <xhtml:link rel="alternate" hreflang="it" href="https://fisurin.com/it/ragade-anale/cause/"/>
    <xhtml:link rel="alternate" hreflang="de" href="https://fisurin.com/de/analfissur/ursachen/"/>
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    <loc>https://fisurin.com/pt/fissura-anal/fissura-anal-cronica/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/anal-fissure/chronic-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/fisura-anal/fisura-anal-cronica/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/fissura-anal/fissura-anal-cronica/"/>
    <xhtml:link rel="alternate" hreflang="fr" href="https://fisurin.com/fr/fissure-anale/fissure-anale-chronique/"/>
    <xhtml:link rel="alternate" hreflang="it" href="https://fisurin.com/it/ragade-anale/ragade-anale-cronica/"/>
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    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/anal-fissure/chronic-anal-fissure/"/>
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  <url>
    <loc>https://fisurin.com/pt/fissura-anal/fissura-vs-hemorroida/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/anal-fissure/fissure-vs-hemorrhoids/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/fisura-anal/fisura-vs-hemorroides/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/fissura-anal/fissura-vs-hemorroida/"/>
    <xhtml:link rel="alternate" hreflang="fr" href="https://fisurin.com/fr/fissure-anale/fissure-ou-hemorroides/"/>
    <xhtml:link rel="alternate" hreflang="it" href="https://fisurin.com/it/ragade-anale/ragade-o-emorroidi/"/>
    <xhtml:link rel="alternate" hreflang="de" href="https://fisurin.com/de/analfissur/fissur-oder-haemorrhoiden/"/>
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    <loc>https://fisurin.com/pt/fissura-anal/tempo-de-cicatrizacao/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/anal-fissure/healing-time/"/>
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    <xhtml:link rel="alternate" hreflang="fr" href="https://fisurin.com/fr/fissure-anale/delai-de-cicatrisation/"/>
    <xhtml:link rel="alternate" hreflang="it" href="https://fisurin.com/it/ragade-anale/tempi-di-guarigione/"/>
    <xhtml:link rel="alternate" hreflang="de" href="https://fisurin.com/de/analfissur/heilungsdauer/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/anal-fissure/healing-time/"/>
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    <loc>https://fisurin.com/pt/fissura-anal/depois-da-cirurgia/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/anal-fissure/after-surgery/"/>
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    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
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    <lastmod>2026-11-01</lastmod>
    <priority>0.9</priority>
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  <url>
    <loc>https://fisurin.com/pt/fissura-anal/tratamento/creme-de-nifedipina/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.7</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/anal-fissure/treatment/nifedipine-cream/"/>
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    <lastmod>2026-11-01</lastmod>
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    <lastmod>2026-11-01</lastmod>
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    <lastmod>2026-11-01</lastmod>
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    <lastmod>2026-11-01</lastmod>
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    <lastmod>2026-11-01</lastmod>
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    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/anal-fissure-cream-pregnancy/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-pregnancy/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre uma base de madeira com fundo pêssego, ao lado do título do guia sobre pomada para fissura anal na gravidez</image:title><image:caption>Na gravidez, primeiro as fezes macias; qualquer pomada que relaxa o esfíncter é decisão do seu médico.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-pregnancy/pt/fig-1.jpg</image:loc><image:title>Semáforo da fissura anal na gravidez: primeiros passos seguros em verde, tratamentos a decidir com o médico em amarelo e sinais de alarme em vermelho</image:title><image:caption>Por onde começar, o que perguntar ao médico e quando procurar atendimento, segundo a diretriz ACPGBI 2023 e a coorte de Poskus 2014.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/efeitos-colaterais-pomada-fissura/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fissure-cream-side-effects/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/efectos-secundarios-pomada-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/efeitos-colaterais-pomada-fissura/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fissure-cream-side-effects/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-side-effects/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre uma base de madeira ao lado do título do guia sobre efeitos colaterais das pomadas para fissura anal</image:title><image:caption>A dor de cabeça é sobretudo da nitroglicerina; nifedipina e diltiazem dão mais ardor ou coceira local.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-cream-side-effects/pt/fig-1.jpg</image:loc><image:title>Tabela comparativa dos efeitos colaterais das pomadas de nitroglicerina, nifedipina ou diltiazem, lidocaína e hidrocortisona para fissura anal, com risco de dor de cabeça e como lidar</image:title><image:caption>Principais efeitos colaterais por tipo de pomada para fissura e como lidar com eles. Baseado em Cochrane CD003431, Sajid 2013 e ASCRS 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/gel-ou-pomada-fissura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/gel-vs-ointment-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/gel-o-pomada-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/gel-ou-pomada-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/gel-vs-ointment-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/fissure-gel-vs-ointment/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre uma base de madeira com fundo pêssego, ao lado do título do guia que compara gel, creme, pomada e pasta para fissura anal</image:title><image:caption>A base muda o conforto; o princípio ativo decide se a fissura fecha.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fissure-gel-vs-ointment/pt/fig-1.jpg</image:loc><image:title>Tabela comparativa de gel, creme, pomada e pasta para fissura anal: base, sensação oleosa, manchas na roupa, permanência na pele e uso típico</image:title><image:caption>Como gel, creme, pomada e pasta se diferenciam no uso diário em volta da fissura. Nenhum ensaio mostrou que um veículo fecha melhor que outro.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/fisurin-ou-nifedipina-manipulada/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/fisurin-vs-nifedipine-ointment/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/fisurin-vs-pomada-nifedipino/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/fisurin-ou-nifedipina-manipulada/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/fisurin-vs-nifedipine-ointment/"/>
    <image:image><image:loc>https://fisurin.com/img/fisurin-vs-nifedipine-pharmacy/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre uma base de madeira com fundo pêssego, ao lado do título da comparação entre FISURIN e uma pomada de nifedipina manipulada</image:title><image:caption>Mesmo relaxante do esfíncter; base, anestésico, protocolo e disponibilidade diferentes.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fisurin-vs-nifedipine-pharmacy/pt/fig-1.jpg</image:loc><image:title>Árvore de decisão para escolher entre FISURIN e uma pomada de nifedipina manipulada conforme o país, a preferência de textura e a dor ao evacuar</image:title><image:caption>Como decidir entre FISURIN e uma pomada de nifedipina manipulada. Nenhum ensaio comparou os dois produtos diretamente. Fontes: ASCRS 2023; Perrotti 2002; SIUCP 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/o-que-e-fisurin/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/what-is-fisurin/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/que-es-fisurin/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/o-que-e-fisurin/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/what-is-fisurin/"/>
    <image:image><image:loc>https://fisurin.com/img/fisurin-what-it-is/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre uma base de madeira com fundo pêssego, ao lado do título do guia que explica o que é FISURIN</image:title><image:caption>Nifedipina mais lidocaína num hidrogel sem corticoides, com um protocolo de 6 semanas.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/fisurin-what-it-is/pt/fig-1.jpg</image:loc><image:title>Linha do tempo do protocolo de 6 semanas do FISURIN: consulta, semanas 1 a 2, semanas 3 a 4 com controle, semanas 5 a 6 e decisão na semana 8</image:title><image:caption>O protocolo do FISURIN semana a semana, como os pacientes da Clínica Proctológica de Lima o recebem. Quem confirma o fechamento é o cirurgião.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/pomada-de-hemorroida-para-fissura/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/hemorrhoid-cream-for-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/crema-hemorroides-para-fisura/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-de-hemorroida-para-fissura/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/hemorrhoid-cream-for-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/hemorrhoid-cream-for-fissure/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN com fundo pêssego ao lado do título do guia sobre por que a pomada de hemorroida não fecha uma fissura anal</image:title><image:caption>Pomadas para hemorroida agem em veias e pele; a fissura precisa que o esfíncter relaxe.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/hemorrhoid-cream-for-fissure/pt/fig-1.jpg</image:loc><image:title>Árvore de decisão com perguntas sobre dor ao evacuar, duração da fissura e corticoide na pomada, indicando quando parar a pomada de hemorroida e passar a uma pomada que relaxa o esfíncter</image:title><image:caption>Pomada de hemorroida na fissura: quando parar e o que fazer em seguida. Baseado em ASCRS 2023, ACPGBI 2023 e Antropoli 1999.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/hidrocortisona-fissura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/hydrocortisone-cream-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/hidrocortisona-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/hidrocortisona-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/hydrocortisone-cream-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/hydrocortisone-fissure/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN com fundo pêssego ao lado do título do guia sobre hidrocortisona na fissura anal</image:title><image:caption>A hidrocortisona alivia a pele em volta da fissura, mas só por alguns dias e nunca mais de 7.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/hydrocortisone-fissure/pt/fig-1.jpg</image:loc><image:title>Linha do tempo do uso de hidrocortisona na fissura anal: início com diagnóstico confirmado, uso curto, suspensão no dia 7 e troca para pomada relaxante do esfíncter se a fissura continuar</image:title><image:caption>Hidrocortisona na fissura: um ciclo curto com data marcada para acabar no dia 7; se a fissura continua, o próximo passo é relaxar o esfíncter. Baseado em ASCRS 2023, ACPGBI 2023 e Jensen 1986.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/lidocaina-pomada-fissura/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/lidocaine-cream-for-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/lidocaina-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/lidocaina-pomada-fissura/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/lidocaine-cream-for-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/lidocaine-cream-fissure/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN com fundo pêssego ao lado do título do guia sobre lidocaína pomada para fissura anal</image:title><image:caption>A lidocaína anestesia a ferida; só relaxar o esfíncter permite que ela cicatrize.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/lidocaine-cream-fissure/pt/fig-1.jpg</image:loc><image:title>Ciclo de quatro etapas da fissura anal: dor ao evacuar, espasmo do esfíncter, menos sangue na ferida e ferida que não fecha, com a lidocaína atuando só na etapa da dor</image:title><image:caption>O ciclo dor–espasmo da fissura: a lidocaína alivia a dor, mas o espasmo e a falta de sangue continuam até que o esfíncter relaxe. Baseado em Jensen (1986) e Perrotti (2002).</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/remedio-caseiro-fissura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/natural-remedies-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/remedios-naturales-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/remedio-caseiro-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/natural-remedies-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/natural-fissure-ointments/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre uma base de madeira com fundo pêssego, ao lado do título do guia sobre remédio caseiro para fissura anal</image:title><image:caption>Pomadas naturais lubrificam e protegem; fezes macias e, se a fissura é crônica, um relaxante do esfíncter permitem que ela feche.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/natural-fissure-ointments/pt/fig-1.jpg</image:loc><image:title>Semáforo dos remédios caseiros para fissura anal: verde para fibra, água e banho de assento; amarelo para babosa, óleo de coco, calêndula e mel como lubrificante; vermelho para óleos essenciais, vinagre, alho e álcool</image:title><image:caption>O que ajuda, o que só lubrifica e o que piora a fissura. Nenhum produto natural tem ensaios sólidos de que fecha uma fissura crônica. Fontes: Jensen 1986; ASCRS 2023; ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/pomada-de-nifedipina/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/nifedipine-cream-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/pomada-de-nifedipino/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-de-nifedipina/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/nifedipine-cream-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-cream-fissure/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre fundo pêssego ao lado do título do guia sobre a pomada de nifedipina para fissura anal</image:title><image:caption>A pomada de nifedipina relaxa o esfíncter interno; a cicatrização precisa de 6 a 8 semanas de uso regular.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-cream-fissure/pt/fig-1.jpg</image:loc><image:title>Linha do tempo de um ciclo de pomada de nifedipina para fissura anal crônica, do dia 1 até a semana 8, com o que esperar em cada fase</image:title><image:caption>O que esperar num ciclo de 8 semanas de pomada de nifedipina, segundo Perrotti 2002, a revisão Cochrane e a diretriz ASCRS 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/nifedipina-diltiazem-ou-nitroglicerina/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/nifedipine-vs-diltiazem-vs-nitroglycerin/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/nifedipino-vs-diltiazem-vs-nitroglicerina/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/nifedipina-diltiazem-ou-nitroglicerina/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/nifedipine-vs-diltiazem-vs-nitroglycerin/"/>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-vs-diltiazem-vs-nitroglycerin/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN com fundo pêssego ao lado do título que compara as pomadas de nifedipina, diltiazem e nitroglicerina</image:title><image:caption>Três pomadas, cicatrização parecida, tolerância muito diferente.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/nifedipine-vs-diltiazem-vs-nitroglycerin/pt/fig-1.jpg</image:loc><image:title>Tabela comparativa das pomadas de nifedipina, diltiazem e nitroglicerina por cicatrização, dor de cabeça, uso habitual, principal inconveniente e forma de conseguir no Brasil</image:title><image:caption>As três pomadas que relaxam o esfíncter: a cicatrização é parecida; a dor de cabeça e o acesso fazem a diferença. Fontes: Cochrane CD003431; Sajid 2013; ASCRS 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/nitroglicerina-fissura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/nitroglycerin-ointment-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/nitroglicerina-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/nitroglicerina-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/nitroglycerin-ointment-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/nitroglycerin-ointment-fissure/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN com fundo pêssego ao lado do título do guia sobre nitroglicerina para fissura anal</image:title><image:caption>A nitroglicerina relaxa o esfíncter, mas a dor de cabeça é o preço em até metade dos pacientes.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/nitroglycerin-ointment-fissure/pt/fig-1.jpg</image:loc><image:title>Gráfico de barras: cicatrização com nitroglicerina 48,9 % contra placebo 35,5 %, recaída perto de 50 %, dor de cabeça em até metade, cicatrização em 2 meses de 60 % com nitroglicerina contra 96 % com toxina botulínica</image:title><image:caption>A nitroglicerina em números: cicatrização modesta, recaídas frequentes e dor de cabeça frequente. Fontes: Cochrane CD003431; Brisinda, NEJM 1999.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/nitroglycerin-ointment-fissure/pt/fig-2.jpg</image:loc><image:title>Lista de verificação para usar pomada de nitroglicerina com menos dor de cabeça: o que fazer e o que não fazer</image:title><image:caption>Como reduzir a dor de cabeça da nitroglicerina sem abandonar o tratamento. Baseado na revisão Cochrane CD003431 e na diretriz ASCRS 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/pomada-fissura-anal-sem-receita/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/otc-anal-fissure-creams/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/pomada-fisura-anal-sin-receta/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/pomada-fissura-anal-sem-receita/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/otc-anal-fissure-creams/"/>
    <image:image><image:loc>https://fisurin.com/img/otc-fissure-creams-compared/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre fundo pêssego ao lado do título do guia que compara pomadas para fissura anal sem receita</image:title><image:caption>As pomadas sem receita aliviam os sintomas da fissura; só os relaxantes do esfíncter com receita têm evidência para fechar a fissura crônica.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/otc-fissure-creams-compared/pt/fig-1.jpg</image:loc><image:title>Tabela comparativa que pontua cinco famílias de pomadas sem receita para fissura segundo alívio da dor, proteção da pele e fechamento da fissura crônica</image:title><image:caption>O que cada ingrediente de balcão faz na fissura. Nenhum relaxa o esfíncter; segundo Jensen 1986, ASCRS 2023 e ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/pt/guia/oxido-de-zinco-fissura-anal/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>0.8</priority>
    <xhtml:link rel="alternate" hreflang="en" href="https://fisurin.com/en/learn/zinc-oxide-anal-fissure/"/>
    <xhtml:link rel="alternate" hreflang="es" href="https://fisurin.com/es/guia/oxido-de-zinc-fisura-anal/"/>
    <xhtml:link rel="alternate" hreflang="pt" href="https://fisurin.com/pt/guia/oxido-de-zinco-fissura-anal/"/>
    <xhtml:link rel="alternate" hreflang="x-default" href="https://fisurin.com/en/learn/zinc-oxide-anal-fissure/"/>
    <image:image><image:loc>https://fisurin.com/img/zinc-oxide-fissure/pt/hero-1600.jpg</image:loc><image:title>Frasco de FISURIN sobre uma base de madeira com fundo pêssego, ao lado do título do guia sobre óxido de zinco e pomadas de barreira na fissura anal</image:title><image:caption>O óxido de zinco protege a pele em volta da fissura; o esfíncter precisa de outro tratamento.</image:caption></image:image>
    <image:image><image:loc>https://fisurin.com/img/zinc-oxide-fissure/pt/fig-1.jpg</image:loc><image:title>Lista do que fazer e do que evitar ao usar pomada de óxido de zinco com fissura anal</image:title><image:caption>Como usar uma pomada de barreira de óxido de zinco em volta da fissura e os erros mais comuns, segundo as diretrizes ASCRS 2023 e ACPGBI 2023.</image:caption></image:image>
  </url>
  <url>
    <loc>https://fisurin.com/fr/</loc>
    <lastmod>2026-11-01</lastmod>
    <priority>1.0</priority>
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