# Fissure treatment??



## Tesscorm (Nov 14, 2011)

Would appreciate any advice in treating fissures.  Stephen's never had them before so I'm not really sure how to treat them.  He had hard stools/some constipation off and on the last 2-3 weeks and I think that's when they started.  I've been having him drink prune juice but, I think, after his MRI today and the resulting D, this isn't really a problem now.

I've been telling him to make sure he cleans well and he's used penaten cream sporadically.  Has anyone else dealt with this?  Am planning on buying a sitz bath for him but am not sure that he'll follow through with the time that would entail.  Do they generally heal on their own?  In how long?  Should he see his GI for this?

Any advice would be appreciated!  Thanks


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## kimmidwife (Nov 14, 2011)

Tesscorm,
He definitely should see the GI about this. Fissures can be problematic depending on how deep they are.


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## Mountaingem (Nov 14, 2011)

Yes, I agree with Kimmidwife-the underlying inflammation is what causes the problem; once that's addressed they usually get better. 

Speaking from experience, I've never had one clear up on its own. Usually the GI prescribes Cortifoam and sometimes Flagyl/Cipro, which help.

In the meantime, some of my home remedies are sitz baths with a cup of Epsom salts added-really makes a huge difference over just plain hot water. It should be done twice a day and after each BM if it's possible. Then I use Calmoseptine, an OTC cream that really helps-you have to ask the pharmacist for it because they keep it behind the counter, but it isn't a prescription. And I always try to cleanse the area with Tucks pads whenever I use the restroom.

Hope this helps!


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## Tesscorm (Nov 15, 2011)

Has anyone ever tried Polysporin (an OTC antibiotic ointment) to treat fissures?  Any reason not to use it?  Thanks


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## Mountaingem (Nov 15, 2011)

Yes I've used it, it's great for keeping an open fissure free of infection. It works well, but if you are looking for pain relief I prefer Calmoseptine.


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## Tesscorm (Nov 16, 2011)

Thanks Mountaingem.

As it's my son's first time dealing with this, don't have any experience in what's acceptable or not!  So annoying to have so much doubt with such 'little' things.  Just mean 'little' in the sense that if it were me, without crohn's, wouldn't even worry about trying any treatment but, with him, just never know if something (i.e. polysporin) can affect the crohn's.  

I think the Calmoseptine is similar to Penaten.  He has used it to relieve some of the pain but I'd really just like the fissures to heal so the issue doesn't worsen.

Thanks for your advice!


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## DustyKat (Nov 16, 2011)

Hey Tess,

I don't think an antibiotic ointment would be harmful as such but some of these ointments should only be used for a limited time and I don't know how useful it will be if there is no infection present. 

As you already know one of the key things is reducing constipation so keeping on top of that will certainly help. 

Sitz or epsom salt baths are always very helpful when dealing with anal issues. 

As to ointments/creams...Calmoseptine is very good at healing and reducing itching if itching is a problem. If pain is problematic perhaps you could speak with the pharmacist or doctor about a ointment with Lidnocaine in it. One of the ointments that I use quite frequently at work for shallow wounds, anal area included, that has excellent healing properties is Ungvita, it is a Vitamin A cream. 

I think if this problem persists, without noticeable improvement, for more than a week I would take him to the doc just to be on the safe side. 

Dusty. xxx


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## Tesscorm (Nov 16, 2011)

Thanks Dusty,

Getting so annoyed with this!  Sorry, rant coming!   Stephen is just not helping with this!!  For days he'll tell me 'it's fine' followed by the rolling eyes like I'm being over-the-top worried, so I think (hope) all is good. :thumleft:  Then a few days later, he'll ask for the penaten cream. :frown:  But, when I suggest something more like a sitz bath or that he use Tucks, he just shrugs likes it's not that bad.  :confused2:  All 'seems' good for a day or two (because, you know if I ask, its that paranoid mom brush off), then he'll say it hurts when he goes!  :yfrown:  Ugghhh!!!

Our home nurse came by last night, when I mentioned seeing the GI re the fissures, she brushed it off (because, of course, she has no real training in Crohn's) which reinforces Stephen's belief that I'm over the top! :ymad: And he says, 'I'm not going to the doctor for _this_" !  Ugghh, ugghh, ugghh (do we have a head banging screaming emoticon?).

Meanwhile, this has been going back and forth for a couple of weeks now and I really don't know if its better, worse or the same!

Okay, rant over!  LOL   Will go home and do the annoying mom thing and insist on the sitz bath, epsom salts and polysporin (will see if I can get Ungvita here) and will just accept the _humpph _and rolling eyes as part of being a mom!  sigh...


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## hannah-rose (Nov 19, 2011)

Tesscorm said:


> Thanks Dusty,
> 
> Getting so annoyed with this!  Sorry, rant coming!   Stephen is just not helping with this!!  For days he'll tell me 'it's fine' followed by the rolling eyes like I'm being over-the-top worried, so I think (hope) all is good. :thumleft:  Then a few days later, he'll ask for the penaten cream. :frown:  But, when I suggest something more like a sitz bath or that he use Tucks, he just shrugs likes it's not that bad.  :confused2:  All 'seems' good for a day or two (because, you know if I ask, its that paranoid mom brush off), then he'll say it hurts when he goes!  :yfrown:  Ugghhh!!!
> 
> ...


Hello! I'm a little bit of an expert on fissures so let me see if I can help 

First of all, I'm not sure how old your son is, but if you want him to take his fissures a little more seriously, tell him to read my blog. I guarantee he'll be running for the salt bath whilst necking laxatives in no time.

For most people, fissures aren't a big deal, yes they're very painful, but they go away once constipation has eased off. They can become chronic though, and then they're harder to treat, and you can tell him that if he doesn't get it under control now he could eventually wind up needing surgery that carries with it a risk of incontinence.

Scaring your son aside, the first thing to do as others have mentioned is to make sure his BMs are soft and easy to pass. A good diet, lots of water and osmotic laxatives - epsom salts, lactulose etc. will ensure this happens.

Next he should really be taking two salt baths a day. Waste height warm water and a mug full of salt. This will help dry the fissures out and heal them up.

Cleanliness is important to prevent infection, because fissures are open wounds and obviously the bum isn't the cleanest area. Make sure whenever he goes for a number two he showers after to make sure the fissures are free of bacteria.

There are lots of creams etc you can get, but if theyre very superficial sudocreme is a healing cream or vaseline protects the area and keeps it moist and also lubricates and protects prior to a BM.

I really wish I had taken my fissures more seriously, if I had I wouldn't be in the mess I'm in now, and if my story can prevent anyone else's pain then that'd make me really happy.

Hannah x


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## hannah-rose (Nov 19, 2011)

Ps if they are due to Crohn's they can be even harder to treat so he should really see a doctor if they get worse or deep or bleed a lot, as no amount of the above will make them go away. 

xx


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## Tesscorm (Nov 19, 2011)

Thanks so much for your reply!!  Did speak with him today and really tried to emphasize the importance of dealing with the fissures NOW, before they become a real problem.  He seemed to understand (maybe he's realizing that they just aren't going away on their own) and promised he would be more diligent! 

Thanks again for your advice!


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## hannah-rose (Nov 20, 2011)

No worries Tess  

I just wish somebody had told me years ago to take care of my fissures, because I probably wouldn't have gone through so much pain and suffering - if I can help somebody else then that's fantastic. I hope Stephen feels better soon.

Hannah x


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## Tesscorm (Nov 20, 2011)

Hi Hannah,

Can you explain what fissures have to do with Crohns (other than location)?  Everyone, with or without Crohns, will get a fissure (or more) at some point and they generally just heal on their own.  Why is this different for someone with Crohns?

I understand that hard stools can cause the fissures but, again, everyone has hard stools now and again which may or may not result in fissures, which usually heal.  So, I'm still confused as to why Crohn's creates more of a problem regarding fissures???

Thanks


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## Grant (Nov 20, 2011)

My Fissures have always been caused by diarrhea & the constant wiping afterwards. I use wet wipes(un perfumed) after the initial toilet tissue then I use GTN ointment which is a godsend, it takes time especially if you are in mid flare but it does work albeit with a bad headache or two.
Rgds
Grant


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## Mountaingem (Nov 20, 2011)

@Grant-what is GTN ointment and why does it give you a bad headache? If it works I'd like to give it a try, headache or not.


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## Grant (Nov 20, 2011)

MountainGem, GTN is Glyceryl Trinitrate. It was used  apparently for people with Angina & was rubbed in to swell the arteries or veins affected. Now this causes more blood to get through & used for fissures it increases blood flow & that aids healing. Headaches wise probably due to increases blood flow throughout the body(thats a guess) but I get them when I use it & its a common side effect.
Please follow the link
http://www.netdoctor.co.uk/medicines/100001258.html
Best Wishes
Grant


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## hannah-rose (Nov 20, 2011)

Tesscorm said:


> Hi Hannah,
> 
> Can you explain what fissures have to do with Crohns (other than location)?  Everyone, with or without Crohns, will get a fissure (or more) at some point and they generally just heal on their own.  Why is this different for someone with Crohns?
> 
> ...


Hi Tess,

Well, as far as I know, if your Crohn's affects your rectum and anus, and these areas are inflamed, you can develop anal ulcers (fissures). Sort of like mouth ulcers I guess. I still haven't had my illness diagnosed, but my first colorectal surgeon told me that he diagnosed my anal fissures wrongly and they were in fact anal ulcers caused by Crohn's.

Inflammation results in impaired healing, so it's possible that if you develop Crohn's in your anus you could develop anal ulcers/fissures and they wouldn't heal without a treatment to reduce inflammation, or it's possible you could develop fissures from constipation and then subsequently develop inflammation in the area and have a Crohn's flare and the Crohn's could make it difficult for the fissures to heal. 

In my case, I suffered from chronic fissures all my life, which never healed completely, and then turned into a large infected ulcer, which was curretaged (all the infected tissue scooped out under anaesthetic) and I was left with a clean open wound.  My surgeon expected this wound would heal, but it didn't, and it's only healing now that I'm having Infliximab to reduce the inflammation and allow for healing.  

I don't know whether I had fissures and then developed Crohn's because of this, or whether I always had anal Crohn's, or whether I don't have Crohn's at all (I haven't had a confirmed diagnosis, although I have had unofficial diagnosis from about 5 different specialists.)

I hope that's explained it a little bit - you can learn more about anal fissures here

Hannah xx


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## hannah-rose (Nov 20, 2011)

Grant said:


> MountainGem, GTN is Glyceryl Trinitrate. It was used  apparently for people with Angina & was rubbed in to swell the arteries or veins affected. Now this causes more blood to get through & used for fissures it increases blood flow & that aids healing. Headaches wise probably due to increases blood flow throughout the body(thats a guess) but I get them when I use it & its a common side effect.
> Please follow the link
> http://www.netdoctor.co.uk/medicines/100001258.html
> Best Wishes
> Grant


I used GTN ointment for a while - the ointment works to relax the anal sphincter muscle, as sphincter spasm is the cause of chronic fissures that wont heal. It gave me a headache too because it dilates the blood capillaries and the blood rushes into your head, although it was a sharp headache that lasted about a minute and then went away.

Hannah xx


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## CyCrohn'sGuy (Nov 21, 2011)

I developed a fissure about 6 months ago which bleeds profusely whenever I have a BM.  My GI told me the cause was due to chronic diarrhoea so we started off with salt baths which did nothing, followed by Asacol suppositories which again were unsuccessful.  He is now recommending an "Anal Stretch" using just the surgeons fingers (ouch!!!)  as all the other methods are contra-indicated for me. Research suggests that this method is successful in 66% of patients but knowing my luck over the past couple of years I would be left with a bucket for an a**h*le as well as incontinence.  He wants me to have the procedure done before Christmas.  I've already sent my Christmas wish list to Santa and am hoping he has the super-duper mega tampons in stock.  Any advice is greatly appreciated.


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## Mountaingem (Nov 21, 2011)

Have you tried Cortifoam or Rowasa enemas? Cortifoam has helped me a great deal, especially when Canasa suppositories did not. I don't think stretching sounds so great, for the reasons you mentioned-only Crohnnies could joke about such stuff!


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## CyCrohn'sGuy (Nov 21, 2011)

I'll look into those two products.  Thanks Mountaingem.  Keep well.


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## hannah-rose (Nov 21, 2011)

CyCrohn'sGuy said:


> I developed a fissure about 6 months ago which bleeds profusely whenever I have a BM.  My GI told me the cause was due to chronic diarrhoea so we started off with salt baths which did nothing, followed by Asacol suppositories which again were unsuccessful.  He is now recommending an "Anal Stretch" using just the surgeons fingers (ouch!!!)  as all the other methods are contra-indicated for me. Research suggests that this method is successful in 66% of patients but knowing my luck over the past couple of years I would be left with a bucket for an a**h*le as well as incontinence.  He wants me to have the procedure done before Christmas.  I've already sent my Christmas wish list to Santa and am hoping he has the super-duper mega tampons in stock.  Any advice is greatly appreciated.


Are you not able to use GTN ointment, or an anal dilator or botox?

I haven't read good things about the 'anal stretch' as it can apparently damage the muscle and tear the fissure more - I know it's not commonly used in the UK in adults. Whereabouts are you from?

Hannah x


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## CyCrohn'sGuy (Nov 21, 2011)

My GI did not suggest any of those alternatives.  What is a GTN ointment and can I buy it over the counter or does it have to be prescribed? I am in Cyprus, eastern Mediterranean island.


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## hannah-rose (Nov 21, 2011)

GTN is an ointment which relaxes the anal sphincter muscle, so basically would do the same thing as a stretch, ie reduce the high muscle tone. Botox is also a temporary treatment which relaxes and temporarily paralyses the sphincter muscle. I didn't want to scare you I was just concerned for you as I've read that it's quite an old treatment (stretching) and carries a higher risk of incontinence and damage to the anus than other treatments.


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## CyCrohn'sGuy (Nov 21, 2011)

Thanks so much for the info.  I will definitely NOT go ahead with the stretch and will search out these alternatives.  Thanks again.  Keep well.


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## hannah-rose (Nov 21, 2011)

No worries 

Obviously, and I must stress this, I am _not_ medically qualified, so please talk through alternative treatments with your own Doctor. 

There's some more information about treatments for anal fissures here 

Also, this is an excellent and hilarious blog by a guy who had an anal fissure that he named Bob, and his experience of anal dilation.

Hannah x


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## myriahdawn (Feb 13, 2012)

This may sound crazy / gross, but....  If the muscle (in regards to Crohn's pt's) it too tight then would any type of massage to the area help?  Has anyone tried this?  I have a fissure that seems to be getting better, but then suddenly it will bleed and I will have minor discomfort again.  Will it every totally go away?


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## DustyKat (Feb 13, 2012)

Astra had a thread about that! Not in relation to fissures but having a sore bum hole and massage, don't know if it will help... 

http://www.crohnsforum.com/showthread.php?t=12380

Dusty. xxx


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## Tesscorm (Feb 13, 2012)

My son found that sitz baths with epsom salts helped.  He also used penaten lotion for pain/burning.

I believe his were caused by hard stools/constipation - prune juice helped this part of the problem.


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