Anal fissure driving me CRAZY

[FullM3lt]

What's up everybody :ycool: I'm pissed off at the world right now trying to deal with what I think is an anal fissure. I have not been officially diagnosed but all the symptoms match up. I am in remission from my UC and have been for a while...but I think the years of being out of remission took their toll.

It all started about 2.5 weeks ago when I had a rather large/firm bowel movement. Usually, this makes me happy :ylol2: but I felt a sharp pain as it was coming out and I've been in pain ever since...I have a high tolerance for pain but at times this is the worst pain I have ever experienced.

These are my symptoms...

- Occasional bright red blood while wiping, but not in stool
- normal/regular formed bowel movements (once a day in morning)
- Not extremely painful while taking a deuce (poo), but about 30 minutes after the pain begins and gradually gets worse until about 3-4 o'clock then it gradually tapers down to no pain by 6-7 PM
- There is very little pain in later PM hours. In the morning before I take my deuce, there is absolutely no pain at all. Then I take my poop, and my day of hell begins all over again.

Some days have been better than others, but there is always pain from the morning all the way till the early evening. I have a golf trip coming up in two weeks with my dad and I'd like to be able to enjoy my time...it's really hard to enjoy anything dealing with this pain.

I absolutely HATE using pharmaceuticals, but I'm close to giving in. Has anybody had positive experiences with treatments like nitroglycerin? If this doesn't improve by Monday, I will probably go that route, but the side effects kinda turn me off to the idea.

I just needed to vent. I don't think anybody understands how bad this pain is until they have actually had one....

 

[theOcean]

I find that after a bad bowel movement, if I take a sitz bath it helps with pain. What also helps is applying vaseline before passing the bowel movement, because I find it helps prevent the anal fissure tearing.

Otherwise, I've been trying stool softeners or Miralax to make my BMs softer to prevent the fissure from getting worse, and also so that it can hopefully heal.

 

[FullM3lt]

I find that after a bad bowel movement, if I take a sitz bath it helps with pain. What also helps is applying vaseline before passing the bowel movement, because I find it helps prevent the anal fissure tearing.

Otherwise, I've been trying stool softeners or Miralax to make my BMs softer to prevent the fissure from getting worse, and also so that it can hopefully heal.

Thanks for your input :hug:

I ended up going to the ER since I couldn't wait to make an appointment. They did anoscopy which was extremely painful with a fissure! Definitely dropped a few four letter words during the anoscopy :ylol2: I felt like Steve Carrell when he got his chest waxed in 40 year old virgin :rof:

Nothing else abnormal going on down there which is good. I was diagnosed with an internal fissure. I don't think it's too severe because the doctor had trouble finding it...but the pain can definitely be severe at times when it's spasming.

So I got some stool softeners (never thought I'd need those!), nitroglycerin .4% cream and some hydrocodone that I'm not going to take lol that stuff makes my poo so firm.

 

[theOcean]

Oh dear! I think one of mine is internal, too, so I totally understand how painful it can be.

And yeah hydrocodone does that Good luck managing them! I've been dealing with mine for awhile too. Keep holding out hope for that they'll go away once my seton is out -- it sticks out and irritates the area where it is which is super unhelpful.

 

[theOcean]

Are you on any other medication? Maybe something else to be contributing to your BMs aggravating the fissures.

(Also, drinking tons of water helps!)

 

[FullM3lt]

Are you on any other medication? Maybe something else to be contributing to your BMs aggravating the fissures.

(Also, drinking tons of water helps!)

I am not on any traditional meds for my ulcerative colitis...I use medical cannabis to keep my condition at bay which has worked great for me over the past 4-5 years. I eat a high fiber diet and I drink anywhere from 80-100 oz of water a day...this fissure kind of came out of nowhere. I remember the day that it happened. The pain isn't really that bad while I'm pooping, but it begins to burn and spasm about 10 minutes after and that can last for hours before it calms down.

I have been in the bathtub or on the couch with a heating pad all day...I pick up my nitroglycerin tomorrow so I'm really hoping that it helps. F U FISSURES!

 

[theOcean]

That's great to hear! I'm in Canada and it just became a lot easier to apply for MMJ, so I'm probably doing that in the next month. (For sleep problems rather than my Crohn's, though.)

Good luck!! I know how awful those can be. Have you had a doctor take a look at it yet? (Though they'd probably just recommend stool softeners, too. It sounds like you're doing the right thing with your diet.)

 

[FullM3lt]

That's great to hear! I'm in Canada and it just became a lot easier to apply for MMJ, so I'm probably doing that in the next month. (For sleep problems rather than my Crohn's, though.)

Good luck!! I know how awful those can be. Have you had a doctor take a look at it yet? (Though they'd probably just recommend stool softeners, too. It sounds like you're doing the right thing with your diet.)

Yes, I went to the ER two days ago and had an anoscopy done (very painful with a fissure) He looked around with a tiny scope and prodded around with his fingers...and fissure was the diagnosis. I'm pretty sure he aggravated the fissure during the anoscopy because I wasn't having blood before but I have the last two days.

I'm on docusate sodium 3x a day which hasn't really helped much yet. They also gave me nitroglycerin which I literally just applied to my rectum :rof: wow the headache was immediate but it's not too bad. I only did about 75% of the recommended dose just to see how I reacted and I feel like it stopped the spasming a little bit but it still burns...

What I don't understand is that the half life of nitroglycerin is 3 minutes. That means it's out of my system in 15 minutes. So why does it say to only apply it every 12 hours? Hmm...

I'll report back tomorrow. I have a lot of homework to do :ycool:

 

[FullM3lt]

Little update...

The past few days have been a living hell!...I don't want to get too excited or ahead of myself but I remembered that eating salmon always gave me a soft stool. Yesterday I ate very lightly and had a nice chunk of salmon for dinner and my stool didn't feel like glass today! It wasn't completely painless but it's the first day without blood in 5-6 days.

My spasms have been the worst during the middle of the day so I had to drop one of my classes...I'm bummed, especially since I had an A in the class but honestly I'm more worried about my health right now. I still have two online classes to keep me busy and I don't have to drive 30 minutes to campus to go to those.

Keeping my fingers crossed....will report back soonish.

 

[justbreathe8]

Have you tried prune juice to keep your stools soft? That worked for me. I used to just drink a little bit before I went to bed

 

[FullM3lt]

Have you tried prune juice to keep your stools soft? That worked for me. I used to just drink a little bit before I went to bed

I do have some prune juice but I'm not a huge fan! Thanks for the tip though! I've had salmon for dinner the past two nights and it has helped more than the colace the ER gave me.

No blood today and no serious spasms yesterday....things are looking up but I'm still cautiously optimistic. I just want my life back! This is 10x worse than a flare IMO!

 

[justbreathe8]

Yah I'm not a huge fan either! I hold my nose and drink it through a straw lol. Well that's good that the salmon is working! What about split pea soup? That's awsome that things are looking up! It's a long road but you'll make it!! (Even the days it feels like you won't!)

 

[FullM3lt]

Thank you so much for the positive words, justbreathe! It really helps me.

Once again, I am cautiously optimistic...but today was another good day. Only minor burning and itching, not even close to the 10/10 pain that the spasms bring. I am still applying the nitroglycerin once a day around an hour after my BM and I have been taking at least 3 sitz baths a day, sometimes more. I've also made a conscious effort to relax my b-hole! :ylol2:

For those struggling with a similar issue, you gotta get your stool soft! That is the key.

 

[theOcean]

I'm glad to hear you're feeling better! I've been having similar issues since last August, and would love to have them go away, too.

 

[FullM3lt]

I'm glad to hear you're feeling better! I've been having similar issues since last August, and would love to have them go away, too.

I hope you can find relief soon my friend! These things are hellish...

I'm pretty sure my issues started last summer as well, but I thought it was hemorrhoids at the time. It didn't get really bad until mid march...I feel your pain. :hug:

 

[FullM3lt]

Little update...

I'm completely pain free...it almost happened overnight. I credit the nitroglycerin, h2o and stool softeners. Unfortunately, the stool softeners have left me with diarrhea but I guess that's better than an anal fissure.

I took my last docusate sodium pill 4 days ago....why do I still have diarrhea?? Does anybody have experience with this?

 

[theOcean]

That was the problem I had with Miralax... It would end up working too well and then I'd end up with diarrhea. It's a hard thing to balance, but I'm sure you'll figure it out.

It depends on how slowly/quickly things go through your system, I'd think. I know for me it takes two days. Otherwise: try adding more potassium to your diet to try and treat the diarrhea.

 

[FullM3lt]

That was the problem I had with Miralax... It would end up working too well and then I'd end up with diarrhea. It's a hard thing to balance, but I'm sure you'll figure it out.

It depends on how slowly/quickly things go through your system, I'd think. I know for me it takes two days. Otherwise: try adding more potassium to your diet to try and treat the diarrhea.

Thank you so much for all your input, ocean :hug:

I'm on a golfing trip with my dad right now so there's really not much I can do at the moment...I was tempted to take a vicodin because it slows down my bowels but I'm going to hold off until I get back home.

I think part of my problem has to do with the lack of THC/CBD I've been getting lately. I barely used any at all during my adventures with my anal fissure since cannabis seems to slow down my bowels and makes them more firm :ylol2: I have some cannabis oil here that I could vaporize...but I'm at a hotel. My pops is cool with how I use cannabis for my condition but I still feel weird medicating around him lol...

This doesn't feel like a flare up. Usually when I flare I have to go to the bathroom all the time but nothing comes out. AKA tenesmus. Right now I just have explosive diarrhea 3-4 times a day.

Okay, my rant is over :rof: Sorry for the gross details! I'm sure everybody on this site is used to hearing/talking about poop.

 

[theOcean]

It might be! And I totally understand about feeling weird about being around family members, haha. My family all knows, but I still wait until my Dad leaves or my mother goes to bed before I vape.

Yeah, it doesn't strike me quite as a flare, either. I think it's probably a combination of the stool softeners/lack of cannabis. Hopefully it calms down soon! :hug:

 

[Jabo]

Hi, I am really glad you are feeling better. Just in case it comes back, I won't to tell you how I got rid of my anal fissures. I had terrible anal fissures for over 10 years. It was soooo bad. I tried every medicine. Stool softeners, steroids, suppositories, nitroglycerin, herbals, over the counters...... some things brought a little relief but in the end nothing really worked.

I started trying to do anything and everything I could to heal my anal fissures. Eventually, I was able to cure them without surgery (surgery wasn't an option anyway because my Crohn's was so bad the doctor refused to do surgery but instead told me to just tough it out and gave me pain pills). There are two things that I think really helped this.

First, I got my Crohn's under control. I did this through a strict SCD/Paleo like diet, but that wasn't enough. It also took Humira and supplements. The two key supplements that I think were related to helping the fissures were digestive enzymes and betaine hcl. After I started taking these at the start of every meal, my digestion improved. One key thing was that there wasn't whole food in my stool anymore. This in turn made my stools far less acidic. Gone was the terrible burn during a BM because the stool didn't have as much acid to make it burn. I tried lots of brands of digestive enzymes and betaine hcl, but anything that was rated high on iherb or amazon was okay for me.

The second thing I did, and this sounds crazy but it was sooooo important was that I applied chapstick down there. By this time I was no stranger to putting cremes and suppositories and who knows what down there from the doctor. What happened was one winter day my lips on my mouth were very dry and cold and they cracked and bled. I noticed the pain was of a certain nature but less intensity to the pain down there and I released that both parts are kind of "lips" at the end of the digestive track and so I thought if chapstick can help my mouth lips, why not my anal area. hahaha. I tried and to my surprise it really helped. After a couple of weeks, I had my first bm without blood in a decade. I sat in the bathroom and cried.

The problem with the chapstick method is that it wasn't permanent. It really helped far better than anything I had tried and made them go away, but as soon as I stopped, they came back. Still.... I was happy with a stopgap solution. Finally, it wasn't until I got my Crohn's under control as mentioned above with meds, diet, and supplements that it finally worked and they didn't come back.

I think the chapstick worked for a few reasons, but these are purely speculative. One, the chapstick had coconut oil and bees wax in it. Both of these were kind of disinfectants. They naturally kill bacteria and other bad actors. Two, they really helped moisturize the area. I think that my poor stools and their acidity had dried out my area down there and the dry flesh was much more likely to not be elastic and rip during BMs. Soooo painfully rip I might add. By moisturizing, I think it gave the skin more flexibility. For a long time in the past I had used steroid suppositories and they kind of helped. In hindsight, I don't think it was the steroids that helped, but the base of the suppository that was moisturizing the area. One key to identifying this is that if I could put the suppository in 1 hour before a BM, the fissures were less likely to reopen as bad. The third reason I think the chapstick helped was that it had peppermint oil in it. This was a double edged sword. The peppermint oil made things burn, buuuuut that burn was an icy/hot kind of burn and actually allowed everything down there to relax. This was much like how the nitroglycerin but without the headaches. Also, for the first 3 days, there was actually more blood. I am not sure why this was, but the pain was noticeably less from day one so I continued to use it. Honestly, at that time my poor anus was like hamburger meat. It was sooooo bad. Eventually, all the fissures were healed through diet, supplements, meds, and the chapstick. The chapstick alone didn't do it, but was a huge part.

This was my test case of one. I have no idea if it would work for anybody else, nor am I a doctor. I just wanted to share my story. Hopefully somebody will have something they can take away from it. I am enclosing a pic of two different kinds that worked for me.

 

[justbreathe8]

When I had a fissure my surgeon actually told me to use carmex and bacetracin (alternate one each day) on my finger and apply it inside to the fissure and it did seem to help. So the Chapstick helping makes sense. Def worth a try!

 

[FullM3lt]

Checking in again, thanks for the great tip, Jabo! I'll keep that in mind. I actually have a tube of unused burts bees sitting in my car.

Turns out that my "flare" was just the effects of taking docusate sodium every day. I'm back to having 1 formed BM a day...unfortunately, my fissure is acting up again. Although it isn't nearly as bad as it was originally. It's pretty uncomfortable, but i'm learning to deal with it. The pain did go away completely for a few weeks, but a week after I started having regular BM's again, it reopened. I got too greedy and ate bad food and started cycling again, which definitely doesn't help fissures....I've actually come to the conclusion that cycling has played a big role in my fissure after reading this article about impaired anal sphincter function in cyclists

Impaired anal sphincter function in cyclists

I have been drinking prune juice 3 times a day, but that hasn't done a ton. It has limited the tearing, but anything short of diarrhea seems to re-tear the wound.

Once I get diarrhea, my fissure heals. However, having diarrhea is fairly uncomfortable on its own...when I stop taking the docusate sodium, my stools go back to normal size and frequency but it re-tears my fissure! AHHHHHH

Just venting. I am on the brink of getting it under control. Luckily I have a few weeks off between Spring and Summer quarter for school so I can lay low and let my ass heal.

The worst thing about all of this is that my UC is better than ever :rof: My BM's are awesome, too awesome....

EDIT: Just tried the Burt's Bees chapstick. You're right about it being like icyhot! I'm still unsure about how I feel about this feeling, but I will continue to try it as long is it causes no problems!

I feel like my fissure from last month was more internal and this one is more external. I have been putting my nitro in my bum with no issues, just minor burning. The pain feels like it's more on the outside. Your chapped lipped analogy actually describes exactly how my a-hole feels hahaha

 

[FullM3lt]

Well, I put the Burt's Bees on and what ensued was the worst pain and spasming I've experienced in the past month. lol I shouldn't take advice off the forums

 

[justbreathe8]

Yikes! I'm sorry that happened! I guess everyone is different. I once read that putting garlic down there worked for multiple people. Needless to say ill never be doing that again. That was the worst pain I had too! Maybe just try something without a tingle like neosporin

 

[theOcean]

Oh gosh! I'm sorry to hear that. Maybe soak in a sitz bath for a bit to help ease it.

 

[Jabo]

Well, I put the Burt's Bees on and what ensued was the worst pain and spasming I've experienced in the past month. lol I shouldn't take advice off the forums

Sorry to hear about the pain. Thanks for reporting back.

For me, the first few days it did burn, I had to work into it slowly, but after that the pain was gone. I was hoping it would work for other people but everyone is different. I hope you find a way to heal in another way!

 

[FullM3lt]

Sorry to hear about the pain. Thanks for reporting back.

For me, the first few days it did burn, I had to work into it slowly, but after that the pain was gone. I was hoping it would work for other people but everyone is different. I hope you find a way to heal in another way!

Hmm well maybe it did do something. It was very painful that day but it has been improving since then. Although I haven't reapplied it for the fear of making it burn again lol. I tried the same thing with coconut oil and vegetable glycerin and the burn was bad when I did that too...actually that's the day I ended up in the ER :rof:

In the last 4-5 days I'm actually having formed BM's with very minimal pain...I've found out that whatever I eat first thing in the morning is the "plug" in my colon so I've been eating lots of fresh fruit, prune juice and salmon for breakfast so that the plug doesn't get too hard. :ylol2:

I've also upped my hash oil consumption in the past week....coincidence? I think it has helped me a lot.

 

[theOcean]

That's great to hear you've been finding things that help! I actually got prescribed a new medication for constipation and since then I haven't had any pain or straining -- it's called Resotran if you might be interested. It's just a pill you take once a day and it worked almost instantly for me.

 

[Jabo]

Hmm well maybe it did do something. It was very painful that day but it has been improving since then. Although I haven't reapplied it for the fear of making it burn again lol. I tried the same thing with coconut oil and vegetable glycerin and the burn was bad when I did that too...actually that's the day I ended up in the ER :rof:

In the last 4-5 days I'm actually having formed BM's with very minimal pain...I've found out that whatever I eat first thing in the morning is the "plug" in my colon so I've been eating lots of fresh fruit, prune juice and salmon for breakfast so that the plug doesn't get too hard. :ylol2:

I've also upped my hash oil consumption in the past week....coincidence? I think it has helped me a lot.

I am very happy to hear that you are getting better in any way you can!

For me, like it is seemingly so for you, it was a lot of things that helped me. Finding a diet was huge (SCD/Auto immune paleo), plus meds, and then finally the Burt's Bees was the thing that got me over the tipping point.

Since your last time was bad, I can completely understand if you don't want to try again. But if you do, I would like to make a suggestion and after having read your post about the pain, I reeeeeeaaaaaally regretted not saying it before, so I will take this chance now. Actually, I felt really bad because you listened to me and it didn't turn out well, but I am glad you reported back so others can know and understand.

At the start, I was so torn up down there and the Burt's Bees was so powerful, I didn't even apply it directly and definitely not inside. I just applied it on the outside and just a very little bit (think that when you put it on your mouth lips you don't actually use very much). I would know though if I had put enough on and close enough if it started to burn. I am pretty sure once or twice I put too much and immediately had to shower to get it off. But with a little bit down there as I walked and moved around, it would spread and work in on its own (just like when you put it on your lips and rub it around). For the first three days, blood actually got a little worse and I don't know why, but the pain was less. Then after that, it started to heal and noticably so. After healing happened, then I was able to apply larger amounts and more directly and after a few weeks even internally a little.

 

[Jabo]

That's great to hear you've been finding things that help! I actually got prescribed a new medication for constipation and since then I haven't had any pain or straining -- it's called Resotran if you might be interested. It's just a pill you take once a day and it worked almost instantly for me.

I think not having constipation is huge. Even to this day, if I am constipated a new fissure will appear, I am just lucky now I can heal it.

I think getting rid of constipation was a must do requirement for me to heal, otherwise it would just reopen everytime. I tried sooo many medicines, pills, and fibers and couldn't ever get it to work. In fact some of the meds I took actually put me in a Crohn's flare. It took care of my constipation alright, but not in a way I wanted. I didn't try the medicine you mentioned but you can be sure I will ask my doctor about it sometime. I am all for doing anything that makes us better.

Interestingly, the way I did finally get my stools soft in the end, was just eating a high fat diet. Lots of coconut oil, ghee, and animal fat. It really just made things soft and smooth. I was really surprised. All my life I was told high fat was bad, but here it was making me better in at least one way.

 

[theOcean]

Well, they have finally debunked fat being bad for you after all this time! It's been all over the news lately. So there is that. I know it really helps my digestive problems too.

 

[suavecito]

Hey there, first time posting but i read this all and sounds like what i have going on too. Im 34, have a gardening business in california and havent been able to work since august due to burning, itching, inflamation, and pain. I went to the e.r. twice in september because i couldnt take the physical pain and inflamation anymore. I couldnt pass stool from the spasming anal sphincter and blinding pain. I didnt know what it was like to be constipated. I had no idea what was wrong. I had never had any health issues before so this was foreign to me.
First e.r. visit was useless. They tested, poked, and proded and said "youre constipated", take this suppository and see a GI dr as soon as possible. With no insurance, soonest appointment was 3 months away. I went back to the e.r. a week later because the suppositories were not working. They did blood work, ct scan, injected dye into my veins for the ct scan, i drank a half gallon of liquid solution for the xrays, and they poked my butthole. They said there were no signs of internal bleeding or hemorrhoids so i had to see a GI dr for a colonoscopy.
Immediately following that e.r. visit, I called the GI dr office where i had an appt in 3 months and demanded to be seen. I was given an appt the following morning. The colonoscopy was done 2 weeks later in late september (30th) and they found the fissures, 2 polyps, and diverticulosis. Biopsy results (Oct 8th) found polyps to be benign and follow up visit with the surgeon resulted in recommendation of another surgery to do LIS (lateral interior sphincterotomy). I was referred to another surgeon for that surgery and i saw him October 21st. According to this next surgeon, this surgery will "permanently" fix the interior sphincter muscle. The fissure causes the interior sphincter muscle to spasm and close in order to protect you from the pain of the fissure. This spasm also causes the blood flow to the fissures to stop and impedes the healing process. I am waiting on authorization from insurance to approve the surgery and i will be scheduling that soon.
My question now. Has anyone had this done and is it the permanent fix the surgeon said it would be? The surgeon said, you can live with and treat the flare-ups or solve the problem altogether. I dont want to put myself through surgery if I dont have to but i also dont want to live with this all my life.
Thanks