by NeuropathicGuy » 21 Aug 2009, 15:09
Hello folks, I've been wrestling with my fissure for a few months now, and am far from healed, but feel that I've learned enough where I can contribute a bit now about what's helped me. It took me a lot of severe pain and a very urgent, unbearably painful trip to the emergency room to really get serious about tackling this thing using every means necessary.
DISCLAIMER:
I don't know if any of this has actually helped heal my fissure any, but it's certainly reduced some of the incredible pain associated with and following bowel movements.
DIET:
I eat a daily regimen consisting of high fiber bran cereal (the Fiber One brand is great for this), sushi (with brown rice if available), soy beans (edamame), and boiled vegetables (mostly broccoli, cauliflower, carrots, and cabbage). Note that the boiled part is critical; when I was eating raw vegetables in salads, they didn't digest nearly as well. For protein I've found that small portions of boiled fish and boiled chicken work well for me. Any fried foods are a major no-no, in my case anyway, as they come out rock solid at the other end.
STOOL SOFTENERS:
For me, Miralax (Movicol overseas), whose ingredient is polyethylene glycol, has worked the best for me. In my experience, it works better than docusate sodium, which is what my physicians typically suggest first. Miralax is strong, however, so adjust the doses as necessary for your own digestive tract (too much can sometimes cause diarrhea). I personally split a full day's dose in half and take one part after lunch and one part after dinner. It tastes weird at first (like plastic water) but you get used to it quickly.
TOPICAL HEALING OINTMENTS:
I have tried both 0.2% nitroglycerin in aloe vera, 0.2% nifedipine in petrolatum, and a combination of 0.2% nitroglycerin / 2.0% hydrocortisone / 5% lidocaine. For me, the nitroglycerin based ointments provide the most short term symptomatic relief (i.e., they reduce pain and calm down the sphincter spasms), but they also come with a throbbing headache as a very overt side effect. The nifedipine ointment does not seem to give me much short term relief from symptoms, but most literature I have consulted seems to suggest it offers better long term healing rates. I alternate between the two every other day (but never both at the same time as this can potentially lead to sudden hypotension!) as I figure a combined approach likely wouldn't hurt. When applying the ointment, I put a little inside the anal canal using a syringe, and also rub a little around the anal opening using a finger.
TOPICAL PAIN OINTMENTS:
If I have an inkling that a particularly painful bowel movement may be coming, I use an over the counter product called dibucaine (brand name is Nupercainal) around the anus a few minutes before the bowel movement. This can help numb the pain a little bit, although it will not completely eliminate it. I have also heard of an over the counter product called LMX5, which contains the numbing agent lidocaine, that can be used in the same manner, although I have no personal experience with it. Both of these topical analgesics are not always readily available in brick and mortar drug stores, but can be found easily at many online stores, so look on the Internet if you have trouble locating them locally.
OTHER MEDICATIONS:
One colorectal surgeon I consulted with prescribed me Valium (diazepam) due to my severe anal sphincter spasm (it was so tight that even gas could not pass through the sphincter). While not often used for this purpose, I have found the Valium to be of great benefit. Even at low doses, it helps relax my sphincter. I have found that it makes it easier for stools to come out during bowel movements, and more importantly, I credit it with reducing the painful and uncomfortable anal spasms that follow bowel movements. Do consult your physician if you're interested in more information on this, but I can tell you that Valium certainly seems to have helped me.
Finally, I did have one severe spasm and pain episode that prevented me from standing, walking, or even moving without extremely terrible pain. That sent me to the emergency room in a wheelchair. After confirming my fissure via a rectal exam, the emergency room doctor prescribed me an opiate painkiller. He indicates that opiates are typically contraindicated for bowel diseases due to the side effect of constipation. But, he says that in very bad cases like mine, sometimes it is necessary to use them in the short term to "break the cycle" (his words verbatim) of spasms. During those several days, my bowel movements and spasms were very, very, very painful and completely debilitating, and I took the opiates plus Valium and temporarily increased my dosage of Miralax (to counteract the opiate constipation). Eventually the pain levels got back to a controllable level. At that point, I quit the opiates and continued the Valium and Miralax as well as diet and topical ointments. Knock on wood, but since that time I have yet to have the same level of incapacitating pain that sent me to the emergency room.
SUMMARY:
After employing all of the above, my fissure is clearly still present, and does still cause pain and discomfort daily, but has been noticeably more manageable. It will take time to see what happens in the long term, but I feel strongly that what I've described above has at least helped me to some extent, and am hopeful that some of the information can help others as well.