Thank you to everyone for all the informative posts I see here. I would love to get any advice you can offer. I have what I'm pretty sure is an acute anal fissure caused by a gastroenterologist during a colonoscopy. Tomorrow will be 4 weeks since the procedure, and it is still impressively painful, and not clear to me it is improving. I read that "6 weeks" is the transition from acute to chronic, and I would love for this to not become chronic. (I've developed a lot of sympathy for all of those on this site struggling with chronic issues!) I have pretty stunning pain during a bowel movement, visible blood on toilet paper only some of the time, but pain is not just for a while after bowel movement, it continues off and on (but vast majority of the time "on") all day.

What seems unusual about my case is that many apparently get fissures from issues with constipation, and that has never been an issue for me (I've been mildly constipated or a day or so perhaps 2 or 3 times in my whole life, and I'm in my 60s); I am pretty athletic and typically eat a large volume of high fiber food, with 2-3 bowel movements per day. However, this seems to be working against me because, since the fissure was caused by the colonoscopy, it feels like it never gets to heal, as each bowel movement re-injures it. At first, not knowing what it was (did not know about "fissure") I was convinced by a friend to try preparation H. Gave up on that after about 8-9 days. Then I read about sitz baths. These are the best thing I've found at reducing pain, but the pain reduction is only temporary. Next, I tried eating no solid food (just water, and a little bit of juice and jello) to see if I could stop having bowel movements long enough to let the fissure heal. A day without a BM was the best things have felt but, a few days into this, I had 2 BMs (go figure!) and was in pain again. I don't have a lot of weight to spare, and, by 5.5 days without eating, I'd lost several pounds and was feeling weak enough (and still in pain), decided this was not sustainable. Now I'm eating very moderately.

Finally got to speak by phone with gastroenterologist. I've had perhaps 6-7 colonoscopies from him in the past (my mother died of colon cancer at 46, so I was at risk), and was always quite impressed by him - I was not at all accusatory, but he was rather evasive ("you had a couple internal hemorrhoids, perhaps they were aggravated by the prep"). From what I've read, people generally do not feel internal hemorrhoids at all, and I described to him what sound like exact symptoms of a fissure. He prescribed some $100+ hydrocortisone/pramoxine cream, which I've used twice so far - the first time, it seemed to partially alleviate pain, 2nd time no effect (I used it right after a sitz bath and, with the discomfort of applying it, the cream seemed to make things worse, at least temporarily). It's not clear to me whether I should force myself to use this cream (which I would if it actually promotes healing), or it's just supposed to mask pain.

Please give me guidance in what I can do to prevent this from becoming chronic: 1) does hydrocortisone/pramoxine cream actually promote healing?; 2) I read on this site a link to study from Italy in which 5 days of progressive digital anal dilation (10 minutes each morning/evening) had good results, do you recommend this?; 3) my bowel movements are already pretty soft, should I take laxative to make them more diarrhea-ish (I've had that a couple of times, and it hurt as well!); 4) is there an important reason to see a colorectal surgeon to have this scoped (ouch! I would not look forward to that right now, and afraid the process would cause more damage); 5) I already have healthful eating and exercise habits (remarkably, along with sitz bath, running is when it is hurting the least), but what else could you recommend? Apologies this post is so long, wanted to be clear about things. Please, ANY tips would be *very* appreciated! Thanks!

Hi there, I'm so sorry this happened to you. I had a colonoscopy for the first time a couple of months ago and getting a fissure from it was my top concern. The doctor reassured me that it would be very rare to get one from a colonoscopy, so I think your doctor definitely made a mistake during the procedure.

To answer your questions, hydrocortisone is not going to heal the fissure, but instead thin out the skin and slow the healing.

Several people have had success with dilation on this forum, but I think it depends on how painful the fissure is, in order for this to even be attempted.

I think that very soft stools can cause pain due to being more acidic. Try a barrier ointment like Vaseline before a BM to protect the wound.

A colorectal surgeon who is skilled in treating fissures doesn't need to scope the area to diagnose you correctly. They will simply look gently to get a clear view externally and examine what is going on. Please don't let the fear of a doctor visit stop you from getting medical help.

Take care and let us know how you get on.

I would see a Colon Rectal Surgeon. Mine never looked with a scope. My first time he gave me a cream that helped it heal. Can’t remember the name right now. It caused pretty bad headaches at first, but helped me heal.

My second time, this cream did not help me and I needed a Botox procedure.

My heart goes out to you. It’s an awful condition. Best wishes on healing up fully and hopefully soon.

I would even consider talking to a malpractice attorney if this colonoscopy caused this. You should have no pain in that area after a colonoscopy (I've had two) let alone a full blown fissure. You cannot avoid having a BM and it will usually backfire if you try to mess with being regular. You absolutely want a soft bulky stool even with a fissure. Now you are probably even more stressed out and guess what that does? It makes it worse because of the tension on your sphincter and that tension will not allow you to heal no matter what creams or magic bullets you use. You need to truly approach this with a calm mind. The sitz baths do help with this. And patience_and_healing is correct, a colorectal surgeon should be able to see the fissure right away without a scope. I had the scope from a general surgeon and it was SOOO painful. And I agree that soft, loose stools are to be avoided as much as dry hard ones.

Get your fiber intake up, keep running, keep doing sitz baths, drop the ointments and creams, forget the laxatives and RELAX when you go to the bathroom (maybe get a squatty potty - I did). Do not strain or push, let your body do most of the movement for you. You should strongly consider seeing a colorectal surgeon very soon - it doesn't mean you are getting surgery - it just means the right person will look at you.

Thanks so much to each of you for the helpful advise! I wrote a long update and tried to send it to the website, but apparently it vanished. Here is the short version: I’m 5 weeks and 1 day since I was injured in the colonoscopy, and 5 days since I finally got to see a colo-rectal surgeon. He easily and painlessly (without needing a scope) diagnosed that I have an anal fissure and that it is on the posterior side (which I believe is the more common location). He prescribed diltiazem cream applied 3-4x per day for 4 weeks; lidocaine cream for pain; cocoa better/zinc suppository to be put in each night before bed to help protect tissue for morning BM; and scheduled a followup appointment in 5 weeks. He said that the hydrocortisone cream combo was of no value (and, as noted here, is counterproductive if it causes tissues to be thinned); and that the manual dilation study has since been discounted, but that while it does not have curative value, it is not harmful. He told me I should eat normally (when I described my normal diet and habits) - I had already lost 8.5 pounds by the time I saw him, but have managed to at least stabilize my weight since then. I appreciated his honesty: he said the diltiazem cream works for 60% of patients. If that fail, the next step is botox and, if that fails, surgery - which, even as a surgeon, he said is the *last* resort, with risk of complications, etc… I really hope the diltiazem cream works!

Pain seemed to keep getting worse even since my first post. On some days it is so bad that I spend most of the day just trying to manage it (hot bath, go running, another hot bath, etc…); sometimes, I can not do much else for 8 or 9 hours after morning BM but, fortunately, by evenings, it usually gets much better (until the next morning!). Fortunately, the progression is not continuing to get worse and, today, for example, I was able to function alright for more than half the day. I’ve always been very good with severe acute pain, but the many hours a day, and day after day, is exhausting - I have a great deal of compassion for all the people on this site who have had extended chronic issues with this - wow! Interestingly, people recommended ibuprofen, but that seems to have no effect on the pain, and I haven’t been able to notice any decrease in pain when I use the lidocaine cream. But, as long as this heals, I will be delighted. Thanks again for this site and for generously sharing your advice and feedback!

Since I found detailed posts by others to be so helpful, I’m adding a few details about my regimen (time will tell whether it works or not!): I’m eating more like my regular diet (salads, brown rice, vegetables, fruit, walnuts, fish, etc…) now, just somewhat reduced quantities. I’m doing my best to orchestrate my day to only have one bowel movement - the couple of recent days when I had a 2nd were exceptionally painful, with nearly the whole day taken up by pain management. Every evening before I go to bed, I have a glass of prune juice and put in the cocoa butter/zinc suppository. When I wake up in the morning, I feel like I have to go to the toilet, but I want my one trip to be the whole deal, so I resist and first walk between half a mile and a mile, then run between 1-1.5 miles to loosen things up even more. By that time, I desperately need to go, and only the slightest pushing to open things up is necessary. I’ve read about the “ano-coccygeal support” toilet seat attachment but can’t find a place to purchase one in the USA, so I do my best to simulate that my putting pressure with one finger just below my coccyx while I have a BM. (I’m not sure if this helps anything; my colo-rectal surgeon did not seem to think this was important or necessarily useful - have any of you used the attachment and found it helpful?). It’s surprising that, on some days, pain later in the day does not seem as correlated to the level of morning pain as I would have expected. Sitz baths and running (which I do again later in the day, without the distress of needing to go to the toilet) are the best for reducing pain at least short term.
Tomorrow will be 1 week since I started using the diltiazem cream (and 3 days short of 6 weeks since the gastroenterologist caused the fissure during the colonoscopy); I’m not sure whether things are improving/healing, since it feels so variable from day to day, but I hope so!

Can you give us an update on how you are doing?

Yes, happy to give an update: The short answer: although it took quite a while (I feel in retrospect that I pretty much lost 2.5 months of my life to this), I am delighted to report that I am fully recovered. Here in more detail:

- The gastroenterologist who caused the injury not only never admitted to it, but gave me bad advice about treating.

- Finally, I found a good ano-rectal surgeon, and he put me on a conservative program:

1) Diltiazem cream applied 3-4x per day

2) A suppository (“Calmol 4”” in the USA) before bed each evening.

In addition, I did the following on my own: glass of prune juice every night before bed, and my normal healthful diet with salad and fresh fruit and vegetables each day; squatty potty; wetwipes rather than toilet paper.


For the first few weeks doing the above, I was still in bad pain, howling for hours a day; the two things that helped at least temporarily were hot baths and running.


I had a followup appointment with the surgeon in 5 weeks. By late in the 4th week, I thought I was detecting a bit of improvement and, though not back to normal, I was certain in the 5th week that the pain was at least a bit reduced.


The surgeon said that, if things had started to improve, he suggested I continue doing what I was doing, if that was acceptable to me. He made another appointment with me in 6 weeks. During that 6 weeks things improved and improved until, by the time I saw him again, I was pretty much recovered, and he felt that I could keep doing what I was doing for a few weeks more but, unless things took a turn for the worse, there was no need to see him for a followup. That was a month ago and, by now, everything is back to normal, with no pain. What a relief!!!


I must say, I never fully appreciated how devastating constant pain can become until I went through this. For example, as a musician, I went from being very productive composing and practicing (averaging at least 5-6 hours per day) to a drastically reduced schedule - but most of all, my creativity nearly vanished when I was distracted all the time by pain. Happy to say it has returned!


Thanks so much to everyone on this forum for the helpful information and comments. If anyone who is experiencing an anal fissure for the first time is reading my post, my one big-picture suggestion is to realize that “after 6 weeks, an acute anal fissure becomes chronic” might be a rule of thumb, but don’t be disheartened about timetables — and, even if you are doing the right things that will eventually cause everything to heal, it may takes some weeks before you can observe the improvement start (at least it did for me).

Thanks for the update. I am so glad you are healed. Sometimes it does not seem like this will ever heal. Some of the stories of people who have suffered for years are not very encouraging. I have never hear of Calmol 4. Did you find that it helped?

Calmol 4 is a suppository that is cocoa butter and zinc oxide. There’s no way for me to know how much it was this vs. the Diltiazem vs. time that caused the healing, but my sense is that the Calmol 4 was a critical part. The surgeon said that his mentor was “old school” and would *only* have patients use the suppositories (no Diltiazem) and they would heal. My impression is that they both promote healing and ease (lubricate) things so that it is less trauma to the area to have a bowel movement. I would use one each night right before going to bed.