I had AF 5 months ago that healed on its own. A month ago, I had another AF due to an uncontrolled BM. I have been seeing blood in most of my BM since then (which is driving me nuts). Usually it is fresh blood on the TP and some on the stool. There were couple of incidents when I saw TP drenched in blood. My pain has been manageable most of the times (I would rate 4/10). I usually get some burning sensation, mild spasms and some stinging pain for few minutes and it is gone until I have the next BM. There were few instances when I had BM with no blood at all. But next BM would usually have some blood.

I went to CRS couple of weeks ago. He examined from outside (without probing) and could see a fissure at 6 O'clock. I was checked for anemia and was found normal. From past month, I have been following a strict diet of fiber, veggies, stool softeners and water. I apply GTN 3 times a day. Still hasn't stopped the bleeding. From past few days whenever I apply GTN, I can feel a lump or a possible internal hemmie near the 6 O'clock AF. I am not sure if hemmie was since the beginning and if this is the source of my consistent bleeding. I bleed only during BM. Either way, this bleeding (not pain) has been draining me emotionally. My next CRS visit is in 5 weeks. I called CRS office couple of times to address this bleeding and they said it takes some time (even with an internal hemmie). If anyone has had similar problems or have more insight please share. I am pretty clueless on how to stop this bleeding. Thanks!

Hello, I know seeing blood in your stool is very alarming and terrifying, but it looks more than it really is. So it takes time to stop. At least with me was like that.You need to maintain your BMs soft Like paste tooth consistency. Avoid as much as possible hard and running stools. And also try to limit your BMs to once a day. So the fissure has time to heal. Do sitz baths with plane warm water or Epsom salts, once or twice a day at least for 20 minutes. And if you can have a bottle of hot water and apply it to your butt or sit over it will be great. Heat is very good When you have a fissure. About your hemmie, it sound to me more like a sentinel pile. Here is the definition of a sentinel pile:
"An anal fissure is often accompanied by a lump on the outer edge of the anus. This lump is called a ‘sentinel pile’ as it signals trouble beneath it. When the fissure is acting up, the sentinel pile will often become quite hard and painful and itchy. Sentinel piles are often mistaken for hemorrhoids"
Finally I want to share with you some recommendation my doctor gave me to manage my fissure:

1.Wash your butt only with plane warm water not soap.
2. Before a BM luv yourself with a dab of Vaseline, to make it easy to pass and to clean later.
3. Don't clean your butt with toilet paper, use warm water or baby wipes, preferable for sensitive skin.
3. Between BMs protect your butt with Vaseline or an ointment for babies to ease irritation.
4. Try to limit your BMs to one a day.
5. Avoid at all cost diarrhea or running stools.
6. Keep your BMs soft.
7. Do sitz baths with warm water one or twice a day

I hope I could have helped some how. Best of luck.

Hi Kpain,
Sorry to read of your pain in dealing with this but welcome here.
Firstly, I'm not a professional but it does sound very much to me like you have developed a Sentinel pile or skin tag close to the fissure site, which is normal, so try not to worry yourself too much. They are generally attached to the end of the wound and develop as the fissure heals. Most of the time they are pretty manageable and cause no issues but may be permanent, although settle and shrink more over time. Your CRS will be able to confirm this for you.
It could be an internal pile in the area, which can bleed as you know, but it could also be bleeding from the fissure, which would also be completely normal still. It could be a combination of both. This happens with a lot of people and if seems that if your pain levels are generally decreasing, you are healing well, even though you may still bleed too...As time passes however and your fissure heals more, this should start to calm down for you too.
Your CRS is right in saying that these things can take a few weeks or months to completely resolve and the healing process can be slow but it is gradual...
I had a couple of really annoying & irritating internal hemmies that were a nightmare for a few weeks after my surgery, to the point I considered banding them, but I didn't and they did eventually calm down again. It did take a while, but it got better. Key is just to stay as strong, level-headed, positive & patient as you can through your recovery.
Try not to worry to a great extent about the bleeding because it is completely normal, not nice, but normal and you won't be alone with this. ..Just keep doing everything you can to look after yourself and make sure especially that you are not excessively straining on the loo and keep things nice & soft & are also not "over-cleaning".
Exercise is always a great help along with hot heat on the bottom (bath/ bottle etc...) to promote blood flow & increased healing.
I think it's worth looking into B Vitamins to help with bleeding issues & I always take Zinc as it assists wound repair in the body & general immunity.
Wishing you all the very best with this & your healing process & hope you begin to feel much better soon

Betty Blue and Ever the Optimist.........Thanks for reply and advice.

I will take your advice and make some changes in my routine to see if it helps. I have a question on the BM. During BM, usually the first few stools are bit formed (and hard some times) followed by easy release of the rest (paste like) with no effort. I have not been successful in making first few stools very soft. I drink close to 15 glasses of water a day and I take Milk of Magnesia at night to keep it soft. I eat white rice during lunch and dinner along with veggies and fruits. I am wondering if it is rice (some say it is binding) that is causing some of these hard stools. There have been instances where I had bloodless BM even when I ate rice. I am not sure. I take 2 tablets of Citrucel during day and 2 table spoons of Milk of Magnesia at night. I am scared to increase the intake of MoM as I do not want to have diarrhea. Is there any trick to keep the first few stools paste like and soft?

I had the same problem as you until I found Miralax. Miralax gave me the consistence I was looking for not too hard and not too soft. I took it twice a day in the beginning, at the worst of my fissure. And later, when I improved I took it once a day. You need to increase the fiber in your diet. Instead of white rice why not use brown rice, whole wheat spaghetti and bread. All bran and so on?

Hello I have anal fissure and internal haemorrhoids too. I also have so much blood that it drips into the toilet and is everywhere in the toilet bowl including toilet paper and stool. I did have 3 days there where it didn't bleed but of course it started back up again.

I have complete running poo now, I seem unable to get that normal soft stool. It's either the runs or constipation and I figure the runs will do less damage to my anus that constipation. I try and July go once a day though.

I wish I had some advice for you, seems a few have already said some great things. I just wanted you to know your not alone, my situation seems exactly the same as yours.

Good luck

Thanks Bettyblue. Just to get an idea.......can you tell me how many teaspoons of miralax you took 2 times a day during your worst phase? And also how much time did you give between these 2 intake? I understand it works different for different people. And also if I go with miralax, I may also have to do some experimentation with the dosage.

The usual dose is 17 grams (about 1 heaping tablespoon) in 4 to 8 ounces of water. One to 3 days (24 to 72 hours) is required to get the BM consistence you are looking for. I will start with one dose at night after your last meal and see if is working ( you don't want running BMs, they are equally bad for a fissure). If is working then you don't need to take more. Now if your problem continue, then you can take 2 doses. One in the morning and one at night. Try to have only one BM movement a day until the fissure is healed.

As of today, I am in the 7th week of dealing with this fissure. Since last 2 weeks, I have seen significant decrease in bleeding. Now I see only mild spotting once or twice a week. I think this happened by changing stool softeners. I take 100mg colace in the morning and 17 grams of Miralax at night. Switching from Milk of Magnesia to Miralax seem to have helped. My stools are now more consistent. But I am still unable to have one BM every day. Usually it takes 2 BM a day for complete evacuation. Miralax seem to have helped in controlling the bleeding. Thanks for the good advice given here in this thread. Regarding pain, it is still the same. It is mostly manageable pain. I would rate 4/10 and occasionally I get 6/10 which goes away once I apply GTN. To further decrease my pain level, I will probably try hot water bottle as sitz baths makes my skin at fissure site raw and irritating.

As suggested by ETO and Bettyblue, I think I may have a sentinel pile. I can feel it just inside when I apply GTN. It is not bothering me much during BM and also not painful when I touch it . But I am getting concerned that with a sentinel pile and in my 7th week of fissure if I am heading towards having a chronic fissure. Usually I read acute fissures heal in 4 to 6 weeks. I understand it takes time to heal fissures. And any improvements or healing should be measured by weeks. How to determine if I have a chronic fissure? Is it the increase in the pain level or more bleeding or both? What are the main indicators of a chronic fissure? Any advice or suggestions. Thanks!

PS: My next CRS appointment is in 2 weeks. I will ask the same questions to my CRS and will let you guys know.

Hi, any update on you? How are you doing?