I have had to take 30 mg of methadone daily for about five years to treat a neurological condition. Constipation is often severe as a result because opioids pretty much stop peristalsis. After an impaction turned into a severe blockage my gastroenterologist advised me to stop Metamucil and eat a low-fiber diet. That works pretty well.

I've changed medications several times. I'm now taking Linzess, Amitiza, Motegrity, magnesium, Senna (I can vary this as necessary), and a daily suppository.

My BMs vary in solidity depending on diet and exercise within the past day or two. I never really know what to expect. Now and then I have to pass rocks; more often stools are a bit loose; and sometimes I have a normal stool followed by 12-15 episodes of diarrhea--this goes on up to 5 hours, so I never schedule activities outside the house before 10 am.

I started seeing a proctologist about six months ago. Things were going as usual until the day before one appt I had to pass a larger, harder rock than usual. My fissure broke wide open for the dozenth time. Blood, pain, etc. I told him about it.

He said my interior has been going into spasms, tightening when it should loosen. He decided to do an anal dilitation. I'd never had one. I lay on my side and he began.

The pain was worse than labor. My husband and the other patients could hear my shrieks and screams in the waiting room, though I did my best to be quiet. He was making something inside me larger and larger. Howls of pain kept erupting from my mouth... Then finally it was over. The pain was far worse than tearing the fissure, and lasted three days instead of a few hours.

I'm curious: is this how every doctor does this procedure? I would imagine a dose of some relaxing medication (as when I had my cataract surgery) and waiting for it to take effect would be a good idea. He wiped around an ointment he said was a local anesthetic but it had no effect at all. It seems like even a brief-acting general anesthetic, and doing the procedure in a hospital, would be kinder. Or at least a local anesthetic, like dentists use to numb nerves before filling a cavity.

He said that if my problems continue, he'll do this again now and then. I cannot imagine permitting him to. Is this degree of agony so necessary and common that I should simply face it? Or do other docs use different methods?

Personal opinion: doing anal dilation on an active, bleeding fissures sounds painful and counter-productive...At least wait until the open wound have closed (even if still raw and tender), and then start dilate away? And based on what I saw on this forum, dilations should start gentle, never forced. Listen to the body.

Thank you! I sure agree. I hope others will reply, because I'd love to know whether or not any sort of local anesthetic, or perhaps a Valium ahead of time, is usually used for this process, and if it tends to be done in an office or in a hospital.

My doctor was running late that day. I'd had to wait 75 minutes, and he knew I'd barely make a cardiac stress test thanks to his delay, so it's possible he worked on me faster than he usually would.

It was interesting to run on a treadmill right after all that agony, but I passed with flying colors. I managed to face 1) a pain-tolerance stress test and 2) a cardiac stress test the same morning. Failed the first, for sure!

Dang that sounds intense! Anal dilation is sometimes done under general anaesthesia with fingers or a balloon mechanism. I am really surprised he did that if it caused you so much pain. Hopefully, that pain was worth it and your fissure improves! Keep us updated!

Self anal dilation healed my fissure. If you search for my posts on this, and those of some others on the forum, you will see that it does help. I went through the mill before I resorted to this.

Many thanks to the latest repliers. It's very interesting to learn that anal dilation is sometimes even done under general anesthesia, by fingers or a balloon mechanism. I'm not sure what he inserted (the eyes in the back of my head having closed once the kids grew up and moved out), but as I left I saw a wall rack containing a dozen or so all-metal contraptions that looked that the sort of thing e might have used.

I'll look up the balloon type and self-dilation posts.

The crazy thing is that when I saw him again last week I had so many other topics to discuss and so little time that I didn't quite register what he said as I was leaving his office. I didn't realize he was assuming that it was the *fissure* that had caused so much pain that I wound up in the ER. I should have said, "No! No! It was what YOU did to me!" Then he said, "I might have to do the procedure once every few weeks until you feel better," and he was gone.

I was in my car and he was surely working on his next patient by the time I processed that. In July we'll have a very different discussion!

I had anal dilation done in 2014, during a sigmoidoscopy. I think it helped, but only for a short while. I believe it was a balloon. No issues if you are sedated.

To summarize what I've been learning: Looks like sedation is very important, unless a person can do self-dilation; the physician should be very gentle, go slowly, perhaps use a balloon, and avoid dilating a fresh, raw fissure.

Thanks, everyone! I'm in no pain right now, just trying to figure out what approach to try if my fissure tears open again. I've persuaded my opioid prescriber to switch me to a milder opioid that recent research suggests is effective for my condition but is a lot less likely to cause constipation. That could start happening in August.

It'll be a long process--first I'll have to endure weeks of withdrawal from methadone (while my neurological symptoms come raging back). Then the new medication will be introduced (and, I hope, it will subdue them). If Med #2 is indeed less constipating, I'll be using progressively fewer doses or types of my current anti-constipation meds. Now and then I'm bound to taper them too quickly and have to pass a rock, and that %$&^* fissure will tear again. I'll alternate between diarrhea and really hard stools for a while, and eventually things should settle down.

I'll be reading posts here in the meantime, learning as much as I can. My proctologist keeps warning me that if the fissure opens again I'll have to have an anoplasty, but that seems pretty drastic when my body's core problem is medication side effects, and I'll be reducing them.

Thanks again!

If you want to maintain the fissure yourself without enduring a painful dilation again, you can gradually dilate at home at your own pace. I did this for weeks starting small and gradually increasing the size and I never experienced pain because it was gradual. This self dilation reduced my spasms to almost nothing after usually having spasms for around 3-7 hours after a BM. It hasn't healed my fissure but it did improve the symptoms dramatically and some people heal 100% with this method. :)

Thank you--good point, and I've added it to my Try This list.

I only have spasms for a few days after passing a rock. Normal BMs are fine.

Rocks have been happening less often since two extra meds (Amitiza and Motegrity) were added to my daily list. Unfortunately, my insurance just rejected Amitiza on the grounds that I'm already taking Linzess. I'm appealing via personal letter, but obviously a doctor's letter would have more weight.

I have very little faith that my proctologist's office will make sure he sees the insurance letter. Even if he does, he's very busy and seems to have ADHD, so I might have to force his staff to squeeze me in to see him between his regular appointments to hand it to him in person with a quick explanation. I see a lot of specialists, but this is the only one who's instructed his front office to simply delete all voicemails to do with prescriptions. Several weeks ago, I learned that rule the hard way!

If this problem isn't resolved, the rocks will return and that fissure will go wild again. I caused the most recent fissure-rip by accidentally forgetting to take *one* Amitiza during a crazy-busy day. I can make them rarer by taking lots of extra Senna and enduring 4 or 5 hours of diarrhea each morning. I lived that way for years. Senna's tricky stuff. The "right" dose changes daily depending on what I eat and how active I've recently been.