My journey has been an interesting one. I was traveling overseas when I came back to the US (home for me) and was stranded in NYC due to weather conditions. I was already having problems with urinating and the tip of my penis hurt real bad. I had convinced myself I had a urinary tract infection but while at the hotel, the worst pain of my life hit me and I had to be rushed to the local ER, where I spent 9 hours in between opiate shots to find out via a computerized tomography that I had a kidney stone. This was my first encounter with one and I can say I hope it is my last because I have never felt pain such as this, one that I don't wish even on my worst enemy.
I came back home the next day after we were authorized to fly (and medicated and in panic the pain would come back mid flight) and recuperated home. The 3mm kidney stone eventually was expelled out with no pain and a follow-up visit to the urologist was recommended from the NYC doctor who saw me at the emergency room. During this time, without my necessary awareness and given the pain and traumatic experience of the actual kidney stone, I failed to realize that I was also constipated and would spend days without going to the bathroom, alternating between feces that were thin and pasty and difficult to pass and bouts of nocturnal diarrhea. Aside from this and taking attention from my bowel movements was the fact that even after passing the stone, I was experiencing urinary hesitancy, this feeling of needing to empty my bladder and yet only drops would come out. I would go to the bathroom 30 times a day. To complicate matters further, the urologist prescribed antibiotics because he felt perhaps a post-kidney stone passing urinary tract infection could be taking place, even though no culture was found in the urine. I went through 2 CTs, a cystoscopy (which is the most horrible procedure one can have being awake) and a prostate exam, with no diagnosis found.
Now that my bladder problems went undiagnosed and were deemed "psychological" due to lack of diagnosis, I began noticing that every time I would go to the bathroom to defecate, my feces would come out bloody and I would experience a sharp pain. I attributed originally this to be hemorrhoids since I had them before occasionally and to be honest with you the pain can at times be quite similar. However, unlike my prior occasional bouts of hemorrhoids, this went on for days. And to make matters worse, it would not help that my feces continue to come out pasty and difficult to pass, further potentiating the problem. The 2 prostate exams I had further made it worse and neither doctor was gentle when examining my rectum. This was an overall nightmare but I am now healed and wanted to recommend some steps to those who suffer from this condition:
1- First and foremost I read here that aside from the physicality of this disease, that it is a psychological syndrome. This is the best and most accurate thing I read. DO NOT LET THIS TAKE YOUR LIFE AWAY FROM YOU. At times I would find myself depressed and all I wanted to do was lay down and read things on the internet about procedures and such. This is healthy and informative to a degree but force yourself to do things as you normally would: go to work, take walks, go out with friends, etc... To stay at home ruminating definitely caused worse anxiety and I felt deterred my initial improvement.
2- It should be no news that eating habits are the first thing to tackle. Because I like to eat and cannot fast for days as some people have suggested, my diet consisted of pretty much bananas and baked/mashed potatoes for days. I know some people are lactose intolerant and milk may in fact potentiate problems. But this diet, accompanied by LOTS of water and liquids is really what helped through treatment. And at least I would not be starved. I initially was eating apples but was informed that even though it is full of fiber, its acidity makes it difficult for the fissure to heal. You want to treat your fissure as a sort of a paper cut in a place that is bacteria-prone and very difficult to heal. As such, the acidity in foods can be a deterrent. The minute I cut apples, I noticed healing. Each body is different but this was an interesting observation. Broccoli and cauliflower were also foods that I would sauté and eat when I got tired of potatoes and bananas. Bear in mind diet was even more a difficult topic for me because the urologist gave me a list of foods I could not eat due to high calcium oxalate content, which could once again result in kidney stones. So my list of allowable foods was even smaller
3- I began doing sitz baths in the morning and in the evening after I would defecate. I noticed that the panic I created around going to the bathroom due to pain and the psychological fear of bleeding was so bad that I was constipating myself and making the problem even worse. I would sit in bed praying and hoping I would not go to the bathroom more than once per day so the fissure would heal that I would make myself even more tense, which is a big no-no for this disease. Please, as much as you can, refrain from doing this because it potentiated the problem. Once I stabilized by bowel habits, I would go to the bathroom twice per day and even though I would bleed, I would keep a positive attitude and follow with the sitz baths. The baths can be done with warm-to-hot water and a pan full of chamomile flowers boiled which I ran through a strainer into the half-filled bathtube, turning the water slightly yellow. I would sit there for 20 min and found that this was really helpful and soothing and further enabled circulation into the area, which is needed for the fissure to heal.
4- Now comes the actual medicines. I put in my mind after reading some stories about sphincterectomies that I would do everything in my power to avoid the procedure and going through surgery. I even consulted with a rectal surgeon and this was key to my healing but I will mention everything that I took per day and will remind everyone that this involves discipline and patience, two things that I learn along my journey as I had neither:
a. I took probiotics to stabilize my bowel movements every day. In the morning I would take one Florastor and one Culturelle and then another Florastor at night.
b. I took activated charcoal since my naturopath mentioned it would be helpful in cleansing the stomach from toxins. 2 per day - one in the morning and one at night - with food.
c. I only began healing (after reading on this forum) that taking Magnesium and Vitamin E are helpful because the first helps with constipation (which I often fell during the peak of my anal fissure crisis) and the second with actual healing. My homeopath mentioned that everyone should take Magnesium, up to 1,200mg/day so I continue to do so even now after being healed. The vitamin E I take one gel in the morning.
d. FIBER - yes, you probably read people take lots of Fiber. Here in the US, Metamucil is the most popular but it is orange-flavored and tastes disgusting. So I went with Benefiber, which is a clear, tasteless powder that you can mix with water and I took 3 x per day. In addition, I also took Psyllium Organic Fiber as well that you can buy in capsules. So as you can see, lots of fiber indeed.
e. After my sitz baths, I would then go about following a routine. I first would insert (via an enema organic aloe vera into the area - you do not need to go all the way up the colon, just a tad bit so that the aloe vera can penetrate a bit). Secondly, I would use a topical cream prescribed by the oral surgeon that consisted of Diltiazem/Lidocaine/Prilocaine (2/1.5/1.5%), which in the US has to be ordered from a special pharmacy and gets shipped to your house. At times, it did give me a mild headache but it beats the pain and discomfort of the fissure so I kept applying it with my pinkie after the aloe vera. Thirdly, I used Boudreaux Butt Paste, which is an ointment that has 40% Zinc Oxide (in the UK, I know they have ANUSOL, which is similar but the PREP H gels and pastes in America are not as good so you have to complement with this paste. I laid aside those other ointments as they were only mildly helping). Finally (and this I found to be the most helpful), I used Vitamin E coconut/palm oil suppositories which would not only get more of the ointments into the rectum but also would itself assist with the healing. The Hydrocodone suppositories were really helpful in the beginning phase when pain and discomfort would be present, even after going to the bathroom. But I heard too much usage of those can actually irritate the membrane even further and make healing more difficult so I laid those aside as well.
I am now almost one full week without bleeding and continue to follow the above routine diligently (or another full week, at least) since no blood, discomfort or any other symptoms exist. I will also remind you that this disease is a bit tricky. You think you are recuperated and all it takes is one hard bowel movement to take you back to point zero. Do not lose hope and be patient. I feel much better and more comfortable. Make sure you chew your meals as much as possible: I am now back to eating bread and other things in moderation and find myself sitting there like a ruminating cow but I noticed that even with meats, my feces are fibrous and healthy. And most importantly: stay positive! This disease is detrimental but can be healed with lots of patience and dedication.
Finally, I also found that some patients with anal fissures can also have urinary hesitancy. I continue to experience this, although significantly less and find it indeed to coincide with either times in which I am constipated or when I am about to go to the bathroom. No allopathic doctor could find what was wrong with me but I am finally on the path to full recovery and with a different mindset and appreciation for things. Hopefully this will help you out there who is currently suffering from this disorder.
