Atypical fissure situation - please help!

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Atypical fissure situation - please help!

Postby LostForWords » 14 Jan 2014, 11:50


I think its about time that I make one of these diarie threads so that I can keep track of how things are going while getting some input from the rest of the board members.

To make a long story short I will tell the following. I have had problems on and off (mostly on) with my anus and bowel movements since summer 2012. At first it turned out to be a fissure in the 6 aclock position which I was able to heal without prescribtion creams. I had this for about 4 months I think. This was followed by a couple of months with no symtoms at all but at some point I started to get the itch, minor pain during bowel movements and burning right after BMs which was greatly reduced with sitz baths. Not half as bad as having a fissure but still enough to send me back to my GP.
He diden´t find any fissure but was able to see that the anal lining was red and irritated and that one of my veins was somewhat enlarged but he said that it wasen´t a hemorrhoid.

I was send home with a steroid creme (one of the strong ones) which was combined with some anti fungal/bacteria drug.
I knew that this could thin the skin but went for it anyway as I was fissure free at the time. I used it 8 days, 2 times a day. The itch and burning went away after 2 days or so and I had some swelling which was significantly reduced. I had this swelling for so long that I diden´t even know that something was wrong with it as I haven´t noticed that it was developing so must have been over a long period of time. After stopping the cremes it only took a few days and I was back to the same as before the cremes.

A few weeks went on with no improvement. At some point I ran into some serious constipation. I still went everyday but it was like I was having some kind of obstruction. I diden´t pass ANY gas for like a week or so and my stools were very hard and dry so I had to strain a lot to get it out. After a week or so it cleared up but I was left with a very tight anus and had to keep straining a lot even with soft stools.

I went to the GP again and got a digital rectal examination + the standard fissure check (visual while spreading the skin). This was extremely painfull. My GP said that he diden´t find any hemorrhoids and no bleeding or mucous on the glove. I did however have 4-5 anal fissures!
He wanted me to try the steroid creme again but I refused. Instead I asked for Diltiazem, which I got and have been using for a little more than 3 weeks now and it seems to be doing nothing for me.

As mentioned in the titel, I think that my fissure situation is rather atypical and here is why:

On the positive side:

I have no bleeding what so ever.

I have only minor fissure related pain while having a BM and most of the time I have no fissure pain while having a BM.

I don´t have pain after bowel movements other than some minor sting pain from time to time, not everyday at all. This is very wierd to me as I do have some severe spasm. At least I think its a spasm. My anus is very tight all the time so I can feel that it feels different than it should but its not a pain per see.

On the negative side:

I have abdominal pain 9/10 days and have had this since the constipation mentioned above. My GP seems to think that this is due to the anal fissures which I find doubtful. I think that I might have some kind of IBD or at the very least IBS. I know that I should get a colonoscopy but I just can´t make my self go for it due to severe anxiety. I mean, I almost can´t go to my GP anymore, how the hell am I going to make it through this procedure, I´d rather die.

I have to strain a lot while having a bowel movement, even with picture perfect soft stools. A lot of times it happens that Im able to get a few cm of stools out and then my anus just shut tight again while having the freaking BM! So of course, I will have to strain even more to force it open once more. I have tried to apply Diltiazem a few hours before having a BM and I have tried to use heat before having a BM and it makes no difference what so ever. The straining is by far the worst of my fissure problems right now as my pulse gets sky high, I get dizzy and sometimes it even hurts my intestines! The anxiety before and during + the depression afterwards combined with OCD research has completely taken over my life even though Im not in constant pain in the anal area as some of you are. I have the abdominal pain seveal times during the day instead.

Not one but multiple fissures (4-5)

I get small tears in the skin around the anus from time to time for apparently no reason. These will heal in a matter of a few days only to occur again, sometimes in the same place and sometimes in a new place.

I have a lump right under the surface of my anal skin. I would think that this was an external hemorrhoid but my GP has not mentioned anything about this. I did ask him if it might be an abscess but he said that it wasen´t but probably just some swelling due to the anal fissures. I think this might be part of the reason why I have to strain but on the other hand, I did have this even before this straining hell began.

Anyone else had symptoms like this? Any suggestions to what I might do about it? Im already doing the following:

Probiotics 2 x a day
L-glutamine once a day
Multivitamin once a day (100 mg vitamin E)
Fishoils once a day
Magnesium glycinate once a day + magnesium oxid several times a day. A total of 750 mg oxid and 200 mg glycinate.
A shot of flax seed oil + olive oil once a day
One table spoon of cocunut oil once a day
Sitz bath after every BM which is 2 times a day most of the time
Sitting on heat pad at low temperature several times a day, especially before and after BMs.
Movicol/miralax 2 x 4 g a day.
One walk for 30-45 mins a day
Diltiazem creme 2 times a day
I do a full squat right on the toilet seat and most of the time I support the area with my hand as mentioned on this forum
I drink 2-3 liters of water everyday - no coffee at all and only a very small amount of alcohol from time to time.
No gluten and only one portion of low fat yoghurt a day as the only dairy product.
Red meat only in small portions (max 100 g) and only 1-2 times a week.
Prelubrication with cocunut oil.
I have stopped smoking in order to improve bloodflow and reduce inflamation among other things.

Other than this I try to get some exercise other than walking but its hard due to depression. I used to use my indoor exercise bike but Im afraid to use it now.
I try to do yoga but once again I find it hard to stick with it due to depression.

I did have a package on its way with some digestion enzymes, chelated zinc + carnosine, Rutin, bioflavonoids from citrus fruit, Magnesium citrate, trace minerals and some vitamin c ascorbate but it have been lost by the postal service so I will probably have to wait a long time (once again) before I receive it.

Other than this Im considering trying the following:

Wheatgrass - either topical, orally or both in combination
L-Arginine - either topical, orally or both in combination
Nitro creme - in case this will do a better job than the Diltiazem.
Anal dilation at home - don´t think I can go through with this but on the other hand I will prefer this to LIS or botox anyday as I can do it in the "confort" of my own home.

As you can see Im running out of options and the straining has to be stopped or else it will only be a matter of time before I have to deal with anal prolaps and hemorrhoids too. The abdominal pain also have to stop as it is very painfull and sometimes wakes me up from sleeping several times. The spasm/contraction also has to stop or else the fissures won´t heal. Oh and the constipation that comes out of nowhere also has to stop or else I will get retears everytime I heal (if I ever achieve this that is).

Any advice will be greatly appreciated.
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Re: Atypical fissure situation - please help!

Postby LostForWords » 16 Jan 2014, 14:47

I was hoping someone had some advice in which I could try, still hoping! :)

I will make an update now as I need some advice on the latest development in my situation.
Today I woke up 6 am with severe abdominal pain. This has happen a lot lately. It went on for 6 hours but got less severe as time went on. The wierd thing is that my morning BM was missing. I don´t know why but I never got the urge to go. I knew that this could be a bad sign that some constipation was going on and well, it was. Time went on and halfways through the day I was able to get the urge through eating a high fat meal. As soon as the stools reached my rectum I could feel that this was bad and it really was. I had to strain more than ever before in my life and the pain was pretty severe, I had trouble breating and felt like I was going to faint. It took me a long time to get it over with and almost nothing came out! So all the straining, pain and retearing was for nothing, absolutly nothing at all.
At the time I was done and sitting in my sitz-bath I realised that I probably should have waited with the BM untill I could get my hand on some glycerol suppositories. I have some now and I will try them tomorrow morning if Im able to stick them up there that is.

The wierd thing is that after the BM I felt fine down there. No pain, no burn, no itch and no increased contraction. On the other hand, I don´t know if its even possible for my anus to contract more than it already is.

I´m really starting to consider going through the colonoscopy procedure as I think theres a pretty good chance that my fissure and on/off constipation is due to some underlying illness. I have been having narrow stools also for the past 4 weeks or so but this could also be due to my anus being in a contracted state all of the time.

I don´t really know what to do anymore. I mean, I do all the right things, with the exception of lacking some exercise and being depressed, stressed out and anxious everyday but I don´t think that I will be able to do anything about this untill my psychical problems get better.

ANY advice will be more than welcome!
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Re: Atypical fissure situation - please help!

Postby owmybum » 17 Jan 2014, 04:27

Hi lostforwords,

I'm so sorry to read of all the troubles you have going on.... It must be really awful for you. I can appreciate all the anxiety you must be experiencing... It truley is an awful affliction to have.

As for advice..... I really can't add much to what you are already doing. You seem to be doing just about everything right.
I am wondering if all your abdominal pain is coming from all the straining you are doing to have a bm?? You must be over using your muscles, and in turn, they will be aching like crazy??

My only other thought is to try something like liquid paraffin ..... A couple of board users have used this, and from what I read, it helps things 'slip' out. I think scientist might be one of them??

I'm sorry I haven't been able to help you more with this..... It really is a difficult one. I would ultimately suggest seeing a proper crs and maybe getting some physio therapy to get all the muscles working properly down there again. In the mean time try your hardest not to strain. If its not coming.. Get up... Walk around and try again when you get the urge again.

fissure after hem banding and tag removal feb 11
Pelvic floor therapy
Botox June 13
Internal flap July 14
EUA and polyps removed Nov 14
Diagnosed with neuropathy Jan 15
Diagnosed with HS EDS type 3 (causes poor wound healing )
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Re: Atypical fissure situation - please help!

Postby PompeyBloo » 17 Jan 2014, 13:15

I'm one of the board users OMB refers to as an occasional user of liquid paraffin (mineral oil in the US). I use it in just such situations as you describe and, yes, it does lubricate the passage so that things slip out - relatively speaking!
Hope this helps
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Re: Atypical fissure situation - please help!

Postby Bettyblue » 17 Jan 2014, 13:27

Lostforwords, I was like you. No pain, no bleeding only spams after BMs and the sensation of having a tennis ball in my anus and feeling it very tight. For what my CRS told me it is very common behavior of a cronic fissure. Because the anal sphincter contracts trying to protect the anus from the wound you have. The problem that you have to expel your BMs could be that you developed what is called an "hypertonic anal sphincter " and it can happen due to the multiples AF that you have right now. Now beard in mind that I am not a doctor. That's way I think the best you can do is look for a doctor who is specialized in that area like a CRS. About your stomach pain. I will tell you what happened to me. I was like you taking like several different kind of oils fish oil, coconut oil, olive oil, you name it. At some point I developed this horrible stomach pains, and I discovered that was the combination of all these oils I was taking and that they together were too heavy for my stomach. I cut almost all of them and my pains disappeared. I don't know if it is your case, but maybe you can try. What I can not understand is that you are having hard bowels movements taking Miralax twice a day. Because Miralax is supposed to pull water into your stool to make your BMs soft. That's way I still think that the best option for you in this moments is look for a CRS. I hope I was able to help you, at least a little. Take care.
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Re: Atypical fissure situation - please help!

Postby Scientist2516 » 17 Jan 2014, 13:50

Hi Lost for words, Owmybum is right, I do use a mineral oil. Kondremul emulsion oil really softens my stools and helps me pass them easily. I don't use it all the time, but when I have reason to be worried, I take a tablespoon, sometimes two, in the morning and evening. You can order it through your pharmacy, or from Amazon. You can get regular mineral oil from any pharmacy (in the USA), but I like kondremul because apparently it mixes very well with the stool, because of being an emulsion.
Good luck!
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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