Hi everyone,
I'm a guy in my mid 20s and I've been suffering from an AF on and off for about two years now. Initially, I had internal haemorrhoids as well (which have come back once) but after being treated with elastic bands, they have gone away. I'm not sure what initially caused it (can't remember). I also have external skin tags (hard to count how many) which get quite large during BM.
I've been suffering with this AF for a while now. Originally, I didn't do much research on it and hoped it would go away. I had a terrible diet and didn't pay much attention to eating enough fiber and avoiding bad foods (i.e. fast food). I wish I had caught this much sooner. My AF has gone away two or three times, but has comeback from when I've deviated from my normal lifestyle (usually on vacation where I probably eat too much and not enough fiber).
Since then, I've been better with what I eat. I rarely have hard stools but they could probably be softer at times. I use metamucil whenever I feel I've eaten bad foods (i.e. too much pizza or meat) but I don't use it daily. I try to eat a lot of fruits and veggies. I do drink coffee (1 cup in the morning) and alcohol (wine mostly). I also take Nitro 0.2% regularly (morning and night).
I do get pain after BMs. I try to time my BMs for every other night so that I can sleep through most of the pain. The pain isn't immediate but shows up a few hours later. Unfortunately, I sit for long periods of time at work (10+ hours/day) so this can be painful somedays. However, judging by some peoples posts on here, the pain isn't too bad. I've read posts on here from people with daily or more than once a day BM but I've always thought that less is more (i.e. the less BM strain you can place on the AF, the better the chance to heal?). The last time my AF was "healed" for awhile was when I had a week vacation and followed a liquid diet from these forums, delaying my BM for almost a week. This worked very well, the downside being I had NO energy that week. It worked out since I was on vacation but couldn't imagine doing that during a work week.
My BIGGEST annoyance however is the bleeding. Though it occasionally bleeds during BM, it almost always (95% of the time) bleeds a little bit the next day. About 5% of the time, it bleeds a little bit 2+ days since my last BM for no reason I can figure out. And then there are times where it bleeds a LOT. There's been a number of embarrassing moments when I've felt the bottom of pants only to notice I've bled all the way through. The times it bleeds a lot, there's usually a symptom (either itching, pain on the AF, or pain on the inside of my thighs). My solution to this is that the day after a BM, I use a piece of TP folded over twice and place it on my anus holding it between my cheeks (may sound difficult to do but has become second nature). That way when it bleeds, it usually just bleeds onto the tissue which I can changes every few hours. Has anyone else had this symptom? Does any have solutions or remedies for this problem? I've read a bit around the forums and haven't seen anyone else discussing this.
Also, any overall advice for me would be great too. My doctor is a specialist in these types of problems, but he's of the mindset that Nitro 0.2% almost always works and surgery/botox is only for extreme cases. Should I be considering a more serious treatment? Although I am weary of the risks involved, I would love to not suffer from an AF for the rest of my life! The only surgery he has mentioned is to cut off the skintags but only for appearance/easier to clean purposes.
Thanks for reading this thread. It's nice to have an anonymous place to share embarrassing stories, power of the internet.

Hey Tempest,
Sorry to hear you are suffering. I had LIS 8 months ago for my fissure. I never bled except with bm's here and there.
My CRS never said to me that surgery was for extreme cases. Surgery is for Chronic fissures, which if you research is over 6 weeks to the best of my knowledge.
There's really is no need to suffer like this and If it were me knowing what I know now, having a really good experience with LIS and a well qualified CRS, I would get a second opinion. It's my opinion, but I believe a qualified( good) CRS is willing to give this surgery to anyone with a chronic fissure who doesn't have some other underlying disease or condition that would keep them from healing. I seriously don't get it?!
I live in a rinky dink, small town and talked to just a few people about my fissure in my family. I know two people besides myself who had this surgery. We all had great outcomes and healed our fissures after this surgery.
There is no need to suffer for the rest of your life. I had my skin tag removed with my LIS because it was as painful as my fissure and I wanted it gone. I can't understand why a doctor would cut a tag off because of appearance but won't do LIS because of pain?!!
Do keep up with your diet, water, etc and try to manage your pain. Maybe you could try something softer instead of the tp to press against the anus. Cotton balls or the squares may be softer. So sorry and hope you get some better options.

pss... Nitro and all the other ointments don't always work. Just about everyone on this board who had LIS used one of the ointments such as nitro, diltiazem, etc before surgery.
Research the statistics on chronic fissures and the ointments, print it out for the doctor,Lol
Seriously, I would get a second opinion.
:roll:

Thanks for the advice Dawn! I'll start researching into LIS

I agree with Dawn, LIS is for chronic fissures, not just extreme cases, and I would run a mile from any surgeon who gave me excuses, because they probably haven't got the experience needed.
I'm a bit worried that you would bleed for no reason. Bleeding following a BM is "normal" (for us with fissures that is!) but bleeding with no BM could signal something else. That has happened to me both times with my fistulas, but never with the fissure.

Hey Tempest- I'm not around as much anymore but try to check in from time to time. I agree completely and I've always seen the criteria of LIS being for chronic fissures (ie 6 or more weeks). Of course, I think you'll find that many and probably most of us on here waited a lot longer than that, trying all sorts of things, hoping and praying we didn't need to have surgery. Anyway- that's what I did. Certainly the surgery is not something anyone would do lightly, but I firmly believe that nothing else would have made my fissure finally heal. It does take time to recover from the surgery and a little luck, as either my CRS or someone on here said, but I would do it again in a heartbeat and much sooner than I did. You are so young and this is such a drain and has such an impact on your life. My biggest regret is that I did not have the LIS sooner. Part of that was me being scared and part was that my fissure would come and go and "tease" me and I would think it was better and get afraid of going backwards. Plus for some reason I never had the spasms people talk about so much- more the pooping razor blades and blood thing and some burning. I had Botox in early Nov. and then again in early Jan and finally had LIS in mid February. The fissure healed pretty quickly ( by my 6 week checkin for sure) but the skin tag I had removed has left an area of scar tissue that is very sensitive and has taken more time to not be an annoyance. Given what you are experiencing right now, you would probably not even think of it much at all. However, here I am at about 5 months post-op and lately I feel like I will be "normal" completely soon. I want to emphasize that from the time of surgery I didn't really have the fissure pain anymore- just the soreness pain from the incision and rarely if ever any bleeding again. Just outside irritation and healing that needed to happen.
A friend said to me back in January when I was considering is I should cancel the surgery because I was "better" and only had the pain and bleeding 3-4 days each week that I should go ahead and get the healing process started. Somehow I realized then I was putting off the inevitable. That was really true I think and confirmed by my CRS- after my surgery he told my husband that my internal muscle was extremely tight and very spastic. So I'm not sure how I wasn't experiencing the spasms in as painful a way as many do, but thank heavens, right?
You've suffered long enough- you need to go ahead now.
Bambi

Bambi,
Miss seeing you on here, but drifting away is a good sign:) So happy to see you are doing well!!

hi dawn,
I live in California and am considering surgery. I have an anal fissure and skin tag now for about a yr. More than one dr said I could ave a really really small fistula but would have to scope me to see. I know it is extremely important to find the best dr. Could you recommend yours? Thanks I'm just scared of being butchered.

hi cyn,
There are a few boardies on here from California. I'm from Florida. I could pm you with the name of my surgeon if you would like me too.We also have a thread that I can put the link to here with a few names of some of our surgeons. NG another boardie is from California. You may want to ask him about CRS's in that area?!
I'm sure there are MANY good CRS's in California though! This is a very common procedure and we can help you with some good questions to ask your surgeon before surgery. Please feel free to private message me:)
Here's the link with my CRS info.
http://anal-fissure.org/t2938-a-thread-for-doctors-info-region-recommendations#58860

Thank you so much for yourcquick reply:)