1) MIRALAX- or generic propylene glycol. This is an osmotic laxative and works by drawing water into the colon to soften stool. It's safe even long term (I've been using for over 3 years) and doctors use it for constipated children. It's non habit forming, non stimulating, and almost none is absorbed into the blood, or processed by the liver (don't believe the scare sites online about propylene glycol, it is not metabolized or broken down by the body and passes through pretty much unmodified). Take 1 full cap of this daily to start, move up to twice daily after a few days if necessary. Aim for a soft served ice cream consistency for your stool. *this can allow you to broaden your diet and eat whatever you would like while you have a fissure (no nuts or seeds though).
2) Magnesium Citrate- This is another stool softener that is very safe and very effective (most people are actually deficient in magnesium). This works but pulling water into the small intestine. I recommend taking 400mg daily in the evening, as it also helps promote deep sleep.
3) SQUAT- No more sitting on the toilet conventionally, as this puts a kink in your rectum and makes full elimination more difficult. "Squatty potty" makes a small stool that helps to elevate your feet into a squatting position while on the toilet. If you're nimble enough, just place your feet on the toilet rim and squat over the toilet bowl. *Bonus tip: Place your hands on the toilet seat behind your feet, and lean slightly back when in this position almost like your reclining in a chair. This will take some of the stools pressure off the posterior part of the Anus (where most people have a fissure) and put more pressure on the anterior which is uncompromised (this is similar to standing while going).
4) 2% Diltiazem- This is a calcium channel blocker that comes as a cream and works topically by pulling blood into the anal sphincter and relaxing it. This helps stop the spasms that occur after going to the bathroom. It is great for overall pain control and helps with the pain from walking by relaxing everything. Apply first thing in the morning before a bowel movement, and reapply after, at least twice daily. Use as long as possible, it takes over a year of healed time before the Anus recovers 50-60% of its pre fissure strength back. Using this daily 2-3 times for 6 months or more will help the area heal faster.
5) NO supplemental fiber- This is a big one for initially healing a deep fissure, and I may get some flak, but hear me out... This goes against what every doctor will tell you, and for good reason. You will need lots of fiber later on, but not initially when healing the fissure. The reason is this... Fiber supplements like psyllium bulk and soften the stool. This bulking is counter productive because you're trying to heal a deep cut. Your stool is constantly stretching this area and tearing it open again from the bottom, even soft stool will do this when it's bulky. The Miralax and magnesium will keep the stool very soft, so it's really a matter of keeping the diameter of the stool narrower for a few weeks. Try to get as much fiber as you can through your diet, this can be anything from cereals, whole grains, fruits, beans, vegetables, etc. Fiber from food doesn't seem to bulk the stool as much as psyllium husk supplements do (at least in my experience).
6) Vaseline- This is gross but will help immensely, especially if your stool is on the hard or bulky side or has a dry tip. Right before you go, put a little Vaseline on the end of your little finger and get it up in there. Squat over a small mirror as it will help prevent injury. This will help the stool slide out with much less friction, pain, or irratation. This step is a life saver if you're constipated.
7) Soft wet toilet paper- find the softest and thickest toilet paper you can and get it wet with warm water to wipe. Most baby wipes are horrible for your septic system (even ones that claim to be Flush able) and will not deteriorate much over time, leading to expensive repairs in the future.
Lifestyle habits- drink as much water as you can, this will make sure your body has what it needs to pull into the colon and keep stool soft. Take ibuprofen as needed for pain, it's also a good anti inflammatory. No codeine, as its constipating. Be active, as this helps keep your digestive system regular. The steps above will help ease the pain enough for you to get a walk in daily. Change your diet to incorporate fiber rich foods like whole grains, fruits, vegetables, etc. We all know what we SHOULD be eating to be healthy. Avoid fried foods, red meats, and anything that won't break down well like nuts, seeds, etc. Chew your food extra thoroughly, especially meat, before swallowing to aid digestion. Consider taking a probiotic daily as this can help keep your entire digestive system healthy and moving things along. -------LONG TERM-------
Try to lower your dose of Miralax gradually after a month or so of the fissure healing (no blood, little pain) to 1 cap a day for 5 days, then 3/4 cap for 5 days, then 1/2 cap, etc. The goal is to be off of it completely at some point. You may find you need a 1/2 cap or more for many months and that's perfectly fine, it's non habit forming for the colon. You're going to want to start introducing supplemental fiber at this point, because it's very difficult to hit the daily intake of fiber with food alone, every day. This will also help bulk your stool now that you have some strength down there, and help to spread scar tissue out and gain some elasticity back. I like organic psyllium husk (NOW organic whole psyllium husks is great). I would recommend 1 tbsp morning and night long term, use as much as you need but introduce fiber very slowly. Start with 1 tbsp a day for a week or so and then slowly move to 2 a day. You don't want to bulk the stool too quickly or you will tear the fissure open again. I would highly recommend taking the 400mg of magnesium daily as well, as there's no down side to this, and it will always help to soften your stool (the body does not build tolerance). Stick with the diltiazem for as long as possible, I would even use it 6 months after the fissure has healed because it's helping to increase blood flow below the surface and heal you faster.
----Some other suggestions of things that may help:
*Cut out caffeine completely (for some it's important and that's fine, it's not a deal breaker for anyone to heal).
*Enemas if you're severely constipated
*organic Virgin coconut oil is a great Topical with antiseptic properties, can be eaten daily also to help lubricate your digestive system
*Topical zinc creams can be helpful and will promote faster wound healing
*Oral zinc supplement (orotate/picolinate are most bioavailable) is a very important mineral in the body for healing injuries in the skin.
*warm sitz baths after bowel movements to ease muscle spams.
There are countless other Topical treatments people will tout online and try to sell you, honestly I haven't tried many of them so I can't say they won't work, but I caution you that MOST will not do much. A deep fissure is not going to be miraculously healed by an herbal cream or extract. Thankfully this area of the body heals quickly, but this is a physiological problem that needs to be addressed through long term lifestyle changes. Increasing fiber in your diet, and cutting out constipating foods...softening the consistency of your stool, and removing strain by changing your posture... relaxing the sphincter spasms and increasing blood flow into the area...and keeping yourself regular with excessive and fiber supplements is what will help you the most.
THAT IS IT! I will go as far as to promise each and every one of you that this will drastically help you with your fissure. With this routine I've healed at least 15 fissures, many extremely deep, typically in less than 2 weeks. The key with any fissure is persistence, and patience. Unfortunately mine come back when I have a night of drinking or forget to take fiber, magnesium, etc. But right now I'm making a conscious long term effort to stick with my steps because they really do work. I've addressed universal reasons why our fissures don't heal, not offered you some random cure that only works for my body. I know it can feel like a curse dealing with this problem, and I want you to know that there is hope for you (without surgery) no matter how bad your fissure is. It just takes time and commitment to these types of life changes. Keep on keeping on!
