THE TL:DR:
This is my personal account of struggling with brutal anal fissures, and eventually recovering. Before the fissures, I had always been a healthy person: diet, exercise, all that. I was proud of being self-sufficient, and wary of the limits of modern medicine. When the fissures appeared, I was determined to cure myself, and tried nearly every nonsurgical treatment, medical and nonmedical. None of it worked. I considered suicide. Finally I relented and had LIS surgery. After a difficult recovery, I've been well for 18 months. In retrospect I have some practical tips.
BEYOND THE TL;DR
A little summary like that can't express the extremes of my experience, like the pain of ripping my sphincter apart on every bowel movement, and the dread of knowing it would happen again on the next one, and living like that for months on end. As a consequence of pain I eventually OD'd on alcohol and THC and got to ride in an ambulance. Fun times!
A summary also can't express the absurdities of trying to fix problems with one’s asshole. I tried everything, including prancing around with electrodes attached strategically to different parts of my anus. No luck.
And it can't express the devastation my chronic pain brought to my loved ones. In my nadir it helped to think of them as well as me. Read on to see how.
CHECKLIST
On a sheet of health "screening questions," I'm a very healthy person. I eat vegetables (check), get regular vigorous exercise (check), have a supportive and loving family (check), and an occupation I find meaningful (check).
Also important, given I'm a resident of the USA: I am one of the few here who is lucky enough to have good health insurance. In the story that follows the expense of medical care was never a significant issue for me. (Obtaining care was an issue, you’ll see.)
WHITE COATS AND FLAKES
It's also important to my story that I'm a scientist. That means I have a healthy skepticism of modern "white coat" medicine. I know statistics and read journal articles. It turns out a lot of modern medical practice is based on habits and convention. It's improving with the emphasis on "evidence-based" care, but doctors aren’t always aware of the role of tradition in their advice.
Of the medical issues in my life (there have been too many), white coat medicine has fixed most of them. But sometimes I’ve discovered there’s no evidence behind the standard advice – and occasionally it could even hurt you. At times I’ve had more success with DIY solutions inspired by my yoga teacher or web forums.
The key point is that before my fissure, I was used to DIY-ing -- looking for evidence, and sometimes getting results from unconventional ideas. So what kind of solution was the fissure going to need? White coat or DIY?
JOURNAL
Month 0: After getting diarrhea on a foreign trip, I had pain and blood on pooping. Nothing awful yet. Primary care provider (PCP) #1 diagnosed it as hemorrhoids and suggested fiber and preparation H.
Month 1: Condition worse. I was pretty sure I had a fissure. PCP #2 inserted an anuscope to see what was going on. Fissure confirmed. Was prescribed nitroglycerin/diltiazem cream to promote blood flow and healing in affected area. This is a standard “medical” (that is, nonsurgical) approach.
(Note: the anuscope insertion was insanely painful, and a preview of things to come. It was also probably unnecessary. If you suspect you have a fissure, an experienced person such as a colorectal surgeon can sometimes confirm it with a 5-second digital exam, which is way less painful.)
Month 2: At this point pain was increasing. I was getting scared because I understood what was happening: every time I had a BM, my fissure was getting ripped apart again, which set the healing process back. It wasn't clear how anyone could truly heal from such a thing. I had to eat!
But I was still confident. I had had a fissure years before (after a strong course of antibiotics) and it had healed on its own. Plus, my success with unconventional health and fitness made me believe I had the power to address bodily issues myself. I doubled down on my already-healthy lifestyle, used the special cream as directed, and waited for relief.
URGENT = 6+ WEEKS
Month 3: Something was clearly wrong. The pain with each bowel movement was now horrible. Defecating was like pooping shredded glass, my sphincter had a horrible violent spasm at the end of the process, and then I would basically be disabled by pain (level 9), laying in my bed, for 30 minutes to 2 hours afterwards, incapable of even speaking.
Naturally I started dreading the next BM, and doing whatever I could to prevent it. The easiest way was to eat less. I remember eating peanut butter, mayonnaise maybe, and of course fiber pills.
I also started drinking more,--up from maybe 2 glasses of wine per week to 6 or 7.
I have no idea how I held down my job, but "work from home" arrangements helped. I do recall that work could be a positive at times – if the pain wasn’t too bad, then concentrating on a project could make me forget it for a while.
PCP #2 took me seriously and referred me to a gastro specialist. Only catch: the specialist's first available appointment was 6 months off.
"But I'm in unbearable pain now," I explained to the scheduler.
"Get your doctor to request an urgent appointment."
I did, and their first "urgent" appointment was a minimum of 6 weeks off -- and that was just a phone call. There was way more demand than there were providers, they explained. I called gastroenterologists around town. Same story.
KITCHEN SINK
By month 4, I was thoroughly humiliated. I had not cured myself, and had admitted I needed help -- but the system wasn't helping me.
While I waited for the phone appointment, I convinced myself I simply hadn't tried hard enough at self-help. I put my self repair project into high gear.
I broke down in tears in front of my wife and begged for her help. (Previously I had variously trivialized and hidden the problem.)
I continued the nitro/diltiazem cream.
I took daily baths which got longer and longer and were some of the only times I could comfortably talk.
I did 10 weeks of pelvic floor physical therapy.
I did pelvic floor yoga 30-60 minutes per day.
I did pelvic floor biofeedback. This is where the PT attached electrodes to my asshole, and we watched a screen to test muscle response to various scenarios. Fun for the scientist in me! but not helpful in the end.
I watched endless youtubes, where people reported they had cured their own fissures with bananas, aloe, starvation, meditation, etc.
I did weekly talk therapy for the pain. This helped me not feel alone and misunderstood.
I increased my use of "self-medication"... adding THC vape pen to my nightly wine.
And finally, I took an entire month off of work, to focus only on relaxing, living right, and healing. I told my employer I had chronic pain, and got PCP #2 to approve me for FMLA leave, which wouldn't pay me, but meant I couldn't be fired for my condition.
HEMORRHOIDS, DIVORCE, SUICIDE
I decided to end my silence and to talk about my problem to anyone who inquired. What did I have to lose? I thought maybe someone would have some useful ideas.
While I got sympathy, I discovered that virtually no one understood the depths of pain I was experiencing, or the months of effort I had put into therapies. Typical comments:
"Just eat a lot of fiber, that's what helps me!"
"I'd stick some aloe up there."
"Oh yeah, my brother had horrible hemorrhoids. Sorry to hear you do too."
For me these conversations were really alienating. Clearly, many well-meaning people, maybe even people who had once had a fissure, were not aware of how bad this condition could get. It didn't help that it was in your butt, an area that was variously trivialized, sexualized, or joked about.
But one conversation I think changed my life.
There was a new guy at my gym (I was still exercising a bit) and when we got to talking I learned he had suffered from a really serious chronic pain condition for >5 years, and been nearly immobilized for about 3. His wife had been his caretaker.
He was the one person who seemed to understand my hours of pain. I was happy to hear he had just gotten an operation and could move again. He was getting back in shape! I felt like there was hope for me.
"I'm so glad to hear you're better," I exclaimed. "Bet your wife is too!"
"Oh, we're divorced now," he clarified.
She had wearied of taking care of him and split.
I got chills at this plot twist -- but not for the reason you might think. I didn’t think she had betrayed him. I immediately understood that woman's needs, and agreed her exit was logical.
I thought about my own wife and child. They tried to hide it, but they were worried, no, really worried, about me. They tried to take care of things that would normally be my job. My son the A student was missing assignments.
Did they know how bad it was? If they did, how long could they live with it? It would be awful to live with someone in misery -- harder if you loved them.
In any case they didn't deserve to experience any of this.
I was not really aware at the time of how much they were doing for me. My wife was on the phone with medical offices and schedulers, trying to get me any kind of care that would help. There was none. There was too much demand. She had to get her own talk therapist.
But I do remember when my wife asked me if I was thinking of killing myself.
"Yeah, I've thought about it," I said. It was a relief to discuss it frankly. "It's a logical solution. But I haven't had the call with the gastro guy. I'm not pulling the trigger at this point."
She knew how bad it was. I tried to smile like killing myself was a farfetched notion -- but it wasn't. I had thought about it a thousand times.
TEMPTATION AND DISASTER
A lot of months 7-8 are utterly incoherent in my memory. But I know it was full of confusion and reversals.
Somehow I was back at work. I have no idea how I was meeting deadlines and doing zoom calls, between 2-hour baths and additional hours in the pain bed after BM's, but I was on the FMLA list, so maybe my colleagues had low expectations.
The much-delayed call with the gastroenterologist was about 10 minutes (absurd, after months of waiting), and accomplished one thing: he referred me to a colorectal surgeon (CRS).
The CRS recommended LIS surgery and scheduled me in the first available spot, about 6 weeks out.
Then something weird happened. I started getting better. I kept a "poo and pain journal" every day and the evidence was pretty clear. Pain during BMs went from a 9 to a 7, 6, or 5. The pelvic floor PT noticed some reduced tension in my sphincter muscles. I was having regular size BMs and eating a little more.
Finally, I thought, all my clean living had paid off! I'm doing it!
I talked to my spouse about canceling the surgery.
"I'm getting better, the PT is finally working. And unnecessary surgery is always a bad idea," I said reasonably. "Why risk getting cut open when you don't have to?"
Her response was vivid.
"That sounds totally wrong," my wife cried. "You’ve only gotten a little better. This thing has become your entire life! What if it comes back and then you need to start again, and wait another 6 months? You need help now."
She was beyond distressed. The strength of it shocked me. Previously our big discussions about money and health had looked like stock photos in an insurance ad: two adults, calmly discussing some papers over a clean kitchen table with a vase of flowers on it. It wasn't always a joy, but it was civil.
I remembered the divorced guy at the gym. A lonely vista opened up in my mind: life without my family.
I didn't fear they would leave me. Instead I saw that I was already leaving them. Lost in my pain world, concerned only with getting through another day, I wasn't the same person they had known before. Or I had known before. I had no idea who I was.
They needed me back. I needed me back. It wasn’t time to take a chance on one of my pet theories.
"Well, ok, I won't call and cancel now," I backed off. "I still have a couple of weeks to decide."
SPEAKING IN TONGUES
It turned out my wife was right. A week later my BMs were more screwed up than ever. I could only have them in weird positions, like lying on my stomach, because the muscles and nerves were so fried and confused. The pain journal showed 9s across the board. I only had a couple of clear hours a day when I wasn't in pain or in shock from having been in pain.
Now I was just counting days to the surgery. I ate almost nothing, and drank wine and smoked my THC vape pen to get through the evening until I fell asleep.
Until one evening I counted vape hits wrong (or something) and collapsed multiple times walking across the yard. I came to consciousness with my son, a trained lifeguard for the city pool, checking me for heart issues, stroke, more, and speaking in his emergency-responder voice.
"I'm going to put my hands on your neck now, and tell me--"
Is that his official voice, I thought? Shit, I must be fucked up. Soon I was in an ambulance. I spent the night in the emergency room literally speaking in tongues -- nonsense syllables, names and numbers no one understood. I had a notion I might be dying. In my occasional moments of clarity I saw my wife and son there. I told them I loved them. Or at least I think I did. I hope I did.
"Is he always like this?" the ER doc asked my wife, baffled by my presentation. With no idea of what to do, he reverted to suggesting we were wasting his time.
No, he was not “always like this,” my wife clarified. Why did he think we had come to the ER? That person on the bed ranting was a regular guy in extreme pain. He had probably OD’d on self-administered pain killers. Because every time he took a shit he ripped his sphincter muscles apart. Again.
OPERATION AND AFTERMATH
The evidence is that, for many people with chronic fissures, LIS works. According to one review I read (https://linkinghub.elsevier.com/retriev ... 6021011788), the LIS operation has excellent odds of healing fissures (judged at 6 weeks post-op) compared to other approaches: 30 times more likely to show healing than placebo, 10 times more likely than "medical treatments" like diltiazem, and 5 times more likely than botox.
So, if I was going to do a white coat solution, LIS looked like the thing.
I had the LIS operation 8 months after my "fissure" started, and the surgeon discovered -- bonus! -- it was actually 2 fissures, posterior and anterior. I also had multiple sentinel piles. The surgeon sliced, diced, and cauterized, and I woke up feeling fine.
But that was just the anesthetic -- it hadn't worn off yet.
I'm not going to go into detail about my recovery, because I've already written too much. In truth the recovery is its own long story. I will say two things.
First, recovery was hard. I had some complications (constipation, and an infection). For a month I learned even more about pain. In addition, a small fistula developed (my CRS explained this was sometimes a side effect of the operation), and -- though it was not very painful -- eventually I had to have that removed.
But second, I never once regretted the LIS, even in the worst moments of the recovery, because I had resolved that I was never going back to the life I had with the fissures. I wanted to stop being a pain zombie. I had tried a textbook's worth of treatments, and the only direction left was to heal from this operation.
I did heal. By 6 or 8 weeks post-op pain was down to 3’s and 2’s, though still some spots and streaks of blood on my stool. That blood was hard to look at -- it made me panic the fissures were coming back. I’d go back into that mode of dread. While the blood continued a long time, the fissures never came back.
At 5 months after the operation, I stopped making entries in my poo & pain journal. There was no blood and no pain. I was living a normal life.
I've had 18 good months since that time. My digestion and sphincter function flawlessly.
Recovering in spirit, coming back from being a zombie, has been slower, but it's happening. This post -- acknowledging what I went through -- is part of it. I hope it's helped you.
PRACTICAL ADVICE
If you think you have a fissure, get someone experienced to examine you with a digital examination. The automatic assumption that it’s hemorrhoids may be wrong.
Don't be too proud to talk about your condition and to ask for help -- from your family, your doctors, your boss, even strangers.
Get a talk therapist that knows about chronic pain. That helped me.
And consider the LIS surgery if it fits your condition. Like any surgery, it's not 100% guaranteed to work, but statistically it has a good track record. It helped me.
Cheers! (I'm back to a very reasonable 2 glasses of wine per week. Threw out the vape pen.)
