I had a huge epiphany about my anal fissure yesterday. My epiphany is that my anal fissures are only about 10% of my butt problems. About 90% of my butt problems are due to a problem in my upper butt crack that is either a pilonidal cyst or pilonidal sinus or pilonidal disease or intergluteal cleft irritation. This pilonidal/intergluteal cleft irritation issue is distinct from my anal fissures.

Three things helped me discover that 90% of my problem is due to pilonidal issues or intergluteal cleft irritation: 1# When I applied the nifedipine ointment with my finger, I tried to find the area of the most pain with my finger. I wanted to apply the most nifedipine ointment at the exact place of the most pain. To my surprise, the area with the most pain was two or three inches above my anus, not the anus itself. 2# I propped up my cell phone on some clothes yesterday, and I got naked from the waist down. Then I video taped my anus. The video resolution was a little bit blurry, but I noticed that the only irritation I could see in the video was at my upper butt crack, not at my anus itself. 3# So I googled "Upper butt crack irritation" and found out about pilonidal cysts/pilonidal sinus/pilonidal disease/intergluteal cleft irritation.

The treatment that I have been doing for my anal fissure consists of two main things: 1# making my poop soft (without it being a loose stool) and 2# relaxing the anal sphincter (nifedipine). Those two things will do nothing to heal my pilonidal/intergluteal cleft issues. I am going to go back to my CRS to get my pilonidal/ intergluteal cleft issue treated.

When I first had butt pain in 2008, I believe that all my butt pain was due to anal fissures, not pilonidal/intergluteal cleft issues. I healed up my anal fissure in 2011 for about a year by eating nothing except green beans for three weeks straight and only drinking water. I don't think that I had pilonidal/intergluteal cleft issues then because I don't think that eating only green beans would heal pilonidal issue/intergluteal cleft. Pilonidal issues/intergluteal cleft is not affected by the poop itself. Pilonidal issues/intergluteal cleft is only peripherally affected by bowel movements due to the wiping.

Then in 2012, the pain in my butt gradually started coming back. And i think that the pain I had in 2012 was probably due to anal fissure, not pilonidal/intergluteal cleft irritation. But at some point between 2012 and October 2022, I developed a pilonidal/intergluteal cleft issue. I think for a long time, I thought that this problem in my upper butt crack was an anal fissure because it was all in my butt, and I had never heard of pilonidal cysts/pilonidal sinus/pilonidal disease or intergluteal cleft irritation. but I found out yesterday, most of my butt problems are not due to anal fissure.

Hi expedite_it - it's great that you have located the source of your pain, and also that you'll visit your CRS soon. Please let us know how you get on.

dmcff wrote:Hi expedite_it - it's great that you have located the source of your pain, and also that you'll visit your CRS soon. Please let us know how you get on.

I have an appointment with my CRS on Monday. I will let you all know how that goes.

I don't know how long I have had this pilonidal cyst or intergluteal cleft irritation. It is amazing to me that it didn't occur to me to check EXACTLY where the pain is coming from and to google upper butt crack pain until about three days ago.

Had you ever heard of pilonidal cysts or intergluteal cleft irritation before I mentioned it?

I had not heard of intergluteal cleft irritation before, though had heard of pilonidal cysts. Perhaps if you use the search facility on this forum you will find some references to these conditions.

dmcff wrote:I had not heard of intergluteal cleft irritation before, though had heard of pilonidal cysts. Perhaps if you use the search facility on this forum you will find some references to these conditions.

I went to the CRS today. The CRS did a rectum exam. CRS said that I don't have a pilonidal cyst. I forgot the exact words the CRS used to describe my issue in my upper butt crack, but it was something to the effect that it was intergluteal cleft irritation. He said that moisture from sweat caused this issue. He recommended I buy calmoseptine at Walgreens, which is a skin barrier. Walgreens didn't have any calmoseptine. So I bought Boudreaux's Butt Paste, which has zinc oxide. I also bought two more bottles of nifedipine. If my anal fissure does not heal all the way in the next three months, I will return to the CRS to seek botox or surgery.