Hello,

Multiple fissures might occur due to Crohn disease. Probably you should repeat at least blood tests to check on very first symptoms.

Another question, do you have spasms after BMs? Or there is only pain during BM.

Hi there,

I didn't know crohns could cause fissures, but I have done the blood test in the past with no signs of it (although I know the test isn't 100% conclusive).

Typically there is only mild to moderate pain during the BM and slight pain and burning for 30 min after. I always take a sitz after every BM, so that may be helping to reduce the pain. I only get the all day pain on large external fissures which happens maybe 2-3 times a year (vs my smaller ones 2-4 times a month).

I don't know if this helps. I got a major fissure in mid 2009. It healed after about 5 months using Diltiazem. However I was still getting pain and couldn't lead a normal life. It transpired that what was happening was my anal muscle tone had increased with the muscle spasms from the major fissure and despite the major fissure having healed, I was now getting minor fissures with most bowel movements. Like you, the stools were soft, but they were large due to fibre in my diet and Movicol (Miralax in the US I think). However, even attempting to get the stools to a smaller volume didn't seem to help. As I'd been in great pain with the major fissure, I'd also developed something of a pain cycle between bottom and brain, in that the kind of minor fissures that wouldn't bother most people, registered as painful to me.

It took me seeing three surgeons to find this out! In the UK, if a fissure has healed, it's not medical orthodoxy to perform the LIS operation, even if the patient is still in pain. However the third CRS I saw (the best of the lot!) said that some people still need it, even so. So I had the LIS operation and it sorted me out. It took a few months for the pain cycle to downgrade to normal sensation - but everything's normal now. I can even pass large, wide stools, which might cause the kind of minor scrapes which everyone would suffer from in such circumstances, and the sensations are absolutely normal.

I'm not saying that this may be the same for you; I'm just offering information in case it's helpful. My recommendation would be to see a really good CRS and explain what's going on for you, have an examination, and ask for treatment options. The CRS I saw explained that the anus is quite a delicate apparatus and if disrupted (by a fissure for example) it can take a while for it to settle down again. I think having a fissure may also alter, in minor ways, the process of passing a stool (you tense muscles without realising it for example) which again, may take a while to relax back to a normal bowel habit.

beansbeans wrote:Hi there,

I didn't know crohns could cause fissures, but I have done the blood test in the past with no signs of it (although I know the test isn't 100% conclusive).

Typically there is only mild to moderate pain during the BM and slight pain and burning for 30 min after. I always take a sitz after every BM, so that may be helping to reduce the pain. I only get the all day pain on large external fissures which happens maybe 2-3 times a year (vs my smaller ones 2-4 times a month).

Are your multiple fissures visible on examination?

I know these are older posts but, I’m going through similar symptoms (multiple recurring fissures appearing anywhere around anus even though I have soft bm’s) as beansbeans was and I’m curious as to how everything is now? Did you get answers? Lauren12’s explanation for these types of fissures makes perfect sense which is so reassuring to me.

very useful thread.

How did it go? I'm same as you, got one in my left side 5 years ago, then shortly after on my right side, had those 2 for years, been taking miralax last 2 years and since then it seems like those 2 main original ones I got have healed, but I get fissures all around my anus from a slightly harder bm, if I don't take enough miralax
Did surgery help?

Lauren12 wrote:I don't know if this helps. I got a major fissure in mid 2009. It healed after about 5 months using Diltiazem. However I was still getting pain and couldn't lead a normal life. It transpired that what was happening was my anal muscle tone had increased with the muscle spasms from the major fissure and despite the major fissure having healed, I was now getting minor fissures with most bowel movements. Like you, the stools were soft, but they were large due to fibre in my diet and Movicol (Miralax in the US I think). However, even attempting to get the stools to a smaller volume didn't seem to help. As I'd been in great pain with the major fissure, I'd also developed something of a pain cycle between bottom and brain, in that the kind of minor fissures that wouldn't bother most people, registered as painful to me.

It took me seeing three surgeons to find this out! In the UK, if a fissure has healed, it's not medical orthodoxy to perform the LIS operation, even if the patient is still in pain. However the third CRS I saw (the best of the lot!) said that some people still need it, even so. So I had the LIS operation and it sorted me out. It took a few months for the pain cycle to downgrade to normal sensation - but everything's normal now. I can even pass large, wide stools, which might cause the kind of minor scrapes which everyone would suffer from in such circumstances, and the sensations are absolutely normal.

I'm not saying that this may be the same for you; I'm just offering information in case it's helpful. My recommendation would be to see a really good CRS and explain what's going on for you, have an examination, and ask for treatment options. The CRS I saw explained that the anus is quite a delicate apparatus and if disrupted (by a fissure for example) it can take a while for it to settle down again. I think having a fissure may also alter, in minor ways, the process of passing a stool (you tense muscles without realising it for example) which again, may take a while to relax back to a normal bowel habit.

Where your fissures, and major fissure, in typical or atypical positions? Like I have what seems to be a similar problem to you, but my fissures are all on the sides they feel like rather than top or bottom

I also get fissures from an even slightly harder than normal BM. My fissures don’t really hurt and they heal pretty quickly with the use of medihoney, tui balm and other topicals. I have a complete arsenal of products. Are some people’s anal skin way more prone to tears?
I’m due for my colonoscopy soon and I’m dreading the prep because of how easily I get fissures. Any tips on how to make the prep easier? I was thinking of fasting a few days prior so there’s not as much to clean out.