"Good news for you," the doc announced. I was splayed out on the table, on my side, with my pants down at my ankles. He had a scope up my behind that felt approximately as wide as a watermelon.
"Fissure's healed. No sign of it anymore," he said.

"Are you sure?" I blurted out, incredulous. Stupid thing to say, as he's the one with the anoscope in my butt and about twenty years of experience peeking in other people's butts. He's a certified butt expert.

"Totally healed over," he said, unmoved by my doubts.

"Then . . ." I trailed off. I had expected him to start giving me the speech about LIS surgery and so on.

"Now you have hemorrhoids," he explained, sensing my confusion. "That's what's still causing you pain. Your fissure might have healed months ago but you never knew it."

That was about the gist of the conversation I had with my CRS about six months ago after suffering a fissure almost two years. I doubted him quite a bit, but since that office visit he's looked in there a few more times and still no fissure. I now believe him 100%.

Here is what I learned about healing the fissure and about hemorrhoids, in case it helps anyone. Here is an executive summary: "fiber fiber fiber is NOT the answer!"

1. I was consuming too much fiber. The CRS, as well as every blasted site on the internet, kept saying "eat more fiber." So I did. Take psyllium. So I did. The problem was that no one ever asked me what my diet was already like. Turns out, I was already eating lots of fiber. Whole wheat bread, oatmeal, avocados, beans, vegetables, etc. Now I was adding to it. That resulted in lots of "product" that needed to come out, which meant lots of BMs (2-3 a day) and very wide stools. This might be OK for some people but I now feel much better with stools about 1" wide rather than 1.5". A reasonable amount of fiber, plus a "cheat" with Miralax every day, keeps things soft and small. You might also investigate a "low residue" diet and try that for a while. By the way, I think "too much fiber" was also a cause of the hemorrhoids by putting too much pressure down there during BMs.

2. Related point -- Metamucil / psyllium. I was suspicious as to why, after about 45 years on this planet with zero problems down there, I now had a chronic anal fissure followed by hemorrhoid problems. What are the odds??!? 2.5 years of pain! It seemed bizarre to me that a person could get hemorrhoids while treating a fissure -- after all, the "cure" for a fissure (lots of fiber) is always cited as a way to "prevent" hemorrhoids! So how could I get hemorrhoids while trying to cure a fissure? Looking back, it occurred to me that my fissure developed just about a month after I started taking Metamucil! I had started using it as a way of lowering cholesterol, and it does work for that. But boy does it bulk up the stools. Too much for me, it turns out. I do not think Metamucil caused the fissure (I have a vague memory of eating a hard bunch of popcorn kernels), but I think it prevented it from healing quickly.

3. Talk to someone. Many of you have checked out Dr. Chung's Youtube channel, Your Friendly Proctologist. He also does private online consults. I talked to him for a half hour and it was well worth it.

4. Popcorn, seeds, etc. On my worst days with the fissure and hemorrhoids (9 out of 10 pain scale) I would usually put some kind of cream in there. Often I'd find that there were little gross bits of undigested "stuff" in there, which was irritating the fissure site. (Or hemorrhoid site too). So if you're having a really bad day, there might be something in there. Once I learned the fissure was healed I went back to eating some popcorn, but I realized that was irritating the hemorrhoids too.

5. Reducing number of BMs. I don't think my fissure would ever have healed with me going to the bathroom 2-3 times per day. Those "triple" days were the worst. Reducing fiber was key to that. I also got lucky. One day I began to feel the normal urge to go for a second time. But I wasn't in a position where I could go at that moment, and the feeling soon passed. It didn't return until the following day, and from then on it was mainly a once-a-day phenomenon. My CRS agreed that you can "train" your body in this way. You don't want to go crazy with it if you really have to go, but I think you can ignore some mild urges on occasion. Get it down to once per day or less.

6. Hemorrhoids. I had some inflamed internal ones that the CRS removed with banding. I'm not actually sure if those were causing much pain or not. The real culprit was developing several thrombosed external hemorrhoids. Those hurt like hell for about a week and then subside, but milder pain seemed to linger for a long time, like weeks. I have no idea, but I probably had 3-4 of these in the months after my fissure healed. (You can feel a painful bump not too far in when you have one of these.) Again, I think these were caused by too much fiber plus psyllium. So, if you're keeping score, I not only had a fissure, but had both internal and external hemorrhoid problems!

7. Walking seemed to help both fissure and hemmorhoids. After a BM it was essential NOT to sit right down. With the fissure, it clenched up in a tight spasm, and walking around for 10 minutes seemed to calm it down. Sitz baths didn't do much for me, but a hot shower after the morning BM was usually a good idea.

8. "Insertables" / stretchers. Given the weird timing of all this, I do not know exactly how or why the fissure finally healed. But it did seem to heal (in retrospect) during a period when I was doing about 30 minutes a day of stretching down there with gradual increases in size to about 30mm of width. I started with just a finger moving slowly around to stretch in all directions. Used lots of lube and went very slowly, working my way up. If you look this up, there is a lot of medical support for doing this instead of botox, surgery, etc. It's all an effort to reduce the anal pressure so blood flow and healing can occur.

9. Heating pad. This was a lifesaver. Strangely, I noticed after about 1.5 years that sitting on the heating pad HURT instead of helped. I suspect this was about the time when the fissure was healing but the hemorrhoids were developing. They prefer COLD. That is one of the main differences in the pain. Fissures like heat, hemmorhoids like cold. At least in me. And hemmorhoids don't have the spasm effect where your ass feels like it could crush a diamond.


In sum, my problem was likely due to the large amount of stool and the need to go to the bathroom 2-3x per day, which kept annoying/tearing the fissure. When I got that down to 1x a day, and also did some inserting, that's when it started healing. I hope this helps!