Hello all. I'm so sorry to see so many of you here, but so pleased to find this forum.
I suddenly developed a Thrombosed External Hemorrhoid in June, which gave me a pain like no other. That was untill 2 weeks later, I also developed an Anal Fissure!! I can honestly say, I have never experianced pain like it in my life. I thought childbirth was the height of pain, but this thing puts a whole new level to pain.
I went to my Doctor, who prescribed Scheriproct Ointment and Proctosedyl Suppositories for the Hemorrhoid, but then went back two weeks later as I couldnt sit, stand, walk, without being in complete agony. And bowel movements were like passing broken glass or someone puling barbed wire out of me very slowly. I have never been in such pain. He examined me (not internally, due to my agony) and sent me straight to hospital, where a Surgeon gave me an internal (which had me almost through the ceiling) and he then told me I had a fissure as well as the Thrombosed External Hemorrhoid, and sent me home, in tears of agony, with Rectogesic!
I explained to him that even though my motions were soft, every BM was agony and were only leaving my body like toothpase, he said the cream would help!
It has now been four weeks of BM agony every day. I have had days when the pain from the BM is so bad, I am just in agony for anything from 6 to 8 hours after. I have spent my time researching anything and everything I can find about this Horrific thing that has consumed my life.
I have been doing the following..
I have 3 Epsom Salt Sitz baths a day for 20 minutes, followed by an Ice pack for the hemmorhoid, then witch hazel if needed. I use the Rectogesic twice a day, and vaseline in between when needed. I am drinking loads of water, and eating only soluble fibre soft foods, loads of fruit & veg, prunes on my breakfast and a glass of prune juice at night. Vitamins E, C, B Complex, Zinc, & Odourless Garlic every morning and a tsp of Flaxeed Oil morning and night. Nurofen Express for pain relief when needed. Vaseline before every BM, and I also brought a Squatty Potty for better Bowel Movements. I also go to bed with a water bottle against my bum to help blood flow.
I have learnt that the main reason for my intense pain, is The Inner Sphincter Muscle which is locked tight and causing me the agony during every BM. The pain is so bad, that even though I am doing slow breathing to relax while trying to go, I break out in a sweat with the pain and feel like I am actually going to pass out. I could cope with everything else, but this Muscle is just agony. I really do not want to go down the Surgery path for fear of complications after. Does anyone have any advice for relaxing this Sphincter Muscle? I have started Reflexology today for it, and have even looked up anal massage, but am unsure at this stage if that would help or hinder. My heart goes out to all you people who have suffered this for months and even years. This is, without a doubt, a Horrific illness that is capable of taking over your life. But I refuse to let it break me. Well, maybe my bum, but not my Spirit :-) Any advice is SOOO welcome. Thank you :-) x

Hi Sunshine,
Sorry to read of your suffering. It's really not a nice thing to have to deal with and although there doesn't seem like any let up right now, things WILL get better but it takes time unfortunately. You sound like you already have a great routine going there and all you can do at this stage, is continue to do what you are already doing, drink lots of water too and just ensure that every BM at this stage is as soft as the other so you do not have to strain in any way to pass your stools. You say that a surgeon diagnosed your fissure? Was this a Colon & Rectal surgeon? If not, it would definately be worth going back for a referral just for a double-check as they really are the specialists in this issue. From what you describe, it certainly sounds like all the symptoms of a fissure and it's good you got started on the Rectogesic straight away. Depending on the location and size of the tear, some can be more horrendous than others and it may/ may not take a long time to heal. In my experience, the first 6 weeks to 2 months were the most painful (the stage that you are currently experiencing) it wasn't until I started using Diltiziam cream that that horrible after-pain started to reduce in intensity (It works in the same way as the Recto but without the headaches) The cream itself works to relax the internal sphincter muscle, so blood flow and healing can be promoted but if it doesn't seem to be helping, you could always ask to try the Diltiziam or ask about Botox treatments? It is extremely painful (we've all been there too) but as the fissure starts to heal, the intensity of the pain does start to reduce - Just keep on top of your painkillers and take them prior to a BM and then use a nice hot Sitz bath or tub to promote further blood flow and healing. It's all about getting an accurate diagnosis and treatment and experimenting with all the conservative methods in the meantime...........and having a lot of patience, inner strength, a positive attitude and a sense of humour to go with it all!.......
Fissures that last beyond 6-8 weeks are considered "chronic" and they do take longer to treat & heal but even a chronic fissure can heal naturally - mine did, as have a few others here. Sometimes the surgery route is the only option for some individuals but it seems to have great results and people do not regret the decision and do not appear to display huge side-effects, although as you are aware, there are some risks......
Scour this site for some fantastic tips and information and there's a lot of diaries and personal stories.......Focus on the success stories and continue to tell yourself you WILL get through this nightmare - but stay realistic, it doesn't happen overnight sadly. Wishing you ALL the very best and hoping you are able to find your healing path and your pain reduces very soon xx

Hi there Ever The Optimist.
Thank you for your reply. So pleased to hear that yours cleared up on its own, I do live in hope but realise Surgery is the only option sometimes, especially when all else fails. My worse day was at the hospital when I was at the "Cure me or Kill me" pain level, and I would have let him knock me out and do whatever just to stop the pain. Alas, sent home with cream was his plan! As for if he was a colon surgeon, I dont know, and it is been something I have wondered about. I am planning to phone my Doctor tomorrow for an appointment this week, as I had looked up that Diltiazem 2% which I think is also known as Anoheal, as yes you are right, the Recto does have bad side effects. I will ask if he was a colon surgeon and if not, ask to see one.
I just cant believe that so many people are suffering this amount of pain, and there isnt more done to help them. This link is fantastic. Just reading that people do recover, and reading what other people are trying is a great help.
Many thanks for your good wishes.   

Hi sunshine (such a breath of fresh air to have a pretty name on here rather than the realistic pain level descriptions members normally choose - I'm guilty too)
As ETO (beautifully named too might I add) has explained, if caught early, and treated correctly, your fissures could be healed before they turn chronic. But for us unfortunate ones who left it late, tried to self treat or were just failed by the health professionals, surgery is a very welcoming (albeit scary) option.
I was at my wits end after 3 years of treating myself for hemmies, finally seeing a doctor and being give 3 creams over the space of a year which were unsuccessful. I was finally then referred to a Colorectal Specialist (after 3 months on the waiting list in the UK and pleasing for him to see me) he gave me the option of surgery 2 weeks later. I jumped at the chance because I was sick of the worry, the pain, the unknowing.
The surgery came upon me quickly and I had a double fissurectomy (cutting away the scar tissue to make them fresh and acute - not chronic and untreatable by creams) I was also give Botox. I had no pain after this surgery. Until my first bowel movement 4 days later, which was the most excruciating pain. It's been 4 weeks since I had it, but I would do it again in a second! It's a long rollercoaster ride but the support and advice on this forum has kept me going. The things on here have helped me get to a painless bloodless BM for the past 5 days.
I wouldn't have found this info in one place. And my GP and surgeon didn't give me anything useful.
The important thing is you stick to the advice on here. Diet is incredibly important. If I knew back then, what I know now, I might have been healed way before surgery.
Cut your fibre, this bulks up your stools, eat certain foods to get your daily intake of fibre but don't take supplements, this is the mistake I used to make. Lots of fibre = big packed poos. This will no doubt retear you.
There's also a huge difference between soluble & insoluble fibre. You need a mixture of the two. Google them.
Drink 5+ litres of water a day (no alcohol or fizzy drinks). Drink when you eat. Chew vigorously to make it less work for your stomach to digest. Take stool softeners (Miralax/Movicol) which will help keep your BMs soft and easy to pass. The doctors say you should aim for a Bristol Scale 4 (google that too) but I find that a 4 tears me despite being the healthiest. I'm encouraging BS 6 at the moment which are heaven. The Botox has kicked in for me and I barely push down there.
That's another thing. Try not to push or strain. Keeping your BMs soft means it should fall out, when you push, your muscles go into spasm and move your fissures around resulting in a "passing a razor blade " feeling. I've not had one of those since my 1st BM after surgery. The Diltiazen was the best of all my creams and its what I'm using now.
Hopefully I'm on the road to healing now as are many of the beautiful people on here. We're all in it together and we're all here for each other.
I hope this helps you sunshine, chin up and don't be scared to go to your doctors. That's what they're there for.
Hope you see some progress.
Drink plenty and poop gently,
Welsh x

I love that Welsh.."Drink plenty and poop gently,"
and shes wright, I drink a full glass of water before my meal and two large glasses of water after. We have all felt that terrible pain, like broken glass, it looks like your doing everything right, I have to say, good for you. Give it time, the pain will be come less and less as you heal.
Don't stress on to much fibre, more soluble for now, easier digestible foods like fish, no red meat.take stool softeners, for now like Mira lax or colace.  Sunshine keep up the good work.

Hi WDF.
I can not begin to imagine how you have coped for three years!! But am so pleased to hear that Surgery has worked for you :D I wish you a speedy recovery from it.
I agree with you, the information on here has been so helpfull, especially as so many people are just sent home in agony with cream and no advice at all. With the level of pain people suffer through this, there really should be more done in the medical field to help.
I did look up the soluble and insoluble fibre and found that I was mostly eating insoluble, which is why I am now having more soluble, but still some insoluble to get the ballance right. The stool consistancy is perfect, but because the Sphincter muscle is locked tight, I still have to push to release anything, and even then, it is only the width of toothpaste as thats as far as the muscle will allow. That is what causes the barbed wire feeling.
As for water, I am drinking it all day, making sure I have a tall glass full every hour. Makes me pee loads but the stools are soft so it does work. I did take Dulcoease stool softeners for the first week, but didnt want my body to have to rely on them, so have managed to maintain the same outcome with the right foods. Everything is just trial and erra isnt it, finding what works.
Hi PGA
It's so awful to know others have felt this Broken Glass feeling, it really just doesnt seem right in this day and age that people are allowed to suffer so much pain. But it does at least help to know you all understand what I mean.
I dont usually eat any red meat, and since this, I only have chicken maybe once a week, and the rest of the time fish, Quinoa, cous cous, sweet potatos, butternut squash soup, lots of fruit & veg etc So a really healthy diet.
I have managed to get an appointment with my Doctor tomorrow, so I shall ask him for the Diltiazem 2% and also find out if the surgeon I saw was a colorectal one, if not, I will ask to see one.
Thank you both so much for your replys and your much appreciated support. I wish you both a fissure/Hemmi free happy life   X

You're welcome sunshine,
Knowing the difference between soluble and insoluble has flipped my life in the past 4 weeks. You're very liky to be able to get your stools at the right level for you, we'll done! Your next move I guess is relaxing that damn sphincter of yours. Diltiazem might be the right option for you if you are in the early stages. If that on its own isn't successful in relaxing and letting you heal, I have no doubt that Botox will work.
Check out the Botox diaries on here by JHH and Rachael. They're currently going through it. I too have had Botox and my sphincter barely moves. 8 days no pain and counting. - my blog is here if you'd like to see a progression
http://anal-fissure.org/t6886-sharing-my-double-fissurectomy-botox
It's still ongoing but I'm looking positive.
Keep up your good work and never rule out surgery, it might be your saviour one day. Good luck with the Diltiazem in the meantime and let us know how you get on!
Drink plenty and poop gently!
Welsh x

Ok, so sitting here waiting for painkillers to kick in, after another delightful session involving my bathroom, a squatty potty, and broken glass....I have just ben reading your blog Welsh. If I was wearing a hat (instead of a towel, from washing my hair before the BM) I would take it off to you!!! My goodness you have been through it!!
I was sory to read all that you have been through, including your relationship break up :( But also inspired by the way you have coped with everything!!!
It certainly sounds like your botox and surgery were the right thing to do, and the updates are so interesting to read. I hope you keep the progress reports coming as its so good to see there is light at the end of the tunnel.
And if this broken glass doesnt stop soon, I sure am going to look into the Botox.
I will see what the Doctor says tomorrow and go from there.
Keep the updates coming.
I wish you Pain Free Poo & Sunshine   X

Sunshine: you expressed & ?

I really do not want to go down the Surgery path for fear of complications after. Does anyone have any advice for relaxing this Sphincter Muscle?

I"m with you on wanting to try things naturally first. Perhaps you have heard of one of the newest natural rem's in Manuka Honey.
Many people will use it in lieu of the vaseline with the added benifits of stopping your spasming.
Her's a small excerpt on this honey from a user suffering from spasms....
"...My fissure spasmed for nearly 7-9 hours per day.....But the truth was, NOTHING was really working and I was in misery…just as I was about to sign up for the surgery, I found out that it wouldn’t be covered under my new health plan.... I considered this DIVINE intervention as it forced me to sit with my problem and find an alternative answer...So how did I finally get my fissure to heal????...Manuka Honey....So here what to do…
http://healsvtnaturally.wordpress.com/tag/manuka-honey-and-fissures/
Click on that to find out her technique of applying it and for other info.
Also sunshine another site said that what keeps a sphincter in spasm is stress.
Guess what is also a big factor in constipation........stress
As this site strikingly details....
http://drbenkim.com/anal-fissure-heal.htm
an excerpt...
"So what can cause your internal anal sphincter to be chronically tense? In the absence of overt neurological dysfunction, the most common cause of a hypertonic internal anal sphincter is ongoing emotional stress.
Emotional stress causes your autonomic nervous system to gear up to fight or run for your life. One of the consequences of being chronically amped for a fight or flight response is a tense and dysfunctional gastrointestinal tract, which includes a taut internal anal sphincter."
So sunshine please do try and relax more while on the loo.
Hope This Helps, Good Luck

Sunshine thank you for your concern and hat removal.
It has been a very very long road and I've been through it with a very supportive family and friends. It has really made me see the important things in life.
Pooping is such a daily occurance that people forget how easy it is. I can't wait to get back to it again.
Thank you for reading, I hope my daily life events bring a smile to your face as you relate to some of my antics. Humour is always the best medicine.
I made my own squatty potty but was too scared to use it. So good on you for doing it! I left that at my recently ex boyfriends. (It was just a cardboard box with squatty potty written in a sharpie on the side -misspelt too).
As for things like home remedies, I've read countless stories of people self treating and it so good to see that it works for these individuals. I wish simple easy things would work for me. I tried vasoline to ease the passing of my stool to it's new home in toilet hell but I found it really difficult to apply it internally to make a difference - mainly because of the pain.
I've also tried coconut oil but its hard to manoeuvre and ends up dripping down my leg and on my forehead as well as up the wall. Jeeese. Such a klutz! I decided to stick with the Diltiazem as it strengthens the Botox and I've bought some vitamin E to take orally which helps support tissue healing. Whether it helps I don't know. But it's all I can do.
If you can use vasoline that's brilliant. Anything you can to to help will benefit your BM.
And as Buttastic said ..,
Relax, chill out as stress affects people internally too.
Drink plenty and push gently our little sunshine!
Welsh x