- 46 yo male in San Francisco, competitive runner (won last 10K I ran, on New Year's Eve) and kayaker
- Recurring anal fissures at varying locations around the anus, not really painful, since November 2015
- Fissures heal, but new ones keep popping up
- NEVER constipated - not since I was a child. At least 2 bowel movements every day, usually 3, no straining, no pushing
- High fiber diet, mostly vegetarian, and very well hydrated, check every time I pee
- Never smoked, no recreational drugs, do not drink alcohol
- Straight, and no anal penetration, not even with a finger
- STD free but have had genital (and NOT anal) warts before
- ZERO other gastrointestinal issues
- No itching or pruritus ani
- 3X/day Nifedipine cream applied topically
- Very active, basically no stress
- HLA B-27 positive, have Ankylosing Spondylitis, on Remicade since Jun 2004, no symptoms of AS since 2012
- Colorectal surgeons can't figure out why the fissures, recommending invasive procedures to explore (colonoscopy and high resolution anoscopy), concerned about side effects of these procedures, which seem exploratory at best

Q1: Curious to see if other patients have had ongoing fissure issues despite perfect bowel movements?
Q2: Whom can I see that would look at a coherent picture of my health, propose a plausible testable hypothesis for my fissures, and only then begin poking around inside? Expense/insurance is NOT a concern

Hi I've had my fissure on an off for 4.5 years it can come back from a soft bm it heals well but keeps coming back so I'm trying it down to weak scar tissue I'm having surgery in a few days hope you find an answer soon x

Sorry to hear you are dealing with this for so long. I can't think of any reason why you would keep getting fissures, unless you have some undiagnosed condition, or you have tight pelvic floor muscles. Sometimes those muscles can get super tight despite being physically fit otherwise. I would recommend a pelvic floor PT, who can use biofeedback or an internal pressure sensor to check what's going on with your muscles. If that turns out normal, then maybe it's time to give the more invasive tests a chance. But I hope you won't have to!

Venture explorer: did you ever find solutions to your issues? I am a 36 year old female with similar health patterns as you, and no GI issues. Just had a sigmoidoscopy actually, and still, nothing. I'm on my second chronic AF, and i just don't understand why they keep coming back. Trying not to lose hope, so thanks for being a person I can relate to. Let me know your updates, and thanks again!

Maybe you guys have a high resting pressure without knowing?

So, after patient examination of my stool, I realized that even though in general it was soft, there were relatively drier and harder parts that seemed perfectly correlated with cuts and bleeding. I also realized that, back in January, I had gone on antibiotics (Clindamycin) after dental bone graft surgery, and that had definitely dried out my stool. So I dramatically upped my dosage of probiotics (I was eating Greek yogurt every day, but not much) by having at least 2 cups of yogurt daily, and often just taking straight drinkable probiotics, and that seemed to have a huge impact, and indeed seemed to make the stool consistently soft and fixed the problem.

Had another little hiccup April 4th after phase 2 of the surgery (another bone graft, plus dental implant) and three weeks of antibiotics (1 week Clindamycin, 2 weeks Amoxicillin + Metronidazole) when it got infected, but have managed to deal with it by overdosing on probiotics.

The probiotics angle is interesting. In my case yogurt dries my stool out, opposite effect. My current bleeding isn't from the stool so much as it is from the sphincter opening up and then pinching, closing off. It's that clamping down after stool has passed that opens it up.

VentureWxpolre how you doing now