I have had an anal fissure for about 15 months now. I was told different things by different doctors but one said it may even be two anal fissures (while another said there may also be hemorroids present). Whatever it is, it's not pretty. The worst part is that it is visible. There is a sentinel pile on the outside of anus, perhaps even more than one. I went to a specialist last winter as I was bleeding after bowel movements. He prescribed Nifedipine ointment which helps but only temporarily. The fissure does not cause me much pain, feels uncomfortable like a hemorroid every once in awhile. My question is: IS IT STILL POSSIBLE TO SHRINK THIS THING? Clearly, after 15 months it is chronic which I know is difficult to cure without surgery. But the pain is not severe enough that I think it is worth having surgery performed. But perhaps surgery is a good idea now before it becomes worse? I take sitz baths with epsom salt about 2x a day, mostly after bowel movements, eat lots of fiber, wipe with wet wipes, exercise..I feel I'm doing what I can to not worsen it but I fear it will get worse before it gets better. Does anyone have any suggestions of more "natural" remedies that have proven helpful with chronic fissures? At 26, I never thought I would be having this problem! I read that like 90% of fissures go away on their own so it's just my luck that I'm part of the small percentage where it doesn't go away. But I'm glad I found a place where people are having similar issues!
Any advice would be greatly appreciated!

-Liz

Hi Liz,
In my experience, the Sentinel pile might never disappear completely but they can shrink considerably over time with careful dietary & toilet habits. You say you've seen various doctors but have you ever had this thing actually diagnosed by a Colon & Rectal Surgeon, who are the specialists in the field of anal issues...it might be worth a referral if this is not the case for you because they will undoubtedly suggest ways forward.
In my opinion, I would be very wary about considering further surgical intervention in the anal area because unfortunately, it can sometimes lead to further complications and it's not unusual for banding or hems excision to result in a further fissure - It's hard to say, which is why it might benefit you to go back again for another opinion.
If it's not painful, I would say leave it for a while & just see if you can deal with it naturally. I know for me, my fissure & consequent surgeries lead to the development of very annoying internal hems. These hung around for a few months but once I learned never to strain on the toilet anymore & switched to using a hand held shower for cleaning rather than any form of wiping, then they dramatically improved! Wiping was possibly the worse culprit for me & even today, if I can't access my shower and use wipes, I am at risk of aggravating them again!!
I also used Aloe Vera, when they were at their most tender and this was a great pain relief and I also believe, helped settle them down over time too....An icy cold compress is also very helpful for relief.
Wishing you all the very best with this pesky issue!! and hoping things calm down for you soon :)

From the sound of it, a lot of folks on these boards were able to shrink theirs as their fissure healed. I personally left it up to the CRS, as I had some concerns about hygiene and cleaning the area well. He decided to take it off. It was painful for a number of days, but I am glad to have it gone so far. I am about 20 days post-surgery, and it's still a little tender sometimes when I wipe, but nothing like it used to be!

Thank you both for your responses! Yes, I finally went to a colon and rectal specialist about a year ago because I needed an expert opinion. He prescribed the ointment and to drink more water, etc..stuff I was already trying. I'm considering going back to him since its been a year and now I know the right questions to ask. But I think I may try dealing with it naturally first..I'll have to try aloe vera. Also, I heard that coconut oil can be very effective. Has anyone tried it? Thanks again!

I've thought i would join and give you my ten-pences worth. I've had a fissure for about 5 years now. At the time it started i didnt know it was a fissure and thought it was a pile, so treated it as such. Had i known, i would have treated it differently as its obviously a chronic fissure now.
A year after it started i had a thrombosed pile, which i got from heavy lifting (of all things) and not related to the fissure, i went to the doctors, was given cream and laxatives and was checked out inside with a dialator. The doctor said he could see i had had a fissure as he could see the scar tissue where it had healed. Strangely, the fissure didnt open when he used the anus expander. When i had this pile the fissure completely stopped for a couple of weeks but as soon as the pile healed it came back (interesting). On and off over the past 4 years i have had this fissure and ive tried everything, the more water, the more vitamins, diet, exercise, coconut oil, you name it ive tried it (except for self dillation-which im about to try). Im my experience, once you have a fissure thats it, you have it for a long time and its a case of constant management.

Ive had what you describe, some days not much blood but lots of pain afterwards, some days not much pain but lots of blood (during and a bit after a poo). Ive had a fissure at the back of the hole and a fissure at the front with a skin tag. What i found is that there has to be a 'release' somewhere in the anus, so if the fissure healed at the back, one would form at the front (if i wasnt careful) and visa-versa.

I had the rear fissure for nearly 3 years and its only been in the past 4-5 months where it finally seems to be healed and not re-opening but i currently have a fissure at the front with a tag now. The one at the back too so long to heal (it would heal for a month then re-open) that i thought it would never heal but i believe that was due to the fissure being deep. The longer you have them, the more deeper they are and affect the muscle underneath the skin, so this obviously takes longer to heal. A lot of these fissure do heal, but it only takes one BM to undo weeks or months of commitment that it can mentally drain you.

Here's what i found over the years.
1. you can do all the water-drinking and good diet all you like, if your poo happens to be bigger than a certain diameter your fissure will open wether its soft or not. Its not always to do with 'hardness of poo" as i have passed small hard poos now and then with no fissure opening, its purely down to diameter. So trying to keep your poo 'thin' really helps ie: fiber, no bulking foods that constipate.
2. The only cream to help the healing for me was Sudocream. Bought in the UK and used on babies and skin conditions, i found this healed quicker than most.
3. Coconut oil works, but really only works best on fissures that have partially healed. If you fissures have closed for a couple of days and you dont have blood or pain then thats the time to apply the oil as its good as keeping the skin and anus flexible.
4. warm baths help the pain and healing process but they wont do it on their own, and not everyone can take a hot bath 3 times a day, sometimes not even every day.
5. moist wipes are better than tissue paper as they dont drag but you still need to be careful when wiping.
6. The pain is far more worrying than the blood. Basically, if the blood is bright red, happens when you poo and stops (generally) after a bm then its pretty much an open cut (fissure) opening and bleeding. The time to worry, is when your actual poo has it in (not on the outside as its passed the tear) but part of the poo and tends to be much darker in colour. (indicating bleeding further up the bowel and a sign of cancer)
7. fissures can bleed a lot, like something from The Walking Dead, but then other days they will not bleed at all, sometimes for weeks/months if healing. But a fresh tear can bleed a lot until your body starts the healing process and tries to close it up.

But the biggest thing i have learned is that every symptom seems to have its roots in one place. A tight sphincter muscle. If you read medical websites you will see that in most cases a tight sphincter muscle nearly always relates to a fissure. They offer surgery in the way of cutting the muscle, hence allowing the fissure to heal. They offer gels and creams that relax the muscle, hence allowing the fissure to heal and the generally ask you to take warm baths (to relax the muscle)...exercise (to work the muscles) and nearly always come back to this point about the muscle.
From my experience, the muscle is the cause of everything. At times ive tried to insert cream on the tear and its virtually shut up tight, other days when ive had no fissure problems its been loose with no pain.
Think about the thrombised pile i had, the blood and pressure were somewhere else (ie: not in the muscle) so the fissure healed. The doctor could expand my anus with his stretcher and nothing, no tear. As time has gone on my fissures have healed then come back..healed...then come back. So at points in my life something has worked. And at points during these healed periods ive walked with a relaxed sphincter (as funny as that sounds but you know what i mean)

In the past few months, more and more my mind has come back to this muscle thing and the tightening, and i truly now believe its all related to this. For this reason i intend to start stretching/working it a bit. I personally dont have a problem with sticking a small dildo up my backside, as ive stuck my finger up it so many times applying cream and its had the doctors tools (ooer) up there a couple of times. that i dont care about trying to exercise it. I believe that un-tightening this muscle is the key to it, the key to the fissure healing. It may take a while and it might need doing every couple of days, but then again, so does exercise, so does applying cream. If you get a tight hamstring they advise stretching exercises. If you have a tight muscle anywhere in your body, they advise you to keep it supple and to massage and stretch. By my reckoning, the sphincter muscle is no different, its simply because of where it is that makes it a bit awkward to get to and a bit embarrassing but im way beyond that. I will report back in a few weeks time and let you know.

ooh arse - So....how did it work?! I have scar tissue that is causing me problems, and I am interested in the notion that massage might help.