Hey guys ! So about 8 months ago, I was on Iron pills for my anemia. I was also not drinking alot of water. So I ended up getting really constipated at one point, since i was one 300mg or Iron which is a pretty strong dose to start off at. Anywho, I got a anal tear. At first it was burning when I went to the washroom , but it wasn't visible. I went to the doctor, she told me it was a haemorrhoid, which I knew it wasn't. I then went to another family doctor, and she told me to take sitz batch 3 times a day for 20 min and gave me cortisone/antibiotic/pain releiver cream +fecal emollient. I noticed a slight improvement with the combination, but it-reteared once more after I passed another stool. 8 months later, the fissure is still there and now it's visible from the outside because there's a sentinel pile that formed. It doesn't hurt so much when I go to the washroom. I don't realize it's there unless I'm going to the washroom. I started the emolient again, and started putting Aloe gel on it. I don't want to undergo any rectal surgery because I think the only reason I got the fissure was because of the high dose of Iron. Also, I can still deal with it, but I just don't want it to get bigger. I heard of something called cauterization so they can remove the sentinel pile. Has anyone gotten that done? Should I be worried? I know the fissure is termed chronic now, but does that really mean I'm going to have to undergo a rectal surgery like I've read on previous forums ??

P.S. Until I get an appointment with a specialist, I was thinking of continuing the emollient, drinking plenty plenty of water and eating fibres and putting aloe on it 3-4 times a day and crossing my fingers it works. It's my fault for not being consistent in the beginning and trying to heal it. Had I known it could become this complicated, I would have treated it more seriously earlier This sucks!

Hi Mary,
So you have a little pain when you pass stool, and no pain at other times? Is that right?
And your sentinel pile bothers you.
If your pile isn't hurting you, I would leave it alone. It may shrink over time, or it may not, but don't remove it just because it's there. It's not causing your fissure, it's a sign that you had one, or still have one. Removing a pile can cause a wound that's very painful and difficult to heal - you can read some people's experiences on this forum.

If you are not getting spasms or any pain except on the toilet, your fissure may be healing. Don't use a coritsone cream long-term, as it can thin the skin and make it more prone to tearing. Ask your doctor for nifedipine, diltiazem or nitroglycerine. Those are all medications that relax the anal sphincter, making it easier to pass stool and increasing blood supply to the area.

I would see your doctor again, ask about those meds I mentioned, ask if the fissure is still open (the sentinel pile does not mean it's open). Good luck!

Thank you so much for the advice !
My mother got me an ointment from overseas which she swears by. She says that's all they use over there for anal fissures. It's called "Nystacort", it's a combination of triamcinolone+nystatin+neomycin and gramicidin. I've been using it for 2 days now. There is a corticosteroïd in there, so I'll stop using it in a few days if I don't see any improvement so as not to pre-dispose myself to skin thinning and re-tearing..

For the nitroglycerine, I know it can lower blood pressure if taken orally, and I already suffer from pretty low blood pressure, do you think it can still lower my pressure although applied topically on an open wound...?

I was worried about nitroglycerine at first, because my blood pressure is low also. Not too low to be healthy, but I do sometimes get dizzy when I stand up quickly. Anyway, I doubt applying nitro to your anus will not cause you problems with your blood pressure unless it's really too low. Some people get headaches - I used to get a sort of pressure feeling in my head but it went away in a minute or two.
If you use it, I'd recommend starting with really tiny amounts way smaller than they recommend and build up over the course of a week. If you start with the full amount you might get bad headaches.
I hope you feel better soon.