Hi all, this is my first time writing in this forum but I have been coming here daily over the past month as it has been my true refuge with the horror I've been going through.

A few basic facts: I am a 27 yr old female and very short (barely five feet tall) and weighed a healthy 92 pds for my frame. I am currently at 86 pds, but this is due to me not eating much for fear of painful bowel movements. I have always eaten fairly healthy, mostly organic foods and very rarely eat any red meat. I sometimes eat chicken and fish twice a week. I have also been drinking 70 oz of water per day since my fissure happened.

This all started about five weeks ago. After brushing off my constipation and attributing it to my pending menstrual cycle, my pain during BMs got worse and worse until eventually I ended up getting a hemorrhoid after one exceptionally excruciating BM that left me on the floor shaking and in tears. I was initially straining, not realizing how bad it is. I ended up making an appointment with a GI, who said she did indeed see a little hemorrhoid outside my anus. She attempted to perform a digital rectal exam but could not due to my pain. She told me to go home and take Prep H suppositories, sitz baths, and drink Citrucel every day. She also scheduled a flexible sigmoidoscopy, which she ended up rescheduling 3x before canceling on me. She called my pharmacy and prescribed me Canasa suppositories and Lidocaine since I complained about worsening pain. I did not get these because I wanted a second opinion due to how flaky she was and how annoyed she seemed by me. She never ended up returning any of my calls.

After some research, I realized what I had was an anal fissure. I could feel the cut in my anus. I scheduled another appointment with a different GI, who was a lot better. She saw that I had a residual hemorrhoid and skin tag (sentinel pile???) and after a quick visual check, she confirmed my fissure. She was a little concerned that it was located on the side rather than the front or back, but said that we will wait and see how things go after the medication. She prescribed me Nifedipine 0.3%/Lidocaine 1.5% compounded and told me to use it for six weeks with a follow up in two weeks (Oct. 28th, 2015). She told me I didn't have to continue using the Prep H suppositories, so I have stopped since then.

I am currently on day 3 of Nifedipine/Lidocaine, and although I don't feel much spasms, I don't know if it is working either. I am putting it directly in the anus, about a pea-sized amount. Does anyone have a timeline for this medication and whether it was helpful or not? The past three days have been HELL, with yesterday being the worst. My stool would not come out due to the pain and came out in little pieces. I constantly had the urge to go, but could not seem to get it all out. It took me five different attempts to empty everything out. I was exhausted and shaking afterwards. I took one Colace stool softener and ate soup the rest of the day.

I am wondering, is this normal for an anal fissure??? I think I am regular because I go every day usually in the mornings, sometimes twice a day. But although I have the urge to go, when I sit/squat, it seems like it won't come out. Is this because of how tense I am, maybe? It takes about 8-10 pellet-sized pieces of stool or pencil-sized stools, before it all comes out in full, normal-sized stools. I don't think the stool is hard, but the first 8-10 little pieces are SO painful!!! I am in tears from the excruciating pain and shaking from it each time. I fear that something is wrong with me and my mind goes to such dark places, thinking the worst...such as do I have a disease, an abscess, a fistula, cancer, anything? I don't have abdominal pain or diarrhea, but do sometimes have the tiniest streaks of blood when I wipe with my Tucks pads or in the stool after a very painful BM.

It just seems like I'll have two days where it is minimal pain and stool comes out in one or two shots, and then right back to the severe pain where I feel like I rather just end my life than live this way forever. I lose hope every time. I am trying to stay strong, but this is ruining my life. I have such severe anxiety attacks, hours before I have to wake up, due to fear of my painful BMs. My heart literally feels like it will explode out of my chest due to it. I have anxiety all throughout the day and can't concentrate on anything. I try so hard to remain positive and just breathe, but the negative thoughts flood in constantly. I also worry about my poor husband who has to see me crying everyday in pain, and I don't want him to have to go through this stress because of me or ruin my relationship. I feel so bad as we haven't gone anywhere since this has happened! I've called out of work so many times as well. Can't help but cry. I am at wits' end. I just can't live like this forever...

Current routine:
-Painful or EXCRUCIATINGLY painful BMs every morning, with the help of some vaseline or coconut oil used as lubricant, followed by 20-30 minutes sitz baths when possible (if I'm not at work)
-Afterwards, I apply Nifedipine/Lidocaine ointment in anus, about a pea-sized amount
-Take one Colace stool softener
-Drink tons of water
-Drink one tablespoon of Citrucel every night before bed
-Sitz bath, reapply Nifedipine/Lidocaine before bed

Why do I have maybe 1-2 days of minimal painful BM before it comes back full force and the cycle starts again? I feel like there is no hope. I am strongly considering LIS surgery + skin tag removal, but also worry about the recovery, side effects, and cost. Does it take long to schedule one if I do go through with it? I am so sorry this is long and winded but I had nowhere else to go...please help me anyone...I can't take it anymore. Thank you so very much...X

That cycle is normal and very frustrating. I highly recommend miralax. I eventually did surgery after 4 months of that frustration and only wish I had done it sooner. Best of luck to you!

Thank you Jbl22424, I was starting to really worry about how extreme my case may be. I will definitely check out Miralax, but strongly considering surgery if this doesn't resolve in the next few weeks.

Severelydepressed wrote:Hi all, this is my first time writing in this forum but I have been coming here daily over the past month as it has been my true refuge with the horror I've been going through.

A few basic facts: I am a 27 yr old female and very short (barely five feet tall) and weighed a healthy 92 pds for my frame. I am currently at 86 pds, but this is due to me not eating much for fear of painful bowel movements. I have always eaten fairly healthy, mostly organic foods and very rarely eat any red meat. I sometimes eat chicken and fish twice a week. I have also been drinking 70 oz of water per day since my fissure happened.

This all started about five weeks ago. After brushing off my constipation and attributing it to my pending menstrual cycle, my pain during BMs got worse and worse until eventually I ended up getting a hemorrhoid after one exceptionally excruciating BM that left me on the floor shaking and in tears. I was initially straining, not realizing how bad it is. I ended up making an appointment with a GI, who said she did indeed see a little hemorrhoid outside my anus. She attempted to perform a digital rectal exam but could not due to my pain. She told me to go home and take Prep H suppositories, sitz baths, and drink Citrucel every day. She also scheduled a flexible sigmoidoscopy, which she ended up rescheduling 3x before canceling on me. She called my pharmacy and prescribed me Canasa suppositories and Lidocaine since I complained about worsening pain. I did not get these because I wanted a second opinion due to how flaky she was and how annoyed she seemed by me. She never ended up returning any of my calls.

After some research, I realized what I had was an anal fissure. I could feel the cut in my anus. I scheduled another appointment with a different GI, who was a lot better. She saw that I had a residual hemorrhoid and skin tag (sentinel pile???) and after a quick visual check, she confirmed my fissure. She was a little concerned that it was located on the side rather than the front or back, but said that we will wait and see how things go after the medication. She prescribed me Nifedipine 0.3%/Lidocaine 1.5% compounded and told me to use it for six weeks with a follow up in two weeks (Oct. 28th, 2015). She told me I didn't have to continue using the Prep H suppositories, so I have stopped since then.

Glad that you stopped using Preparation H as this is a not very useful OTC treatment for hemorrhoids and does nothing for AFs. A fissure most commonly appears in the 12 or 6 o'clock position. Fissures located in other locations are more likely to be associated with an underlying disorder (eg, Crohn's disease), so it's good that she'll keep an eye on that.

I am currently on day 3 of Nifedipine/Lidocaine, and although I don't feel much spasms, I don't know if it is working either. I am putting it directly in the anus, about a pea-sized amount. Does anyone have a timeline for this medication and whether it was helpful or not? The past three days have been HELL, with yesterday being the worst. My stool would not come out due to the pain and came out in little pieces. I constantly had the urge to go, but could not seem to get it all out. It took me five different attempts to empty everything out. I was exhausted and shaking afterwards. I took one Colace stool softener and ate soup the rest of the day.

You do not need to submit yourself to the extra agony of inserting the Nifedipine/Lidocaine ointment inside the anus. It will work perfectly fine outside, as it goes straight into the bloodstream. You need to use it for at least eight weeks to see if it heals you, and it just might. Sometimes the ointment can give you a rash after a time, so watch out for that. Make sure you are drinking enough water and not taking too much fibre for your sex and weight. Definitely do not overdo the fibre! Also, resorting to soup will not give you the calories you need, so just try to eat small meals. I resorted to eating organic baby food, so know just how bad this can get too!

I am wondering, is this normal for an anal fissure??? I think I am regular because I go every day usually in the mornings, sometimes twice a day. But although I have the urge to go, when I sit/squat, it seems like it won't come out. Is this because of how tense I am, maybe? It takes about 8-10 pellet-sized pieces of stool or pencil-sized stools, before it all comes out in full, normal-sized stools. I don't think the stool is hard, but the first 8-10 little pieces are SO painful!!! I am in tears from the excruciating pain and shaking from it each time. I fear that something is wrong with me and my mind goes to such dark places, thinking the worst...such as do I have a disease, an abscess, a fistula, cancer, anything? I don't have abdominal pain or diarrhea, but do sometimes have the tiniest streaks of blood when I wipe with my Tucks pads or in the stool after a very painful BM.

Use your Sitz Bath before you poop, and disgusting as it might sound, poop in the water if you have to, then empty the water. The hot/warm water will bring blood to the area, which is what you need, as the involuntary internal sphincter cuts it off. Believe me, you won't be the first to use your Sitz Bath... Also, do NOT wipe. Dab with wet TP (I use Cottonelle with Vit D and Aloe) then maybe use sterile cotton dressings (they come in packs of tenor so) wet to dab until everything is clean. I found Colace to be pretty useless, and use Milk of Magnesia, a small amount every night, but use Miralax if you have not started already shaking, extreme pain, etc. Most of us have gone though the wretchedness of it. The pain, etc and we all get desperate.

It just seems like I'll have two days where it is minimal pain and stool comes out in one or two shots, and then right back to the severe pain where I feel like I rather just end my life than live this way forever. I lose hope every time. I am trying to stay strong, but this is ruining my life. I have such severe anxiety attacks, hours before I have to wake up, due to fear of my painful BMs. My heart literally feels like it will explode out of my chest due to it. I have anxiety all throughout the day and can't concentrate on anything. I try so hard to remain positive and just breathe, but the negative thoughts flood in constantly. I also worry about my poor husband who has to see me crying everyday in pain, and I don't want him to have to go through this stress because of me or ruin my relationship. I feel so bad as we haven't gone anywhere since this has happened! I've called out of work so many times as well. Can't help but cry. I am at wits' end. I just can't live like this forever...

Current routine:
-Painful or EXCRUCIATINGLY painful BMs every morning, with the help of some vaseline or coconut oil used as lubricant, followed by 20-30 minutes sitz baths when possible (if I'm not at work)
-Afterwards, I apply Nifedipine/Lidocaine ointment in anus, about a pea-sized amount
-Take one Colace stool softener
-Drink tons of water
-Drink one tablespoon of Citrucel every night before bed
-Sitz bath, reapply Nifedipine/Lidocaine before bed

Why do I have maybe 1-2 days of minimal painful BM before it comes back full force and the cycle starts again? I feel like there is no hope. I am strongly considering LIS surgery + skin tag removal, but also worry about the recovery, side effects, and cost. Does it take long to schedule one if I do go through with it? I am so sorry this is long and winded but I had nowhere else to go...please help me anyone...I can't take it anymore. Thank you so very much...

Hope this is of some help to you. If you have LIS, personally I would not have the extra pain of skin tag removal, especially as they can come back. Try reading some of the success stories on here (and mostly success stories are what there are!). It will get better. You would want, IMO, to have an experienced CRS to do LIS. Their bread and butter so to speak. Take heart!! It's not a forever thing and you will get through it.

Dear SavaIci,

You are so sweet. Thanks so much for taking the time to read all this and for all the advice. It almost brought me to tears reading it and just simply having someone understand and knowing what it's actually like. It can get pretty lonely sometimes dealing with this as it is something that I am still not comfortable with when it comes to talking about it with people in my life besides my husband.

I was also concerned with the fact that maybe I am taking TOO much fiber as you pointed out especially for my weight and height. I am taking about 25 to sometimes 35 grams of fiber a day, and I'm thinking I might have to cut down on it..or maybe the Citrucel. I just want to make sure my stools stay soft!! I will check out Milk of Magnesia; I was also considering Miralax instead of the Colace. I just am scared of getting dependent on these! But hope not. So yes, as of right now, I shall soldier on and keep at it with the Nifedipine/Lidocaine.

Thank you again!

Also, about my fissure being located on the side rather than in the 12 o'clock or 6 o'clock position...this also makes me very nervous. How common is this and does it give me a good chance of having something such as Crohn's? I know I don't have an STD. I have read that this tends to be more common in women, but it is slightly scary to know mine is the oddball :/. I don't seem to have any other symptoms.

Cut your fibre down to about 20g, as you are fairly short (like my sister's height :) ) and take a multi vitamin. This saved my life, the vitamins! I take Smarty Pants for Adults which are not only good for you, but delicious too . I get them on Amazon. Crohn's is an autoimmune disease.

Here are some links here on the Forum about Crohn's. I don't have this, but have another autoimmune disease called Behcet's:

search.php?keywords=Crohn%27s&terms=all&author=&sc=1&sf=titleonly&sr=posts&sk=t&sd=d&st=0&ch=300&t=0&submit=Search

We know your pain so well. First of all 3 days is nothing for the creams. They take up to six weeks to work so i'm totally not surprised that you haven't seen a difference yet. Keep on applying it, it'll take a few weeks to seem worth it but chances are it'll help a lot. I didn't start to notice a big difference until about week 8. Fissures are very stubborn and the healing process takes months. I wouldn't be thinking about surgery this early on just continue with the cream. Stool softeners don't really work for me, I need a laxative to make a big difference. Miralax doesn't actually stimulate a bowel movement, it just draws water from your body into your bowel so the poop is softer when it comes out. It's not ideal taking laxatives or any medication but for a few months you'll be totally fine to take a daily dose of something like miralax. Soft bowel movements are key.

It is less common to get fissures at the sides of your anus but I wouldn't worry about crohn's if you have no other symptoms such as diarrhea, stomach cramps, blood and or mucus in your stool. I imagine you would have mentioned those symptoms if that were the case so don't be stressing out about it. I have an anal fistula which is also linked to having crohn's disease but hey, I don't have chrones disease.

Did you tell your doctor you've been seeing blood? That's usually why they send you for a sig test. It's completely normal to have small amounts of bright red blood associated with a fissure. It's just like a cut anywhere else on the body, you disturb it and sometimes it'll bleed so don't worry if you are bleeding slightly after going to the toilet.

It's good that you are applying vaseline before bms. I do that religiously now. My advice to you is keep on with the cream and the hot baths and ask your doctor to prescribe Miralax. There are other types of laxative but that is the favourite round here. I use the British equivalent called Laxido.

If you are in the US, you don't need a prescription for Miralax. It's over the counter in any pharmacy. Don't worry about becoming reliant on this right now; far more important to get things soft as toothpaste and moving through easily.

Also, the best thing is to consult with a CRS when it comes to Crohn's. It's quite common, however, to have blood in the pan or a little on the toilet paper, so don't worry about that. I bleed fairly often, but when I had a sigmoidoscopy done, apart from the wretched fissure, they only mentioned internal hemorrhoids as being the cause of this (and hemorrhoids are something just about everyone has).

Try not to worry, difficult though that is, and if you feel like ranting, always feel free. We know exactly what it's like to feel down with this