38 year old healthy male here who has been dealing with AF for well over a year along with internal hemmorhoids. Believe the problem was mostly from straining while lifting weights, especially lower body exercises like squats and secondarily, occasionally pushing too hard on the toilet. Tried sitz baths and just about every OTC cream (prep H, Dibucaine, Mayinglong) along with natural remedies like coconut oil without much success. Some things made the pain more tolerable but never felt like anything was really fixing the problem.

Dreaded the idea of seeing a doctor for the problem and getting a probe exam but after having some blood spotting, decided it was best to buckle up and go. I went directly to a reputable Gastroentologist rather than my regular doctor. He diagnosed the problem as AF and to a lesser extent internal hems. While the exam was not pleasant, it was over in seconds and I'm so glad I finally went. He prescribed Rectiv for 6 weeks and warned me not to put too much on or I could get a headache. When I first started, i did get a very mild headache the first couple weeks and maybe occasionally after that but a couple Tylenol took care of it or usually it passed in about 30 minutes. The headache was nothing compared to the butt pain so it really wasn't an issue. You apply Rectiv with a disposable exam glove. It's very important not to scratch the area with your nail so always use these gloves when applying any kind of cream.

After just finishing my 6th week of using Rectiv, I feel like I am 99% healed. It wasn't an overnight fix but I started feeling some initial relief after 3 days of use. Then there was kind of a lull with only slight progress until about right about end of week 4. After that, I haven't had any pain at all and no discomfort. I've had an occasional (maybe once a day) mild tickle that goes away in minutes but that may be lingering hemmorhoids or maybe some scar tissue. If that doesn't completely heal over the next few weeks, I'll go see the doc again as maybe I just need a hem cream to fix that.

Here are a few suggestions that worked for me during the healing phase and afterwards:

1. The doctor said never use any kind of soap to cleanse the area as it has a drying effect and makes the skin more susceptible to a tear. I was very guilty of this. He recommended Balneol for cleansing. You can get it at Walmart and Amazon. I definitely felt like this was a huge help. I use it twice a day including after a BM.
2. Use either unscented baby wipes or the moist toilet paper for wiping. i preferred baby wipes but obviously these are not flushable.
3. Breathing exercises while on the toilet kept me from straining and seemed to push things along.
4. Sitz baths at least twice a day, especially after BM. Just make sure not to use too hot of water. I didn't notice a difference with using Epsom salts so after a while I just used plain warm water.
5. Drink 10-12 glasses of water a day. This was a big change for me.
6. In order to get more fiber, i always started my day with Quaker 100% Old Fashioned Oats sprinkled with Wheat Germ, a piece of fruit and a can of low sodium V8. I tried to eat more fruit throughout the day as a snack -apples, bananas and berries worked well for me. Sprinkled frozen strawberries/blueberries berries with a little Wheat Germ for a nice evening snack.
7. I started taking a stool softener at night but after changing my diet and drinking more water, this wasn't needed after a couple weeks as it actually started making things worse as the stools were way too loose.
8. Avoid nuts, popcorn, seeds and tortilla chips. This was very important for me as I had snacked twice a day on almonds for a long time thinking this was a good way to get more fiber but it was actually making things worse once I had AF.
9. Avoid caffeine and alcohol. I couldn't eliminate this completely during my 6 weeks, but did cut down. i went from 2-3 cups of coffee to 1. Limited alocohol to a couple drinks on the weekends.
10. Avoid weight lifting till the AF is healed, especially lower body exercises. I also stopped running and did more walking during this time.

Hope this helps someone out there. I cannot stress enough to go see a doctor for the problem, especially to rule out a more life threatening issue.

Thank you for sharing you story and experience. And very glad Rectiv helped you to heal! Keep going and remember to stick to diet for some more time after healing.

This has been so helpful. Thank you.

I've been battling a wicked AF, as well as a terrible doctor who's only advice was to drink water. And that was for medication that was supposed to be milder than Rectiv. But he gave me Rectiv! I put too much in the first time. And it wasn't that much really. It hits you hard.

And it didn't work the 10 days he told me to do it. Nor the extra 7. Some improvement, but not at all cleared up. I felt like there was no hope.

Thanks to you and your doc I know what I need to do.