Hello!

I've been a regular visitor to this site since Easter when I first suspected that the horrendous pain up my backside might be an anal fissure, so thought its high time I introduced myself...

I'm a mid-40's male, based in the UK, and had an internal Anal Fissure diagnosis confirmed by my GP in early April. The AF came about after a long-term injury to an adductor tendon caused a tightening of the muscles/tendons in the whole pelvic region (including presumably the Anal Sphincter). This led to increasing difficulty with bm's, and sparing the gory details, eventually introduced me to the twilight world of AF!

3 and a half months on and I guess the condition is now chronic...The initial intense pain of the first couple of weeks has subsided, but I'm still left with regular burning after bm's (lasts a few hours) and an inability to sit for longer than about half an hour at a time - if I'm lucky! (not ideal since I have a desk job!). Bending over feels like I might rip myself in two (not sure why!?) and people say execrise is good for AF's, but anything more than walking and I just seem to rip the thing open again..How do people exercise with this condition...?!? Anything but the shortest of car journeys are a nightmare, so without sounding too melodramatic, I'm gradually feeling like my world's closing in on me...

As far as treatments are concerned, initially I tried OTC products, anusol & germaloid, then was prescribed Xyloproct by my GP (had an allergic reaction to that!) then after a second visit, was put on Rectogesic. The Doctor was pretty confident Rectogesic would sort it out, but I'm 5 weeks into the treatment now and if I'm honest not sure I feel any better at all...In actual fact the internal examination on that second visit felt like it put me back about a month, I could barely walk for a week after, and I'm pretty sure the wound was re-opened...To support the pharmaceutical treatments, I've tried salt baths 3x a day for 6 weeks (no effect - in fact I often seemed to damage myself further climbing in and out the bath!), drinking lots of water, taking stool softeners, standing for much of the day and icing my behind when I do sit (to numb the pain and possibly stimulate some blood flow to the area!?). None of these measures seem to be doing much though, if I'm honest...?!

Which leads me on to the next issue, as others have mentioned here, the psychological affect AF's have on you (and, importantly, your loved ones!). It really can/does have a terrible affect on your attitude to life. I was a professional sportsman in my 20's and even in my 40's exercised pretty much every day, until this. Now I haven't exercised in 3 months (anything apart from walking the dog seems to re-open the wound?) and am avoiding social situations now wherever possible (its already put paid to a fledgling relationship too..). I do appreciate the importance of a positive mental attitude, but it is literally 2 steps forward, 2 steps back, and I feel genuinely devastated when after a couple of days seemingly good progress, something as simple as bending over to pick something up, has me back to square one! Its soul-destroying!!

Anyway, I don't want to ramble on in self-pity too much...but thought I should introduce myself before I start popping up asking questions elsewhere on the forum...

Before I sign off, I'd also like to say what a great site this is, full of useful insight, and also, importantly, full of people who understand what this ailment is like and the affect it can have on your life. So thank you everyone for sharing your time/experiences here...if I ever get out of this nightmare, I'll be more than happy to share mine...

Hi Mr Fissure,
I can totally appreciate where you are coming from. I have had my fissure for 10 months and have just had Botox.
I would advise to keep going with the GTN as I didn't even see any improvement with it until about 3 months in. Fissures are pesky little things with great perseverance so we have to show the same level too. In the first two months of this I quite frankly wanted to end it and if it wasn't for my children I may well have done...as I say on quite a few posts nothing can compare to the pain of a fissure...be it child birth, broken bones, kidney stones...can't hold a candle to the soul destroying agony of a fissure.
I too had pain when I bent over in the first 6 months something as simple as putting washing in the machine would make me want to cry...I think it may relate to the position of the fissure as mine is posterior and very deep...but that did stop and I don't get any pain when bending now. I have also been able to start swimming again even with a very active fissure..ok I can't do 60 lengths anymore but at least I can do some.
Again I agree with you that the mental torture of these things is nearly as bad as the physical agony...we live each day in fear of what other people do quite normally, it controls most of our decisions and impacts us in every area...I nearly lost my job and certainly stopped doing things with my children for a while. But please don't give up it does get better and having just had Botox I would recommend that for you if you don't have any pre existing bowel issues as it's made my pain so much better even with my IBS. Ask your doc...your male (seems to make a difference here in the UK ) and this pain is impacting on your life....
You will get better it will go you just have to try and get through the dark times...fight this fissure don't let it bring you down...I keep telling myself that it really is just a cut and it has to heal eventually

Hi Mypoorbutt

Many thanks for your reply and kind words.

I'm sorry to hear you've been struggling with this condition for 10 months, though - you sound like you've been through hell ! Hopefully your botox treatment will bring an end to your suffering - how's it going so far?! Interesting you say its different for a male in the UK - in what way? My doctor never even mentioned botox, but did say if Rectogesic/GTN fails, then the next step would be a consultation with a cr surgeon. Was there any reason you went for botox rather than the LIS ?

Its heartening to hear that all might not be lost yet too with Rectogesic..I'll definitely keep perservering. As far as the application of Rectogesic's concerned, if its not too personal a question do you insert it (as per the Patient Information Leaflet) or are you following NHS 'Choices' website guidelines, which seems to completely contradict and say "Make sure you apply the ointment to the skin around the anus and don't push it inside the anal canal."
I must admit, for obvious reasons I'm hoping the NHS method is the way to go !?!

I'm not actually sure where my AF(s?) is (my GP didn't tell me, and I was so keen to get out after the examination , I forgot to ask!), but it makes sense that if it hurts bending forward then its likely to be posterior too. Its so debilitating, I feel it walking up any sort of incline, even putting socks on without pain feels like an achievement these days!

The mental aspect of an AF is definitely as big an issue as the fissure itself (and seems to widely be ignored by the medical profession) but I can appreciate how you felt in those early days... its not an easy thing for anyone to understand who hasn't actually had it, yet its not something you can easily discuss with people to explain why you're feeling like you're feeling! I'm glad to hear though that you've got through your dark days now and you're in less pain and life's more positive for you again... Brilliant too that you've progressed so far that you can swim again - gives me some hope too! :-)

Funnily enough in terms of my mental state it feels like a bit of watershed today, just posting on this forum for the first time and chatting with a fellow sufferer, so thanks again for taking time out of your Sunday to offer your support...

Take care, and fingers crossed for you, with the botox!

Yes I have def seen what hell looks like and it's fissure shaped,
Botox was awful for the first two weeks as I also had a fissurectomy coz my fissure needed a tidy up apparently lol. But after week 3 I def noticed a difference in the tightness of my sphincter and if I only have one BM a day I'm not in any pain just discomfort...my experience of CRS in the uk is that they don't like to give women LIS as we may have weaker muscle tone due to having babies or planning on having babies...not true as under examination mine was a high 5 (not in a good way lol). I had to have Botox first as my fissure is long and deep so the LIS cut would have to be long too making the risk of incontinence very high...I didn't care at that point but my surgeon did.
My CRS says to put the GTN inside...it's not vital but if your fissure is deep then I was advised to go just past the first knuckle on my index finger...had to start with my little finger though lol.
It hurt me for months to go downstairs even stepping off a kerb made the fissure hurt and my sphincter spasm...but that went about 3 months ago.
Yes it took me a while to get my head round the fact that this could last longer than I expected...I'm quite an impatient person and this I guess has taught me that patience is a virtue
Take care hope you see improvement

Thanks for your reply, Mypoorbutt.

It does take a fair bit of getting your head around the fact that a little cut can cause this much pain and take so long to heal - I've had some pretty bad injuries through sport and an operation 4 years ago that healed much quicker than this. I just put this down to me getting weaker physically (and mentally) as I got older, but seems its probably not as simple as that...

Thanks for the detailed info re: Botox & LIS - again, very useful information for me, for when I next visit the GP and/or CRS. As for the Rectogesic - Eek!! Think I'll use my little pinky first too! LOL! Now just need to find a plank of wood to bite into and I'll be fine...

Seriously though, glad to hear you're mostly out of pain now, that's great news! Hope the botox continues working for you and you make a complete recovery.

Take care...

Oh trust me I was like...how can people say pain is that bad they just couldn't cope...I have had loads of medical stuff and had my knee popped back in by a friend when it dislocated at a nightclub, no pain relief not even much alcohol....well the fissures taught me different that there is a level of pain that exists that is beyond comprehension...so I guess they have also made me a bit more empathetic.
Yep pinky finger deep breath relax...and think of England lol...you may need that plank of wood the first few times.
Wish I could give advise re diet but I'm not much help there as I have to focus on trying to slow mine down lol
Yep as long as my IBS behaves and I don't go to the loo 20x a day then the pain isn't really there..just discomfort...only comes on after the third time lol. I'm grateful I had the Botox even if it is only to make the LIS easier.
Take care and hopefully you will only need time and GTN

...so, another 3 months or so down the line, thought I'd update on my progress (!?) in case its of interest to anyone, or in case anything I write might happen to help someone else suffering from this vile condition.

I've been continuing with the Rectogesic (GTN) after managing to get a second tube from the doctor. Generally my condition has improved over the 6 months, but only up to a point, and its very much a case of 2 steps forward, 1 step back.

I'm not in anything like the pain I was in (in either intensity or duration) at the start, but I'm still a long way off being back to my old self. I still have immense difficulty sitting for any more than an hour at a time, and certain chairs are just an absolute no no! This aspect is probably the worst for me, as it rules me out of a lot of social situations and I now stand all day by my PC while working, which has also brought on pretty bad lower back pain! I can't do any sport/physical activity other than walk the dog (and even then, need to watch steep inclines), and as for relationships/sex - forget it!

So the dilemma I now face, is where do I go from here..?! After 6 months on balance I feel I am getting better, but its painfully slow and my life is nothing like it was prior to the AF. Though I've tried to stay positive, most times I can't help but feel down about what I've become... Yet, on the other hand, if I'm improving, do I just need to stay patient and let time take its effect?

I'm due to see the doctor again next week, when my Recto runs out, and am concerned about the prospect of LIS surgery and the risks of incontinence...Are there other options other than LIS or Botox that might have an effect and help me back to full health (doubt I'll get a 3rd tube of Rectogesic - especially when I tell the Doc I've had a pretty bad spell of Vertigo this last fortnight?)

As you'll probably have gathered I'm not having a good day (after having one of my best days just 2 days ago!) so excuse the moaning rant this post has unwittingly become...To be honest, the mental torture is probably the worst aspect of AF's - its all-consuming...!

Mypoorbutt, in case you happen to read here, I do hope you managed to get your surgery and that you've come out the other side in good health...!? If I don't hear from you i can presume that's the case..!?

BTW, after reading comments on this forum, I'm currently trying coconut oil suppositories, as I believe they have medicinal/healing properties, something which I believe GTN/Recto doesn't possess. Will let you know if I get any joy. Oh and I bought a ring cushion and promptly threw it away after about 5 seconds. Opening the a-hole wide was the last thing my AF needed - so if anyone lijke me is having trouble sitting down and is thinking of one, approach with caution!

Anyway, will keep this thread updated on my progress or otherwise, as it seems like I'm in for the long haul with this little b@***d !

Good luck all!
Mr Fissure

Hi Mr F,
Glad to hear your a bit better...sorry it's not totally better, fissures really do require patience to heal and whether you go for LIS or Botox is up to you...you are male so will have no problem being offered the LIS I think.
As for other things that help yes coconut oil is soothing but I have used it every day for a year and my fissure is still very much here, but anything is worth a try. I have been using GTN for a year now even with the Botox my CRS says he's had people on it for two to three years who didn't want to risk LIS, so if you want to carry on with the GTN it shouldn't be an issue I have two tubes a month lol....I occasionally go dizzy if I stand up straight after putting it on.
I feel one of the main things that help is once the spasms have stopped then it's best to try and get back to life pre fissure as much as possible. I go to the gym swim and walk...but I haven't eaten a piece of fruit in a year and only have a vegetable once a fortnight as I'm so scared of going to the toilet too much...so we have to do what works for us.
You could ask for Botox as there isn't any risk of permanent incontinence from that....although there's not much risk from LIS.
I know what you mean about the sex to be honest that is nearly as frustrating as the food....I really enjoyed it now I often have to make myself as depending on how my bowel has been I know it will kill my fissure so bad after.
I have not had my LIS yet bloody NHS waiting lists but have had my pre op last week so hopefully in the next five weeks the job will be done.
These hellish little things change our life don't let it change you
Chin up and keep going

Hi Mypoorbutt!

Sorry to hear you're still on the forum(!), but very pleased to hear you're on the home straight now with the LIS finish line in sight! Really hope all goes well for you and you finally rid yourself of the AF!

Thanks for the advice re: GTN - I was under the impression you couldn't use for more than about 12 wks, so I will ask about that...I've developed quite a sore rash around my b-hole this week, so sitting down has become even more painful than normal (as has walking) so hoping I'm not developing an allergic skin reaction to it..!?

Agree with your sentiments about trying to keep the normal life, but its amazing how many things are affected by it. Any exercise more strenuous than walking and I seem to re-tear it.
I absolutely share your frustration on the sex-front. Its been a disaster for my sex-life, even though I'm a straight male (so no anal sex issues to worry about)...It finished a relationship before it really even got going and if I try some self-relief when I ejaculate its excruciating (think the sphincter goes into spasm) and pretty sure it re-opens the fissure, so can't even bring myself the occasional relief....! Its one of the main reasons I feel I'll eventually have to opt for the LIS, because I don't think I'll ever be able to have sex again if I don't! Consequently I'm actively avoiding a lot of social situations now, especially where there's a chance I might meet someone...

Sorry to hear that its affected your eating habits so much too! That must be really awful! I have a reasonably healthy diet, which I've not really needed to change too much, but because I can't exercise any more (used to train every day prior to the AF) I've gone the opposite way to you and put on nearly a stone and half in 6 months! I think I probably need to set myself some goals /targets to help in this area, but brilliant you are able to go to the gym and swim!

Anyway, I'm going to wrap it up there. Been a tough couple of days, but finally feeling a little bit of relief after another coconut oil bath soak...

Thanks for all your support and advice (you have enough problems of your own to worry about, so please don't feel obliged to reply!), but here's hoping you have a good, pain-free weekend...

Hi,
Replying isn't an obligation...it actually helps my sanity lol gives me something slightly constructive to do whilst laying on my front hoping the pain goes lol.
Oh the rash doesn't sound good...maybe you are having a reaction...if so then another tube may not be I your future have you tried the MSM cream along with the coconut might help the rash.
I have IBD so many things that are normally great for people with fissures set me off big time....dairy is a no no anyway really (although I used too lol) but fruit can send me to the loo at least six times which was ok pre fissure but would be hell now.
I'm not sure I have ever had a retear so to speak just a git of a fissure that refuses to heal...stubborn doesn't even come close. I remember when stepping down a kerb used to send my sphincter into spasms. Now it's just BMs and like you say sexual gratification.
Must be difficult (ok I wrote hard then realised lmao) if you don't already have a partner to explain this or to be brave enough to start a new relationship...I know I couldn't. It's bad enough with my hubby who doesn't get why things can't go back to normal as to quote him "it's been over a year now how long will it take).
It's this side of it and the constant worry about what will set the fissure off next that can take their toll just as much as the pain.
Great minds think alike I have just done my coconut bath...I add oil of oregano to try n stop any kind of infection.
Got a course tomorrow so will be sat on my butt for well over 10 hours including travel....really not looking forward to that.
Hope you have a pain free weekend too