First I want to thank everyone who has posted on this forum and has aided in my anal fissure finally healing!!!! I am a gynecologist and found myself personally suffering from an anal fissure after I was treated with narcotics 3 months ago for a herniated lumbar disc. After 6 days of no bowel movement and dreading sitting on the toilet because of severe back pain, I finally took a laxative and pooped out a small cannonball tearing my anus on the way out. We all know the severe pain and spasms that ensued for the next 3 months off and on after a bowel movement. I read everything I could find on the Internet and tried it ALL! Finally, I prayed a lot and drew on the basic principles I learned regarding the bowel and wound healing in medical school. After 3 months of suffering, i want to share what i learned. Please use whatever helps you. Try everything. You will heal!

1. A healthy human body knows how to heal an anal fissure. You have to get healthy. And then you have to wait. Ignore the time frame on the internet of healing time being 4-6 weeks. It takes longer than this and is different for everyone.
2. Get diagnosed early, don't ever guess at what you have.
3. Do not use steroid suppositiories. They delay healing of a fissure but are great for hemorrhoids.
4. I went gluten, dairy, tomato, chocolate and egg free 2 months ago. This has been scientifically studied to heal. To be honest, i think i just needed to eat tons of fruit and vegetables to keep the stools loose. I hope to add some of these foods back in small quantities soon. Fruit smoothies helped the most.
5. Drink a lot of water.
6. I took Metamucil for 3 weeks until my stools got so big and i ripped back open with every stool. Then i switched to Miralax. This kept the stools skinny but after 3 weeks i was eating more and having 4 stools a day. Although I wasnt ripping open, the fissure felt like it was burned from the bile acids in my diarrhea type stools. And the spasms continued. I then stopped all laxatives and just eat a lot of fruit and vegetables and water to keep stools loose. Now i only have 1-2 loose stools a day and the fissure is healing very rapidly. Dont stay on the laxatives too long. The bile acids rushing through the small intestines with laxative-induced diarrhea keep the fissure raw.
7. Put some type of lubricant just inside the anus before a bowel movement to coat the fissure. Vaseline, olive oil with basil, aquaphor, anything. Use your pinky finger, or better yet, use a qtip VERY GENTLY. Put your qtip in the anus on the opposite side of the fiasure so it doesnt hurt as much. I like the qtip best because I felt the finger still caused too much stretching.
8. After a bowel movement, cleanse the inner anus gently with olive oil and a qtip. I applied an antibiotic ointment (bacitracin) just inside the fissure. You can also use topical lidocaine cream to numb it a little.
9. Dont sit too much. If you have to, sit on a heating pad or a hot pack.The fissure needs blood flow to heal.
10. The sitz baths are nice, but i truly feel it was the heat of the bath that helped the most. I put coconut oil in my bath. I tried Epsom salts but i felt the salt increased the burning feeling.
11. Initially i used Manuka honey, but went to the antibiotic ointment because i felt it had the most potency when it came to fighting bacteria.
11. I tried Calmoseptine and Pranicure. I didnt think they helped me that much and both caused itching. The Calmoseptine worked great for my son's sunburn though.
12. As the fissure healed it itched terribly. I only got relief from ice at night. If it looks like there is a red rash around the anus,.it is probably a yeast infection of the skin. I applied clotrimazole cream twice a day and it went away after a few days.
13. I bought sensitive skin baby wipes and have stopped using toilet paper on my anus. The hemorrhoidal wipes have too much medication in them and cause more irritation.
14. DO NOT OVEREAT. I had a problem with sweets and overeating sometimes that I think has led to intermittent chronic constipation in my adult life. I have lost 7 pounds since the fissure happened. The less you eat, the less you poop. If you overeat,.this will lead to bigger harder stools. It is not worth the pain.
15. Be good to yourself. Allow yourself to lay down. Let your housework go for now.
16. Dont hold in your stool for fear of pain. Scream if you have to but let the stool out while trying to relax the anus. I chanted "Its going to be ok, its going to be ok" while I was pooping just to get through it.
17. Exercise every morning to get blood flow to the bowel and anus. I walk for 15-20 minutes before getting ready for work. This stimulates the bowel and gets the bowel movement over with.
18. My spasms never lasted more than 4 hours after each bowel movement. Keep telling yourself the pain will not take up your whole day.
19. Keep praying. God is the ultimate healer and will heal you if you ask Him to.

That's great advice thanks so much for posting . Hope you feel normal soon!
Why are tomatoes bad? Is it because they have too much insoluble fiber? Your advice is invaluable and I know it will help others.
Is your fissure anterior or posterior? Is there any benefit of squatting? Do you know if squatting is bad for any of the fissures?
I had read that anal fissure can be related to menstrual cycles. I think I am peri menopausal and started some estrogen cream for a bit first applied it on the fissure then gave it up . I read on this forum it may help but did not seem to help me much so stayed away from it of late. What do you think of that?
Thanks doc for writing in and sorry to bug you with questions
Best HTD

I dont know why tomatoes are bad. I think it has to do with acidity but I'm not sure. It was just one of the foods included in the elimination diet study for fissures. My fissure is posterior. I bought a stool to prop my feet on during bowel movement. I think the stool.is eliminated quicker but I feel like it stretches my anus. I am not very tall. Maybe that has something to do with it. I am also perimenopausal but I don't think it is directly related. Women our age have a lot of stress and we start to age quicker with menopause. I was under a lot of stress when I hurt my back and the fissure was a result of the constipation from the meds I took. I think stress has a lot to do with it because we stop eating right and exercising under stress and are prone to this happening. The estrogen probably will only help as it is acting like a lubricant. I personally would not use it aa it gets absorbed quickly from the rectum and has risks.
I really hope you feel better. It is terrible.

Thanks doc

Thank you. Your comments are very encouraging and helpful. Quite right about getting diagnosed early. I went to my doctor immediately and she took a very conservative approach. I was on citrucel only for six months but the surgeon last month prescribed Niro-Bid for the pain. I'm very careful with my diet. I agree. Six to eight weeks for a tear to heal is a formula that doesn't always fit, not in my case anyway. It has only been recently that my situation has improved a little. I'm happy that you are doing better.