Hello everybody, I’d like to share with you my recent history with an AF and seek for advice. This forum has been really helpful in the first stages of this disease, literally saving my bu** when coming to the use of Rectogesic – details below.
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I’m 26 yo female, with a very stressful job. Recently diagnosed with fibromyalgia; gluten sensitivity and lactose intolerant, very prone to diarrhoea; for me, it was not unusual (but rather the norm) to have 3-4 BM a day – that’s also why I’m very careful about what I eat and I drink (I would say I have a healthy diet – but I’m also a smoker). I never experienced constipation, before this AF.

My terrible journey into fissures started around mid-March, when I had a whole afternoon of strong, watery diarrhoea. I immediately took some probiotics and the problem was “solved”.

A week later I started feeling my anus itchy, and had a mild pain in the morning after the first BM. I thought “haemorrhoids came back” (I have suffered 2nd degreed hems in 2015, but actually managed to deal with them with not too much discomfort, especially in colder months). Strange though, I could not “feel” any bulge, and the anus was perfectly sane from the outside (no veins or rips). Also, no blood at all after BM. This in particular mislead me into thinking it was haemorrhoids rather than an AF.

I went to the pharmacy and was given Daflon and Venoruton (both helping the circulation).
No improvement, the problem persisted and got worse; in another week I started to have big pains in the morning one hour after BM, but nothing that an Ibuprofen could not kill. Plus, I was working on a project and couldn’t afford to stop at all.

All this led me to my very first excruciating day of pain, after one particularly “fluid” BM. Went straight to the ER, received a terrible, awful, disgusting visit after which I started losing small traces of blood.
I immediately got in touch with a CRS in a private clinic, and got an appointment for the next day.
After the anoscopy, performed with a local gel anaesthetic, I was diagnosed with a large but superficial internal fissure, and proctitis.

During the visit, the doctor also performed a sclerotherapy on the haemorrhoids, which I learned later was not helping at all with the AF.

The therapy prescribed was with an ointment called Proktits- M, lots of water, veggies – things I normally do.
The first BM after this visit was excruciating. Like crystals cutting and ripping my rectum. Blood in a quantity I hadn’t had before.

The days later, in agony, I took ibuprofen, which offered an hour or two of relief, not knowing that it actually makes bleeding worse. Not many know this, but it’s true. All the NSAIDs make you bleed even more.
I endured a couple of days, then called the CRS in tears as I couldn’t take no more. Proktis-M was clearly not working, ibuprofen was making bleeding worse, and I had spasm to faint and pain 12/10.
The CRS suggested me to stick to the diet, no ibuprofen (only paracetamol – which obviously did not work) continue with Proktis-M, and take Psyllum that could help me with the BM (even if they were not hard) – which in two days caused me constipation with a hard, gum-like, ball of feces, that I expelled in a BM that resembled like giving birth to a child.
[Something I have learned: never, ever take more fibres if you already eat a ton of them. Or at least, that was my case.]

Called CRS again, mad at him, telling him I had ripped even more after this Psyllum he insisted me to take, and Proktis-M sting and burned like hell when applied internally, so he told me to stop using it. Upon my suggestion, got prescribed with Rectogesic. God bless who invented that cream. 1,5 cm of ointment 3 times a day.
Notice that I was not able to go to work during these two weeks because of the pain. Fortunately, I could work from home.

Also, my BM went from 3-4 to 1 per day, and I was not exactly seeing unicorns and rainbows when this one and only BM had to happen – rather “nightmareish” indeed.

First two days of Rectogesic: headache. But, you know, when you experience the pain an AF gives you, nothing in the whole world is comparable. Took paracetamol and in three days the headaches were gone; later I had only a mild headache that lasted no longer than half an hour at every application of the ointment.
After 3 days of application, I had the first blood free BM, with mild pain – nothing comparable to the ones before. I also began taking half a dose of a laxative in the evening to prevent even more hard feces.
Things got better, and in a week I was able to sit and go to work. Pain after BM was 1-2/10, but still anus with little spasm.

I got a second appointment with the CRS to see how the cure was going ten days ago.
Another anoscopy with a paediatric anoscope, which felt like being impaled, and the CRS told me the fissure was healing. The anal spasm persisted though, so the proctitis, which had even gotten worse.
Again, he performed a sclerotherapy on the haemorrhoids.
He also gave me a paediatric plastic plug (diameter of 18mm) to use to relax the muscle. He told me to stick with Recotgesic for another two weeks.

The morning later, after the morning BM, blood and spasms again, pain 12/10 – I couldn’t move. I was so angry and frustrated I screamed and cried and screamed and cried untill my eyeballs were red and ready to pop out. Rectogesic was no more working on this pain. I felt miserable.

Called the CRS again and asked if the anoscopy or the sclerotherapy could have worsened my situation, and he said basically no.
Now, how can this be true? I went into the hospital able to walk, and the day later I was in tears again and feeling suicidal!

After a week, the pain has finally lowered, thanks to Rectogesic, which in 5 days started to be effective again. I’m able to walk 15-20 minutes, and the pain is max. 2/10 a few hours after the morning BM.
My next follow up with the CRS is in June, and I’m now totally freaked out by having another anoscopy or finger exploration performed on me.

This is my story so far.

Now time for some questions:
• Have anyone of you ever experienced a re-tear after an anoscopy or a visit to CRS?
• Can the sclerotherapy on haemorrhoids worsen the spasms? I feel that the exposed haemorrhoids, ironically, “help” the circulation in the area, and injecting a sclerosant substance that stiffen them is counter-productive – especially when you have anal spasm…
• I’m still having spasms, especially after the morning BM I can feel the rounded margins of the anal muscle are very tight, especially on the right side. Should I be worried? Is LIS the one and only solution to this problem, it it persists at the end of the treatment with Rectogesic?
• When to start using the plug? Even though the plug is a medical one, designed for this purpose, I am afraid I can cause damage or tear the fissure (ah, what the last anoscopy did to me…). Maybe it’s good to start with a gloved finger? Also, which lubricant use? The CRS hasn’t explain me anything about how to use this damn thing.
• Anyone here have an experience with proctitis? I was not given any medication for it, if not this ointment, Proktis-M, which actually sting like hell and cannot use – I think I’m intolerant to hyaluronic acid, and the CRS told me to stop using it because of the terrible burning sensation.
I’ worried this could be a symptom of ulcerative colitis – I have a fecal exam to do as soon as I recover from this AF. Anybody here suffer from AF and ulcerative colitis? Can the fissures be caused by ulcerative colitis?
• Last but not least, how do you deal with set-back? The first (and only) time I had one, I felt like killing myself.

Hi really sorry I hear your suffering
I agree the person who made the link between angina medicine and fissures needs the nobel prize.
I too got my fissure from diarrhoea I have crohns and IBS I could often go 20+ times a day. It never bothered me and I stupidly didn't take my meds and ate what I wanted....cue the fissures and a whole level of pain I never knew existed
I will try to answer some of your questions
1) yes I had an anoscope exam that I feel ripped my fissure from an old CRS. My current CRS never uses an anoscope for fissures and doesn't actually insert anything in there while people are conscious as he feels it has a very negative impact
2) never had that treatment so wouldn't like to comment but again my current CRS think treating hems unless really unavoidable can be detrimental to a fissure and leave scar tissue.
3)there are other options like Botox and continuing with the cream, depends on your healing, many heal without surgery
4)that seems a large size to start with could you ask for smaller perhaps. I did used to do manual dilation with my finger and go round in circles and dilation is recommended, maybe wait till your spasms have eased mid afternoon perhaps. I used coconut oil and ozonated olive oil
5) for a good CRS there should be a difference between ulcerative colitis and proctitis but you can ask for it to be tested also ask to be tested for peri anal crohns
6) setbacks are awful but when you recover it does make it easier the next time as you know you will get back. The toll this takes on us mentally is beyond understanding. I have suffered for years since I was 11 with IBS and 20ish with crohns. Both had a massive impact on my life in terms of pain and what I can and can't do but neither come close to the impact of the sodding fissure. If nothing else it has taught me to take care of myself and respect what my body is telling me. It has also taught me patience and understanding. I thought I understood pain before well sod me I didn't but I do now
We go on stronger than before secure in the knowledge that if we can get through this we can get through anything.
One more thing my current CRS who specialises in IBDs states that any watery BM is too acidic for the skin to handle and will cause or irritate fissures the aim is for a Bristol 3 as this is not acidic at all and is a natural dilation for the sphincter
Good luck you will heal

Mypoorbutt wrote:Hi really sorry I hear your suffering
I agree the person who made the link between angina medicine and fissures needs the nobel prize.
I too got my fissure from diarrhoea I have crohns and IBS I could often go 20+ times a day. It never bothered me and I stupidly didn't take my meds and ate what I wanted....cue the fissures and a whole level of pain I never knew existed
I will try to answer some of your questions
1) yes I had an anoscope exam that I feel ripped my fissure from an old CRS. My current CRS never uses an anoscope for fissures and doesn't actually insert anything in there while people are conscious as he feels it has a very negative impact
2) never had that treatment so wouldn't like to comment but again my current CRS think treating hems unless really unavoidable can be detrimental to a fissure and leave scar tissue.
3)there are other options like Botox and continuing with the cream, depends on your healing, many heal without surgery
4)that seems a large size to start with could you ask for smaller perhaps. I did used to do manual dilation with my finger and go round in circles and dilation is recommended, maybe wait till your spasms have eased mid afternoon perhaps. I used coconut oil and ozonated olive oil
5) for a good CRS there should be a difference between ulcerative colitis and proctitis but you can ask for it to be tested also ask to be tested for peri anal crohns
6) setbacks are awful but when you recover it does make it easier the next time as you know you will get back. The toll this takes on us mentally is beyond understanding. I have suffered for years since I was 11 with IBS and 20ish with crohns. Both had a massive impact on my life in terms of pain and what I can and can't do but neither come close to the impact of the sodding fissure. If nothing else it has taught me to take care of myself and respect what my body is telling me. It has also taught me patience and understanding. I thought I understood pain before well sod me I didn't but I do now
We go on stronger than before secure in the knowledge that if we can get through this we can get through anything.
One more thing my current CRS who specialises in IBDs states that any watery BM is too acidic for the skin to handle and will cause or irritate fissures the aim is for a Bristol 3 as this is not acidic at all and is a natural dilation for the sphincter
Good luck you will heal

Thank you, thank you, thank you for the advices given, and for the kind words. I’m truly sorry to hear your story too.
When I tell my journey to the people I know they most likely laugh at me if only they knew the suffering we’ve been through… Sure we will be stronger, no doubt. I’m also learning to be more empathic with the people that surround me – the only positive result of experiencing this type of pain.
I think that I will change my CRS – after the ripping of the fissure I cannot trust him anymore. Also I was not prescribed with any medication for the proctitis and this leaves me with quite a bit of anxiety. It’s not easy to find a good CRS where I live (IT)
I have a faecal exam to take – calprotectin – which was prescribed by my rheumatologist (the only one who is trying actively to find out what the hell is wrong with my body). As far as I understood, this should evidence any inflammatory state of the colon and intestine. Did you also take this exam to be diagnosed with Crohn’s?

You are very welcome, yes I agree that most people including some docs can be so dismissive of fissures. They wouldn't be if they had experienced the level of pain.
I myself haven't had that test I was sent straight for a colonoscopy which showed up my crohns quite clearly and I often have blood tests to check on inflammation levels. I think that was because I have severe IBS so it could have come up positive from that too.
It is a really good test though I know a couple of people in my crohns group who got a negative from it and on further investigation were found to have an IBD.
You are lucky to have found a doc who is happy to help and if you aren't happy with your CRS then please change because some of them can be quite heavy handed
Take care

Mypoorbutt wrote:You are very welcome, yes I agree that most people including some docs can be so dismissive of fissures. They wouldn't be if they had experienced the level of pain.
I myself haven't had that test I was sent straight for a colonoscopy which showed up my crohns quite clearly and I often have blood tests to check on inflammation levels. I think that was because I have severe IBS so it could have come up positive from that too.
It is a really good test though I know a couple of people in my crohns group who got a negative from it and on further investigation were found to have an IBD.
You are lucky to have found a doc who is happy to help and if you aren't happy with your CRS then please change because some of them can be quite heavy handed
Take care

Thanks Mypoorbutt!
Tomorrow I will take the calprotectin exam. Finger crossed.

I was wondering, in case I need to also have a colonoscopy (which I truly hope not), could it re-open the fissure? Should I wait until the fissure has healed (if at all, ah…)?

Did you had any discomfort during/after the exam for your fissure?

Thank you!

I choose not to have my twice yearly colonoscopy when my fissure was bad. But I do know members who have had no problem having one, my main issue was the prep which makes me quite ill.
I doubt you would have to have a colonoscopy especially if your exam come back with definitive markers. If you had too make sure you request the smallest scope and tell them that you have an active fissure.
I will be having mine this year in July so that will e interesting lol
Your welcome