About 3 weeks ago, I got really constipated, which does not happen often for me. I must have pushed too hard, because after that, I had HUGE hemorrhoids (I've had them on and off since I gave birth to my 3rd in 2012). I was able to rest and get them down to normal, or so I thought. But a few days after that, I noticed it hurt when I pooped, like a stinging feeling. I got some prep H wipes, tucks, and ointment, thinking this would do the trick. Well, things didn't get much better, but I was tolerating at least. I ordered a sitz bath because I heard those also help, so I started using those about 2 1/2 weeks ago, twice a day, with warm water. When things didn't improve much, I began to search more about hemorrhoids, and came across anal fissures, which I'd never heard of before. I suspected that I might have them, and read that it could take up to 8 weeks to heal on their own, and let's just say, that wasn't comforting. I started using a stool softener at night and a fiber pill (2mg) in the evening before bed, but this did not regulate me at all. I got bad diarrhea, which I think actually made it worse. Stupidly, we decided to go on our 10-hour road trip to see family for Thanksgiving last week. I survived the drive there, somehow! But the entire week, I was in pain for hours after each bowel movement. I was still doing a stool softener in the morning and fiber at night. I could not regulate my bowels no matter how I tried! Thanksgiving meal probably didn't help much, but I ate very conservatively.

I came across this site the day after Thanksgiving, when my pain was at it's worst after a BM, and I was laying in the basement of my mom's house while everyone else was enjoying being together. The more I read the threads on this site, the more hopeless I felt. We survived the drive home this past Saturday, and on Monday (11/27) I went to urgent care to hopefully get a diagnosis. I told her I might have an anal fissure and that I am in pain after a BM. She prescribed hydrocortisone cream (2.5%) to shrink the hemorrhoids and told me to use bacitracin, because I could be infected. She referred me to a GI specialist, but I can't get in until Jan 3. I will NOT survive that long! I have three kids with a crazy schedule and a husband who works full time and no family close by to help. I started using coconut oil yesterday, even in my sitz bath, and it is very soothing, and yesterday I had a great day because I didn't have a BM! I switched to miralax/mineral oil mixed in applesauce and took it around 2:45. I tried to add more fiber, but not too much, because the BMs always hurt badly! Then the BM came this morning, and my butt will not stop stinging. I put coconut oil on it, Vaseline, and did my sitz bath in the morning. So here are my main questions at this point:

1. What is the best way to regulate your BMs to where you only have one each day? I'd prefer night so I don't have to be in pain all day--rather heal while I sleep. Can I eat whatever I want (in moderation) while on miralax/mineral oil? I also added 1 tsp of coconut oil to my oatmeal this morning. I will NOT even begin to fix my fissure until my bowels are regular, and it's taken me 2 weeks and I still can't get there!

2. What is the best thing to put on your fissure right after a BM, when the pain is at it's worst? This is my biggest problem and fear right now. I just can't live like this anymore!

3. Is there something to take for the pain that really helps? Something that could be prescribed but won't constipate? Nothing I put on my butt makes the pain go away. I've tried lidocaine, and it helps some.

Basically, I want to have a tried and true regimen that I can follow every day so I know I'm on the road to recovery. Right now, I feel like I have one or two good days and lots of bad days a week, and I just can't do this anymore. I have plans for my life (I'm one semester away from graduating with my 2nd bachelor's) and my kids need me! My family needs me, and I want to have hope again! Please, please help. What has really worked? I've read so many different methods on this site. Should I push to be seen by the GI? Call them up again and cry?

H,

The best cream I got for mine was rectogesic (in the uk) it is a GTN ointment! I found it took a few weeks but it really mad a difference

You really need to see a CRS as hems and fissures need treating differently. The GTN cream is great and really helped my spasms ease, you can buy that online but it’s expensive, and if you don’t have a fissure it won’t help.
Hot baths as hot as you can stand will stop spasms and increase blood flow to the area.
Do not wipe with toilet paper after a BM use a shower or a bidet or wet wipes.
Diarrhoea is as bad as constipation for a fissure as it is by its nature more acidic and will burn the fissure (I got my fissure through liquid BMs due to crohns)
If possible apply a barrier cream...nappy cream is great...before a BM
I never found any over the counter cream that helped my spasms but lots of people do find coconut oil soothing.
I’m in the U.K. but the only painkiller I found that helped with the spasms was gabapentin and as it’s not an opioid it won’t cause constipation.
Really good luck as a Christmas with a fissure is no fun especially if you have nothing to help you

Thanks. Do you mean diaper cream for nappy cream? I've been using coconut oil. What is GTN cream? I do not have spasms--just pain after a bm for hours that I can't control. Is gabapentin the generic name for the pain killer? Will Vaseline work fine as a barrier? This seems to help me during the day, and helps some after a painful BM. Does CRS mean colorectal surgeon? I actually got an appointment with a gastroenterologist today. I'm hoping he can give a diagnosis.

Hi yes diaper cream or Vaseline will protect the area during a BM.
If your not having spasms gabapentin may not help.
Yes CRS is a colorectal surgeon who will have a lot more experience with fissures than a GI but you could be lucky and get a good one.
GTN is mainly to stop spasms and speed healing by increasing blood flow to the area, it can cause headaches though so there are other creams like diliatazem

Thanks so much! So GTN is nitroglycerin cream? Can suppositories help if inserted at night? Do they shrink down the hemorrhoids and make BMs softer? Or are they just a laxative? I'm worried about taking a suppository while also being on a laxative.

Yes it is nitroglycerin cream. There are some lidocaine suppositories that may help, but I would see a doctor before using regular suppositories.
It’s very easy to make a fissure worse so I would always advise seeing a doctor who has experience with fissures before trying anything.
Lots of people on here have made there own coconut oil suppositories and have found them soothing.

The gastroenterologist said I don't have hemorrhoids, but I do have a fissure. Surprisingly, I felt a whole lot better yesterday and today--I think I'm over the worst because I finally regulated my bowels so there is no more straining! Thank you miralax! He said to keep up on miralax, sitz bath twice a day, and prescribed anusol HC suppositories twice a day. I will use them if I don't heal on my own. I put Vaseline on after each BM or when I use the bathroom, and it helps. My fissure is not internal--just at the base. All the sitz baths I've been doing the last 2 weeks must have been healing it! But wow, it's been painful. I'm so happy to see a light at the end of the tunnel! He did say of my fissure doesn't heal in one week, he will refer me to a CRS. And after it heals, he does want to do a colonoscopy to make sure nothing else is going on. We will see if I feel like I need it.