Hello you all!
I am both very sorry that you are all here, because we all know what that means...but also so thankful for the support and sharing of thoughts and ideas.
I first visited this forum about 7 years ago (I was 23 at the time), when I first developed pain, and experienced blood, during BMs after having couple large stools (ah! I did not think stools can get so big!) over several days. For the longest time I didn't have a clue as to what was going on and what was causing my pain/the blood. I was pretty much in denial, thinking that if I just persisted for long enough the problem would go away on its own. Unsurprisingly, it didn't. For years, it was absolute misery, to the extent that every single BM would be an issue, and at times I'd struggle to sit or sleep. My acute fissure turned into a chronic one. One became two, taking turns to flare up. I learned to feel and identify the location of my fissures (they each caused a different kind of pain based on their location and healed differently). Years later, when I gained the courage and finally told my family, I actually learned that they most likely run in the family. Unfortunately, any ideas suggested to help were ones I have already tried. I do wish these problems were talked about so much more openly, maybe many fissures wouldn't get so bad...My trips to the GP were always met with wish to help, but lack of ability to do so. GPs don't seem to have much experience with treating these, and often misdiagnose them as haemorrhoids.
Over the years, I have tried many many things; some helped more, some less. I will try to summarise the ones that were helpful below (this will be a bit long! be prepared). It is my hope that you all find something helpful in there; at the same time I want to remind you all that we are all different—listen to your body, and be brave and ask for help—family, friends, and doctors. Just talking about these problems can be a help in itself. Remember, you are not alone!
Things that helped a little:
• nitroglycerine cream: I tried about 3 years into my adventure with AFs...the cream helped for about a month, but then the fissures flared up with a vengeance; worth trying but unlikely to be the solution in the absence of other factors. Sometimes it only takes one bad BM for things to go south again.
• eating smaller meal portions: when things got really bad, I developed a fear of eating, knowing that all food consumed would at some point have to come out. Over time, I learnt that reducing portions can be useful in reducing the size of my BM, but not eating at all is a horrible idea, as my metabolism slows down, and when the BM finally comes, it tends to be harder than it would be otherwise.
• eating healthy: eating healthy food definitely helped; I learned more about nutrition and tried to make sure that my body is getting all the vitamins and minerals needed to help the healing processes. On itself, it's definitely not a cure. At the same time, eating too healthy—in the form of too much fibre—can be a disaster, leading to large BMs. I think the best idea is to practice intuitive eating—learn what your body and fissures respond to well and follow that. Eliminate things that don't work (for my, seeds and nuts, as well as too much fibre and dairy are often a challenge; chilli depends on the variety and does not correlate with spiciness; bread is actually great! you have to listen to your body, we are all different).
• senna: This laxative herb used as medicine was quite helpful on very painful days. Over time, I learned to predict when I can expect a painful BM the next day; on such occasions, I would try take a senna tablet the night before with plenty of water. Watch for taking too much, or taking senna together with magnesium; it can lead to BMs that literally cannot wait to leave you; these BMs are hard to control and can lead to re-tearing. There's such a thing as too much of a good thing.
• squatty potty: I still use a squatty potty because I think it helps me poop, but I didn't really find it helpful in curing my fissures. If anything, I find that, if one is not careful, it can put a lot of pressure at the back of the anal muscle during a BM, making it harder to prevent re-injury. I recommend, but with caution (i.e., it's great when the fissures are not active).
Things that helped A LOT:
• drinking lots of water: if I drink enough, chances of a bad BM are significantly reduced. As a female, there are days, though, that no matter how much water I'd drink, I'd still have a bad BM—I usually attribute it to hormonal changes.
• Haemorrhoid relief suppositories with lidocaine: I tried these suppositories when my fissures were at their worst. I remember browsing through the Boots pharmacy, trying to find anything that could help. The leaflet accompanying these says that long term use is not recommended unless a GP says otherwise—I've discussed using these with my GP and an AF specialist, both agreed that I can use it if it helps. Initially, I used to use them immediately after a BM, or at night. Sometimes, when things were really bad, even twice a day. Over time I realised that sometimes inserting them immediately after a BM could actually stimulate another BM—not good! Over time, I switched to using them only at night, to aid lubrication as I found that things always improved the next morning. These were really helpful, but I really wanted to switch to using something I'd feel better about—something without lidocaine but with the same moisturising properties. This is where my coconut suppositories come in (Free!! You can make them too. See below).
• exercise: there are days, even now, when a fissure flares up and the pain radiates far beyond the immediate area. The pain can be debilitating. There is one thing that I found helps tremendously when I am feeling a lot of pain: exercise. Physical activity—and I suspected the repeated contraction and relaxation of the muscles—helps the pain like nothing else. Plus, it's hard to focus on the pain when you are trying to do 20 pushups or 50 squats. Although exercise doesn't make the pain go away completely, it does take the edge off of the pain—this has helped my mental state like few other things. So: Stretch. Do yoga. HIIT. Run. Anything that works for you—try different things and listen to your body.
• staying active and doing things in life (going out with friends, seeing movies, hiking, being in nature, reading): I often found that when my fissures were really bad, I wouldn't want to do anything. Just sleep and lay down in bed (incidentally, that was often when the pain would reach its peak; in bed, hours after a BM). I think, in some ways, I was really depressed. I did find over time, however, that making myself participate in life and its activities is what I needed. The activities would take my mind off of the pain; provide a distraction. Months or years later, all I remember is the activities, the memories of the pain are vague or none. The pain has a tendency to try take over your mind; don't let it. Occupy your mind with life—it still has good things to offer and the pain can make us more understanding towards the pain of others.
• manual support during BM: there is no nice way to put this, but I have found that supporting my sphincter muscle from the outside with my fingers can be very helpful in stopping the muscle weakened through chronic fissures from re-tearing. For this to work, you have to listen to your body. You have to know where your fissures are. Feel them, or the scar tissue, as the BM comes and support your muscle by pressing against the location where you feel a tear might happen. Gentle pressure is enough. I think this strategy was sometimes the only reason I got away with a BM that was slightly hard, or too quick.
• ice: Sometimes, when the pain would be very strong, I'd take an ice cub, cover it in some toilet paper and apply to the area. This would provide immediate relief, but wouldn't actually help prevent fissures long term. Do not apply ice directly as you can cause injury. Listen to your body.
The two MOST helpful things:
• magnesium tablets: not sure how I came to try these, but I started taking them couple months into developing AFs. I started with about 500 mg a day (before bed); nowadays I take 200 mg before bed with plenty of water and I swear by this. I take the Osteocare (by Vitabiotics, not sponsored); I've tried other types in the past; I try to select what I take by how my body response to them. The magnesium makes the BMs softer (I believe it works by drawing in water); so make sure to drink it with plenty of fluids. Do not overdo it with the dosage (it can lead to explosive poos).
• Coconut oil suppositories: Over time, I realised that one of the key contributing factors to my fissures is the dryness of the area and the skin. I used to use the haemerrhoid suppositories (with lidocaine) sold by Boots; and I still do sometimes. However, I wanted to find a solution that wouldn't involve medication; one that I could ideally make at home for cheap, and one that I could use longterm without worry. So I got creative. I decided that coconut oil would be best, considering it's low melting temperature (mixtures with bees wax, coconut butter and coconut oil never worked so well; too thick and hard). I'd buy a bug jar of coconut oil (quality stuff you'd use for cooking), and let it melt a little (not to a liquid); ideally mixable and in a lump-free (ish) state). I would transfer the coconut oil in paste form into a plastic piping bag (you can get these anywhere; I got mine off amazon under baking stuff). I would cut off a tip (about 0.5 cm hole; adjust based on your needs) and would pipe little suppositories onto a sheet of baking paper. I would put the sheet onto a tray and let these solidify in the freezer; once solid; I put them into a sealed container, and they are ready to use (all in all, the whole process takes less than an hour). I find that they work for me best when I use one just before bed (this moisturises the area, decreasing the chance of re-tearing), and another one in the morning before my BM (this helps the BM slide out and provides further moisturising effect). Use extra ones as needed during the day. Often I add some essential oils into the coconut oil (especially for the nice smell; Clove, Bergamot, Frankincense, etc.) but the key part is the coconut oil I believe. The great thing about these is that owing to the low melting point of the coconut oil, they start melting as you start inserting them, which means that if you go slow, the potentially sharp edges melt, and won't hurt you. They are also free, and can be used long term without any harm (as far as I know).
I hope you all get better or stay well!
Love
