Hi everyone,
Really glad to have found this forum.

Im 32yo, female.
My Experience with anal fissure has been isolating and exhausting.
Here is my story: I used to get acute fissures with hard bm, but they would heal on their own in a day. And exactly one year ago, I started to get sharp pain spasms in my pelvic area that would radiate to tailbone/bum. It went away in around a week, but not long after I started getting painful bm and fresh blood on paper often. After months of seeing different proctologists (who were treating also for hemorroids and did not prescribe proper medicine in time…. ( ) and one rectoscopy and so many non prescription creams and suppositories, I could manage my fissure, but it would still exist routinely and would make me tense. The pain was usually only during bm and somewhat bearable, sometimes some blood on tissue.
Finally a few moths ago I went to see another proctologist and he said firmly its a fissure that is an old one, with scarred tissue my gut says he was right, as when he did the exam, the pain was exactly like I feel during bm - like he was touching the pain location, and my hemorroids he said are almost at normal level, so that was misdiagnosed before.
He started me on nifedipine 3 times per day for a month. It helped during first week, but then it got much worse, and the only thing that changed was that I started exercising to strengthen myself (like abs muscles) with hopes that it would help, but it rather made it worse…
Now Im at beginning of nifedipine week3, also taking macrogol 4000 (osmotic laxative) and sitz baths of chamomile, and its manageable, but still bleeding after each bm with around level 4 glass cutting pain during bm and itching during the day sometimes.
Doctor mentioned surgery, but not sure if he was talking about LIS or another procedure due to my scar tissue…

Additional complication is that I am trying to get pregnant, and I am quite scared to how I would survive the 9months with the fissure. On the other hand, survived 12 month already.
The doctor said this - if nifedipine fails to help, next up is surgery and he would advice to first have a baby and only then do surgery, unless this becomes unmanageable. And I am super lost as to how I make this decision.
I have been watching my diet, taking also phylum husk for fiber. I am usually very regular, but the stool is quite bulky and I can eat so fibre full etc one day and have hard time with bm, and then another time I relax more with food and it goes well. So I am super lost as to what actually is best with diet… I used to have an eating disorder in my young adult years, and started to notice that constant thinking about food choices became triggering as well unfortunately.
In general, I think this gotten me close to depressed and is affecting my marriage negatively as well.
So lots of struggle!

My questions to anyone who was kind enough to read this far:
1) how did you make a decision to go for surgery? Ie how do you decide when its enough and no longer tolerable? I bet its personal, but any tips would help.
2) Im so concerned of surgery complications… any good advice / readings on the incontinence risk?
3) how do you best manage your diet, any tips how not to get too obsessed?
4) pelvic muscles relaxation - any good resources? I have started seeing a physio trainer specialised in pelvic floor muscles, so happy to share good tips once I get them.

Huge that you for creating an outlet to write my story. Its been a first and it feels good to lay it all out.

I'm a guy so I can't really comment on getting pregnant! But here's my advice based on your 4 questions. And yes, of course it feels good to get it off your chest.

1) I made the decision to have the LIS because I was straining to have every BM and I was afraid I would die on the toilet! At that point I had no choice. I also had played the treating/living with it game for over 6 f*ing years. Enough already!!!
2) My colorectal surgeon aka proctologist had me do an anal manometry test which can tell how strong or weak your sphincter is. Mine was off the charts strong so cutting it wouldn't affect me at all. You also should understand that the LIS is a very successful surgery. He was so nonchalant about it as he said, "Get the LIS and get on with your life!" He was SO right!
3) My diet wasn't the greatest but I did lose 50 pounds in 2020 and am now at a healthy normal weight. That seemed to have no bearing on my fissure issue. It was far too gone to improve at that point although the surgeon said it was a medium sized one. Let's say it was too far gone in the tightening of the sphincter to allow proper blood flow to hear the fissure. Cut the muscle, blood flows, fissure heals. I didn't obsess too much about my diet. I had lost 40 pounds in 2020 before my surgery and it still didn't change the situation. Fiber, no fiber - didn't matter. All I really drink is water. No sugar drinks, no alcohol, no milk, no juice, no coffee, no tea. Didn't matter.
4) You can relax it all you want but it's the overall STRESS in your life that is going to hold you back. Think of the pelvic muscle relaxation like getting a massage because you are stressed a lot and your muscles tighten up in your back. So you get a massage and you feel better, right? But how long does that last? The stress in your life still hasn't gone away, has it? No! So you have to go BACK again and again for more massages. If you don't change the stress in your life your sphincter will get tighter and tighter and that fissure may not heal. Then you want to have a baby on top of that. More stress. Most people on here who are afraid of the LIS end up treating it for many months if not years. Some are lucky and seem to successfully get it to go away. But that seems to be the exception. Botox can temporarily help if you aggressively treat it in the 9 month window the Botox works. And guess what? Botox didn't work at all for me. You want to have a baby so treating it for months on end may not appeal to you. Botox is another temporary solution but you still have to treat it. Having a baby complicates everything as well.

I say get the LIS NOW and then the fissure issue will be over. Then you can have a baby. That's my personal (non-medical) opinion. I can also understand the doctor saying baby first IF you can manage living with this for another year. Can you live with this for up to a year?

There are several women on this forum who have had a baby after LIS, including the one who set up this forum. You can search for their stories and that may help you make a decision.

I'm new to this forum & just have to say that it's SO GOOD to not feel alone!! This is the most awkward health problem to have, because you can't just casually bring it up to people.

I developed my AF after giving birth to my first baby, about 2.5 years ago. It was misdiagnosed as hemorrhoids for about 6 months, until a good doctor finally found it. I tried a slew of different creams until I finally found one that worked for me: diltiazem (2%), lidocaine (2%), hydrocortisone (2%). I have flare ups every 2-3 months, but I use that cream and it (almost always) fixes the problem in a couple days. I also take miralax every day. It's manageable.

I was so scared to get pregnant again, especially because my GI had told me I couldn't use the cream while pregnant. I did a bunch of research & talked to my OBGYN & discovered it was actually fine to use!! So I went ahead and got pregnant & everything through pregnancy and my normal, vaginal delivery was just fine. I did have a flare up after delivery from all the pushing (40 minutes), but the cream worked. I'm 8 months postpartum and still doing okay.

I haven't had to consider surgery yet, because the cream has been working. I don't know if I'll decide to do it eventually or not (because yes, terrified too about incontinence). My doctor has said to wait for surgery until I'm done having kids, because giving birth could easily put me right back where I started. But I'm sure there are a lot of opinions. (And I'm interested in reading those success stories of births after surgery!)

As far as diet goes - I actually had an eating disorder in my young adult years as well, so I'm right there with you. What has helped me the most is to not create a bunch of food rules - just eat whatever I want and rely on miralax to do it's job. Miralax is nice because you can adjust how much you take each day - so if there's a day where I eat food that I think might make my poop harder the next day, I just take some extra lax. I also try to drink A LOT of water (even more when pregnant or breastfeeding), and I do mostly avoid fried foods. I try to get a lot of fruits & veggies in, and I do eat bran cereal most mornings. But I've been okay.

Doing full body scan relaxation exercises has been helpful to me - look up yoga nidra on youtube. Also sitz baths for flare ups. Deep breaths & affirmations while pooping. I would love to hear what else you find out about relaxation - my PF is so tight, always. I just have to constantly remind myself throughout the day to stop clenching.

Hang in there. Know you're not alone. <3

Hi Rachels35,
I hope you are well into your healing and that you are feeling better! Like you, I'm quite new to this forum and having found it, it has given me great emotional support. I'm a 45 year old female, I've spend the last 1.5 years in hell, life as I knew stopped completely and I felt totally alone. I've had a fissure in the past which healed completely, but since Jan 2022, I developed 2 fissures following constipation, one of which healed and the other became chronic. I threw in the towel in Feb 23 and had Botox, the fissure healed completely but last month, it re-opened. And now it is back to square one. I have read several posts about the connection with stress and the tightness of the sphincter. I know that is very much my issue as I drink lots of water, eat well, exercise as much as I can (but limited because of fissure irritation).

I was really interested to read that you've been doing full bodyscans and that you found that to be helpful + deep breaths and affirmations while in the loo.

That last bit is what I am really struggling with and I'm convinced, is what is keeping me from the path of healing. I think I tense up despite trying to take deep breaths because I'm so afraid of the fissure opening and bleeding (my worst fear) and I wondered if you had any tips to share on the breathing and affirmations? (the irony is that the fear causes tension which causes tightness and then re-opening). I am now really sad that I'm in a self-fulfilling prophecy.

As time goes by I become increasingly desperate which leads to greater anxiety and more delayed healing and it feels like a cycle I am really struggling to break out of, but one which I really want to get out of and heal, like everyone else on here.

Thank you!!

Hi AF3
I totally feel your pain and can relate to the cycle of anxiety and knowing the damage this causes! I’m a 51yr old female with a chronic fissure for 1.5years following skin tag surgery. You must feel so frustrated to heal from Botox then retear - what caused the retear? A hard BM or just the Botox wearing off? I’m considering Botox but currently trying dilation and GTN ointment. Not sure if any of it is working altho during dilation I have learnt to kind of meditate - I used an online meditation guy to teach breathing relaxation and actually this has a remarked effect on your sphincter muscles. When I take the dilator out the doc told me I need to relax fully so I don’t shoot the dilator out by tensing. This is very difficult for me to achieve but I have discovered that by breathing in for 3 seconds holding for 4 and breathing out for 5 very slow I can do it. So I’m now practising this on the loo!! The breathing in and holding seems to relax the muscles best so I do this!! I’m no expert however but I’m focusing on controlling the spasms. The pain has decreased a bit with the dilator and I’m taking Movicol now as the stools are even softer than with Lactulose so I’m praying it will heal eventually. Like you I eat healthy I exercise a lot (altho sometimes I can’t cos of the fissure) and I don’t drink alcohol. So I should heal right???? My fissure has other ideas….
Anyway you are not alone and we are not all healed on here xxxx

dear All,

Thank you for your posts.

You not alone; mid-age; CF 1+ yrs. stressed anxiety induced. Thankfully no more spasm pain for last 6+ months after 6 months of daily pain for hours; low QoL! pelvic floor physio (finger dilation) was key to recovery I believe so highly recommend and yes to continued self dilation as long as required. Never had AT specific pain; still regular bleeding ongoing. My advice, you must practice relaxing, deep belly breathing every waking hour! it's hard I know to break bad habits holding breath or shallow breathing is not good and I do when stressed and anxious without knowing! I fit active and that could be a contributing factor; who would of thought exercise is good right? but be cautious squats many movements also with weights make sure you not squeezing down there. Using foot stool on loo helps too; better angle for rectum.

So far, I have avoided meds and surgery.

Hi GrrrAF
Thanks for your posts! What do you do when finger dilating? I’d be interested to know. Im dilating under instruction from my CRS. I’m still sore tho and so annoyed. Each time you get a new cream/technique you think yay this will cure me then the reality sets in that 6 weeks later it still hurts!! Where is my miracle;)
I am also very fit and workout most days altho it’s much decreased and modified since being in this state. I wonder if this doesn’t help. I used to be an endurance cyclist prior to my skin tag op - not any more. So sad can’t even look at a bike seat. Do the coconut oil suppositories help? Do you buy a little mould thing online? Sounds like a useful idea xx

Hi Hazey123,

Difficult to explain dilation online, but I'll say no one really showed me; I just was so desperate to loosen up so figured out myself slowly. You can do same just go for it; may feel weird uncomfortable but if gentle no harm done. DO not do if in pain tho shouldn't hurt. I was not able to do any insertion whatsoever no Dr. exam either when I was in severe tight spasm mode. I started finger dilating only after spasm subsided but still had lingering pain post BMs and after few treatments of physio. Therapist did same with finger but went further into rectum (light presses against the walls) which I can't reach around that far; need much longer arm!

I started one finger (4th or 5th since slimmer) and worked up to middle (thickest) than 2 fingers (2nd & 3rd) which I think was what was turning point BMs back to normal after numerous months of dysfunction. I first went in a bit beyond anal opening pressing gently around the entire wall then went further (if not too tight) just past the sphincter where the issue really is. If I felt too tight, I didn’t force and try another day. But once bit further at sphincter I did same press the walls outwards all way round. I did this 2x day for over month. Lying on side or squat position is better I found.

You can order suppository trays online and best since the molds will be perfect size but I used ice cube trays worked fine and cut frozen chunks when I wanted to use but they crumble sometimes wasteful (but I saved crumbles and melted again for new suppositories). You need to insert fast since the suppositories melt fast! It didn’t cure fissure bleeding but think helped a lot with internal swelling inflammation and great for anal skin irritation so when some runs out of bum no problem soothes skin; just messy elsewhere clothing sheets etc. I used only best coco oil (virgin organic cold pressed).

Good luck.

Hi GrrrAF
Thank you so much for your detailed reply. It all makes sense what you say and the finger dilation and massage technique is similar to that of a few other people on here who have described success with dilation. I’m using an actual dilator but I think I will add in some massage too. It’s all very helpful to hear and it’s reassuring your pain is improved. I’m definitely not as bad as I was now although I’m far from normal!! I just want it all to go away and be back to how I was. However on the plus side Im forced into the healthiest diet ever so that is a positive. The thing I hate is the ups and downs. Some days I think it’s improving and then it gets worse again which is so upsetting. Next week I have an appt with my CRS and he will be able to see if my 2x daily dilation is helping (I hope he will be able to see evidence of healing) it’s hard to tell just on pain levels. I’ve never really bled weirdly just have a terrible non stop burning sensation which some days ruins my life. Most days I can cope ok though. Best of luck and keep me posted. I will report back after CRS check up…. I think he might give me a bigger dilator eek I hope not. I’ve only just got used to this one which is big enough ;)