Hello, I am a female in my mid 30s, and have been struggling with a fissure on and off for years. It always happened with my cycle and then healed on its own, or with the help of compounded meds (ntg, dilt, or nifedipine).

fast forward about 10 -15 years, after the birth of my baby (im now 1 year post partum) I had three horrendous fissures while breastfeeding. worst pain of my life, worst than childbirth. I stopped nursing after a few months and did two rounds of botox.

Here I am still suffering from on and off fissure pain and bleeding, and have seen multiple CRS docs- some say it will heal, others have said I could do surgery but not recommended it yet if I want to have more kids.

My OB referred me to a doc most recently who said it doesnt look severe enough for surgery (2 medium size fissures) but that I could heal with topicals and miralax. basically she said to heal the acute fissures with the compounded creams, and then just continue to stay on miralax forever.

If I eat dairy, meat, bread, or eggs, im guaranteed to rip a fissure the next day. without FAIL. Essentially, I either have to go plant based and gluten free 100%, or stay on miralax forever(which is what the doctor recommended).

My issue isnt one chronic fissure, rather a new one every time the tip of my stool is the TINIEST bit hard, which happens with most foods.

I have lost my mind. on the brink of severe anxiety or an eating disorder. if Miralax is the solution then I guess I can take it the rest of my life and eat whatever I want? side note: I didnt tolerate magnesium, and fiber supplements like psyllium make my stool too bulky and make me tear.

please share any thoughts, advice, or words of encouragement


much appreciated!

Welcome to the forum. Miralax - a brand name for macrogol (polyethylene glycol), also marketed as Laxido, Movicol, etc. - can sometimes be taken for extended periods of time, but you should discuss this with a CRS. I have been taking it continuously for about 4 years without noticeable bad effects.

For pain, some posters, including myself, have found that anticonvulsants like gabapentin and pregabalin are effective. Again talk to a CRS in a pain management setting.

I second what dmcff suggested and I would also recommend pelvic floor physical therapy. The muscles need to be retrained to handle different kinds of bowel movements.

Your comments about the recurring cycle of healing but then easily tearing again and fissure returning sounds very familiar! Have you found the cycle is becoming increasingly frequent, so the fissure free period is getting shorter and shorter?

For me the only thing that broke the cycle was LIS, though maybe Botox might be an option for you also to try first? I’m 4 months post LIS and in a good place, can eat much more liberally now than before, even previous off limit ones like red wine that would’ve led to constipation & retearing are back in scope for me.

So would recommend LIS strongly, 90%+ success rate & 2-3 healing time for me. 95% back to normal now just some residual soreness due to scar tissue but no big deal at all.

Good luck.