Hi,
i hope the subject says all :). i am 24 years old male and this is the first time in my life that i have fissures, so dont know much about it. its now been more than 3 weeks and every time i feel it is getting better, the next BM brings me back to where i was 3 weeks ago. i'll explain whats happening with me and i need help.
I had piles 3 weeks ago and i started taking some homeopathic medicines to cure my piles. i had this severe pain while passing stools on the left hand side of my anus ( i really dont know the medical terms). i thought it was due to piles so i just continued taking medicines for piles.
my stools started getting harder and i always started feeling as i need to go to the washroom but the pain while passing was so intense that i always just used to give up stopping BM. this happened last week.
Finally, i took help of laxatives one night. in the morning, at around 6 am, i had immense pain in my abdomen ( the laxative had done its work very well) that i rushed to poo but again, the pain was so intense that i gave up and came out. but now i had an urgency to poo but the pain was stopping me. the last resort i thought was to go the hospital. i went to the emergency ward and told the doctor. he gave me a pain killer and anaesthetic gel to help me in BM. i came home and finally had a huge BM. there was alot of blood but i think i didnt feel alot of pain because of the pain killer. however, i did feel that the first stool which came out was as hard as a rock and after that it was all liquid. so maybe the first stool was stopping the ones to follow.
i felt really relaxed that day and 2 more days to follow and felt that finally everything will be back to normal. but i was surprised the 3rd day when i again had a severe pain while passing stool and the first stool again was as hard as a rock. again, it was a bloody encounter. then, i told my condition to a friend and he told me that maybe i am having anal fissures. the very next day i took appointment for a doctor.
I went to see the doctor next day, he questioned me and observed my butt and finally told me that i was having acute fissures. well, following is what the doc prescribed me:
0.2% NTG
milk of magnesia
Lilac ( a laxative syrup)
> 12-16 glasses of water
>mangoes
>some more fruits which i cant recall at the moment.
things not to take:
1. bread
2. red meat.
Well, coz of pain, i started taking the medicines he gave and drank lots and lots of water and fruits he told and applied the cream twice a day.
during this week, i had my first BM which again started with a rocksolid stool causing bleeding followed by semi liquid stool. i thought maybe its pre medication stool thats coming out and hopefully the pain will reduce.
Next time when i went for poo, i again could feel it would be a hard one, so i stopped and came out without BM. then again the next day i went but didnt poo and came out. finally, 3 days ago, i couldnt finally resist and had to poo. it was a rock solid one followed by soft ones but the agony was killing. after passing the stool, i could stand the pain and again had to visit the doctor to get a pain killer.
inspite of following a strict diet, lots of water and laxatives, i always am having a painful experience. my first stool is so hard that i give up and come out. and when i pass, i get in so much pain that i have to lie on bed all day.
Please help, what should i take to keep that first stool soft? i am actually afraid to poo now because of the pain. i am taking laxatives daily but it seems they are not working. after taking laxatives, i do angel gas alot :$ :$ and feel like going to the washroom but come out without passing because of the pain. Please tell me if this is normal in fissures?
I failed a very important job interview yesterday because i couldnt make it coz of the pain. these fissures are really affecting my professional life. i am unable to concentrate on my work coz of pain..

Hi Jehanzeb – welcome and I’m really sorry you have to be here! Your story is very familiar. The painful and difficult poops are very common for people with fissures. They definitely get bad enough to strike terror into the heart whenever there is an urge to poo. I know what you are talking about with the hard/runny poos too. That’s frustrating!
One thing you might try is finding the right combination of insoluble and soluble fiber. Insoluble fiber is like green, leafy veggies (spinach especially), which help you go; soluble fiber is like potatoes and squash, which help add bulk to stool. Bran and oatmeal are good because they do both, but you have to drink LOTS of water! There are lots of good ideas about "fissure-friendly food" in under "Diet tips/supplements".
Perhaps the most important thing for you right now, though, is getting your stool softeners sorted. I haven’t heard about Lilac as a laxative, but if it’s a stimulant laxative, you might want to stop taking it. Stimulant laxatives work by stimulating movement of the bowel and sometimes also irritating the intestine – that might just push harder stool through a little more quickly. Stool softeners draw water from the colon into the stool to make them soft. Milk of Magnesia does that, I believe, but I also think it changes the ph of the stomach and intestines – I’m not completely sure about that, so perhaps others can chime in.
Many folks here have used MOM and it worked well, but the most popular stool softener seems to be Miralax/Restoralax/Movicol (the name is different depending on where you live). The main ingredient is propylene glycol and it comes in a powder so you can control the dose. I used it and it really helped me produce those wonderful formed, but soft poos.
It’s good that you got the proper treatment and that you are now using the right meds for fissures. You may have caught it soon enough that the nitro will work. Did your doc say anything about baths? Nice warm baths can also help because they stimulate blood flow to the butt, which promotes healing. (They also help ease the pain.)
Everyone here understands what you are going through. As I said, your story is a very familiar one, so you’re not alone! You’ve come to the right place. The people here are very supportive and can give you lots of good advice. I really hope you find relief soon!

Hi Hopetoheal, thanks alot for your advice. 2 hours ago, i finally had a BM which was quite less painful :) and i owe it all to the advice given in the threads here. although i applied alot of anesthetic gel to ease the pain, but i could feel the pain was bearable. otherwise, even after applying the gel, i had alot of pain passing the stool.
again, the first stool to come out was a little hard but it came out relatively easier followed by soft stool, so i was able to poo without much pain.
after i have done with BM, i had a sithebath with warm better and it was so so relaxing. i could actually feel the pain going away. wheewwwwwwww
i have a few more questions:
1. does smoking has any adverse effect on constipation/ fissures? i smoke one packet a day i.e. 20 cigarettes.
2. am i stuck with this thing forever? :(
3. should i consult a doctor to see if it is only fissures and wont turn into something much more dangerous?
Thanks alot for your help. i really appreciate it.

I'm so glad the BMs are a bit less painful - the baths really help! :D
I'm actually not sure about whether or not smoking causes problems with constipation or fissures. It's possible that smoking might make healing a fissure a bit more difficult because healing depends a great deal on blood flow in the anus and smoking isn't good for that.
Fissures generally do not turn into something more dangerous. Usually the worst-case scenario is they can get infected or turn into superficial fistulas, but we're not talking about cancer or anything like that. Sometimes fissures and fistulas can be symptoms of more serious illnesses, like Crohns or ulcerative colities, but with those, you'd usually also have many other obvious symptoms, like bad abdominal cramping and diarrhea. When you see a specialist (and I really recommend that you do), s/he may send you for tests to rule out those conditions.
You do NOT have to suffer with this fissure for the rest of your life! If the nitro doesn't work, then you might want to consider a surgerical procedure called a Lateral Internal Sphincterotomy (LIS). It sounds terrifying, but it really is, from a surgeon's point of view, a minor procedure. It involves making a very small cut to the internal sphincter muscle to loosen the muscle and stop it from spasming (it's the spasms that cause the post-BM pain). This will break the cycle of tigtening/spasming that prevents blood flow to the anus, which prevents healing. Many of us here have had an LIS and it gave us our lives back. I had mine on May 10th, and it healed my fissure. Recovery is a bit rough for the first week or two, but the pain post-op is usually not nearly as bad as the fissure pain before the surgery.
Another option is botox injections. I didn't have that done, but others here have, so they can tell you more about it. It works on the same principle as the LIS, except it only temporarily partially paralyzes the internal sphincter to allow healing. (Nitro and calcium channel blocker ointments also interrupt the spasms and promote blood flow to the area.)
There are options. The longer you have a fissure, the more difficult it is to heal without surgery, unfortunately. I know you really don't want to hear that! But the biggest regret most people here have had is not having the surgery sooner. I definitely recommend that you see a good colorectal surgeon (CRS) very soon. This specialist will be the person who helps you heal your fissure, either with oitments or surgery, if it comes to that.
Please take all this with a grain of salt - I'm not a doctor and I'm only going on what I've read here and my own experience. Hopefully, though, some of the information you get from this site can help you communicate better with your doctors. And please don't worry too much, either. That's easier said than done, I know, but fissures are not life-threatening, even though they can be quality-of-life- destroying! But you do NOT have to suffer like this for the rest of your life! :D

Hey there,
Just wanted to say, I'm a smoker too. :oops: I know it's not good for us but I'm not sure how easy it would be stopping with all the anxiety of a fissure already,Lol. I'm not sure if it could make constipation worse.I never had a big problem with constipation though, just occasionally... I've taken a stool softener since my fissure and LIS and always drink plenty of water. I'm not sure if I would have any problems with the smoking without all this. I know caffeine can dry out your colon, not sure about nicotine. Just drink plenty of water unless you are able to quit which in the long run is the best choice, of course.

Hi HopetoHeal,
Thanks alot for your advice. Everything seems to be coming back to normal :). i am in office right now and really need to poo but i am not taking any risk :$ . Sithzbaths are really helping me alot. i have also taken an appointment from a doctor and will be seeing him on Friday.
one question (i keep bugging you :$): two days ago, i had a BM ( which i mentioned in my previous message). immediately after BM, i took a warm bath and applied NTG. the wasnt any pain, however, all night it seemed as if something was stuck in my anal region resulting in discomfort all night. is it something normal?
Moreover, i have a feeling that NTG gives me a severe ache in the neck. i dont know if its coz of NTG or my pillow. can you please help me here as well? can you also give me the formula for Miralax/Restoralax/Movicol? incase if its not available where i live, i'll consult my doc and ask him to give me a medicine with the same formula.
@Dawn: thanks a heap :d atleast now i wont have to worry about my smoking habit :D. smoking actually gave me a reason to go out of office when i was having severe pain due to fissures.

I just came in from having a cigarette outside since I don't smoke in the house anymore :D - I confess! LOL! I've cut down a great deal, but I smoke too. :oops:
You are never a bother at all Jehanzeb! The sensation you describe is not uncommon. I often felt like I had something up my butt. It often felt like I needed to have a BM or I had an incomplete BM. That really drove me nuts! I think it was actually sphincter spasms that made it feel like my rectum was full all the time.
The nitro could be causing the pain you describe, but I've not heard of neck pains before. Headaches are much more common because nitro is a vasodialator, so it opens up blood vessels and improves blood flow. This does cause headaches in some people (the headaches often go away after you get accustomed to the nitro). Maybe you can experiement with a new pillow. Also, stress and tension from being in pain might be contributing to the neck pain - but all that said, maybe if the neck pain doesn't go away, you should ask your doctor. Maybe others who know more about this will chime in.
The main ingredient in Miralax/Restoralax/Movicol is Polyethylene Glycol 3350. I think what's important is that you find a good osmotic laxative - that's the kind that draws water from the colon into stool to help produce nice, soft poo. Milk of Magnesia is such a laxative too. There may be some good osmotic laxatives where you live. Just try to avoid stimulant laxatives because they can be harsh and cause dependence over long periods of time. You can also use lubricant laxatives, like mineral oil, and bulk-forming laxatives, like psyllium fiber (just remember to drink lots of water with psyllium fiber!).
It's awful when you have to poo at work! But it's not a good idea to hold it in too much. Many of us carry supplies when we are away from home (we call these our "butt bags"). If you can find very gentle baby wipes that have no alcohol, they are perfect for cleaning up away from home.
I'm so glad you are doing well today! :D

Hi HopeToHeal,
its been some days now and i can feel alot of improvement. no more blood and pain while BM, i think it is healing. the stool is also now normal and soft :):. although after BM i get spasm which results in a little bit of irritation but warm bath takes care of it.
Thanks alot for all your help :)

That's wonderful Jehanzeb! I'm so happy for you! Remember to keep the stools soft for a good long while to make sure the tissues heal properly and get good and strong. Here's to you never having any more butt problems and only having happy BMs from now on!

I have been dealing with an anal fissure for years. In 1987 my first experience with one. I was able to heal it completely with a medication. Hadn't had another attack for many many years. had a horrible experience with it recurring in April of this year. Horrible experience. Thought I had healed it on my own until today. So much blood. The pain is bearable. Not too bad. I have an appointment with my doctor on Thursday and I am so scrared it is larger than before.