Hello everyone , My name is Matt and I'm new to this forum , Not so new to Anal Fissures. I'll make the Bio real quick , I'm 26 years old , Male , Live in NE Ohio. I have been dealing with "rectal pain" for around 5-6 years. It has been off and on , But for around the last 2 1/2 years it has been constant. For the longest time , I was convinced my pain was caused for internal hemroids. A couple of years ago , I went through a Colonoscopy. It was extremely painful and the results were less than satisfying. The results came back as having a "Sensitive Colon". After a few more dead ends , ( Poorly educated doctors) , I finally had a moment of clarity when I seen a specialist. After describing the pain, He provided me with an long anticipated result. He had diagnosed me as having chronic anal fissures.
The best way to describe the pain for me is in three stages, One I have sharp stabbing like pain , followed by an incredible burning pain , Then after 2 hours or so , I will have 2 hours of Throbbing pain with your occasional sharp ripping pain. Its to the point to where I can barely handle using the restroom anymore, I find my self holding back, and trying to avoid having to go. I doubt this is helping the situation, But I can't live my entire life hunched over the counter not moving for hours at a time.
After I found out exactly what was going on with my pain.I did a ton of research and I asked what can we do to fix the problem. Well there really isn't a lot of options out there. I was prescribed Nitro Glycerin Ointment to apply 3 times a day and before every bowel movement. That has to be the worst remedy I have ever tried. I'm talking severe burning and the worst headaches I have ever suffered. The headaches were almost instant , coming within 3 minutes of applied ointment. So basically, I tried it twice, and Never again. I also was told of an optional surgery, Details were vague, And I basically turned it down.
Now at the beginning of 2011 is when I found out about the Anal Fissures. I changed my diet around drastically and seen some pretty good improvement. I switched over to only drinking water. So I only consumed water, I didn't eat fast food, high sugar foods like candy, cake, etc... and Really tried to cut back on red meat, mainly ate chicken and pork. IE: Chicken salads , Chicken Wraps, etc... Well That lasted for about 6 months. I still only drink water , ( except at night, My wife and I will have a couple of glasses of Chardonnay and A few beers.) I still don't eat Fast Food , But have started to eat some cookies and other snacks along with more red meat than usual. The last 3 months have been awful. I mean absolutely awful. I often joke with my wife it would be so much easier if I had a colostomy bag. I say it joking around, But sometimes I honestly feel that way.
I don't know if anyone can help with advice or other options, But I would appreciate to hear any opinions. Thanks Matt

Hi Matt and welcome to the forum!!! Sorry you have been suffering for so long. I too, suffered for 3 years with this horrible pain. Your situation sounds like mine. The shards of glass with a BM and then the spasms for the rest of the day.
I didn't read that you are taking any stool softners. Miralax is a favorite on the forum. 1 cap a day makes everything so much easier. You also may want to try 20 minute soaks in the tub, high fiber 20-25g a day lots of water. I also could not use the NTG ointment. I had tried several others with only short term help. I spent enough money on ointments and creams to buy a new wardrobe, which I needed from the weight I lost.
Unfortunately, with your fissure being so old, it is chronic, and some sort of intervention is needed. My CRS told me, with an old fissure scar tissue forms and it will heal, but only to retear again and again. Which was true for me. I am still on the fence about diet, b/c even with the soft BM's, It would still be painful and I would still get the spasms, but the fiber does help make things move easier along with the water and miralax.
I had LIS 3 weeks ago, and wish I did it 3 years ago, I wasted so much of my life being in pain and trying to heal it on my own. It was the best thing I ever did. I have had no post op problems, no pain, no blood. I am back to living my life like a "normal" person. The recovery was a breeze. I was given percocet for pain and never took 1. Just Advil for a few days. Really deciding to have surgery or not is a personal decision, and you will knnow when you have had enough and just can't live like that anymore. All I can say is it totally changed my life and I am so glad I did it. You are too young to deal with this forever.
I hope some of this helps, good luck!!!

Hi Matt!
Listen, I'm a 39 year old male who developed an AF at about your age. It would tear, then heal up so I never seemed medical attention for fear of embarrassment.
But last November, it came back with a vengeance. I tried all the creams, suppositorys and medications under the sun, and NOTHING worked. I was in constant pain each and every day. Most bowel movements were so bad, I basically was bed-bound after having them when it was in the am. I was missing work, losing tons of money.
I finally but the bullet, and got LIS.
This saved my life.
Just two days after the (easy) procedure, I am pain free. Even after big BM. No doubt, it has given me my life back. Now, of course, there can be setbacks I'm sure, but my advise is not to suffer thru an AF like I did...there's no reason to. Just make sure you get a CRS whose got many LIS procedures under his belt!
I wish you the best on your recovery!

Hey Matt,
Sounds like you really need to take this seriously, which is what you seem to be doing by joining this forum.
Read up on the options which are basically;
various topicals that help relax the sphincter and improve blood flow to the area.
Or option B to most CRSs (Colorectal surgeona) Botox, which also relaxes the sphincter muscle for 2-3 months.
Or option C in NY area SAD (standard anal dilation not to be confused with the 'finger of god'). Where they stretch the anal sphincter so that the muscle tissue loosens, under anesthesia. (but only seems to be available in europe or the NY area).
Or option C in the rest of North America, LIS (lateral internal sphincterotomy) which sounds far worse than it is. They do a shallow cut of the muscle tissue underneath the anal lining to loosen it up.
All these methods have their success rates and downsides. So it very much is a personal choice.
You really need to cut down on the alcohol or even quit if for now as it will only aggravate the situation. Cut down or quit caffeine (tough one I know). You need to eat 20-30 grams of fibre a day (both soluble and insoluble). Lots and Lots of water!!! I do 11 glass or more a day. (this includes juice and herbal tea etc.)
Before you have a BM put a dab of vasoline on your finger and grease your anus as much as you can to help the stool to slide right out. Also drinking a spoonful of olive oil a couple times a day helps with internal lubrication.
The problem is almost always the spasms and the extra tightness of the rectal area. For healing to occur, it needs to loosen up and blood flow to the area needs to improve. Try sitz baths (but keep the area very dry the rest of the time). And sitting or lying on an electric heating pad is great too. Seriously, your wife will be jealous of how much you will love that heating pad! :D
Please read up on all the wonderful shared information on this forum and arm yourself with a whole lot of questions for your next visit to the specialist. I assume your specialist is a CRS? If not, then I would recommend you see one.
The sooner you talk to a CRS, the sooner you can be healed. And don't take just one opinion. See a couple CRSs if you can, before deciding which course to follow.
It will take time, and lots of patience and a serious dedication to help yourself. But you don't need to suffer with this. You can be healed.
In my opinion (IMO) as I am not a doctor, this is what I have gathered so far on my journey to healing. This is what needs to be done to heal.
Hope this helps!
-woi

Oh yah,
I forgot, DO NOT STRAIN!!
(I'm sure you know this anyways)
the object is to make the stool the consistency of soft serve icecream or toothpaste until you are fully healed. This is done with fibre, lots of water, and sometimes a stool softener like miralax.
-woi

Hi Matt,
Welcome to the board. Sorry you have to be here, but lucky you found us!
Well, workingonit has just about laid it out and given you the picture of what is available.
Do go through the various links on the forum, ask questions whenever you have one, use the search facility (up top, right side...says Search) by word. Comes up with a lot of interesting info that way.
I am doing a lot of research into Standardized Anal Dilation (wecc - male - on here, had that done with wonderful results and you can read about it on here too). Most have had LIS, but I don't plan to as always have difficulties after surgery in the healing. Read what others have said about that too.
Believe me, we share and understand your pain like nobody else does!!

Thanks to everyone for chiming in. I appreciate everyone's response. I currently drink around 120-140 ounces of water everyday and consume a Tbl. spoon of Benefiber in the morning. I was unsure of what LIS meant , So after some research I must say it sounds promising, But incredibly scary. This is what Wikipedia has stated for surgical procedural:
The open technique involves making an incision across the intersphincteric groove, separating the internal sphincter from the anal mucosa by blunt dissection, and dividing the internal sphincter using scissors.
The closed technique or subcutaneous technique involves making a small incision at the intersphincteric groove, inserting a scalpel with the blade parallel to the internal sphincter and advancing it along the intersphincteric groove, and then rotating the scalpel towards the internal sphincter and dividing it.
In both techniques the lower one third to one half of the internal sphincter is divided, to lower the resting pressure without destroying the effect of the sphincter. The closed technique results in a smaller wound, but both techniques appear to be similarly effective.
I mean we are talking about cutting the sphincter muscle with a pair of scissors!! Call me crazy, but that seems like it could have some serious complications later on in life.
I am seriously considering this LIS surgery as an option. Again thanks to everyone so far for you advise.

Hey FatMatt,
Welcome to the boards, anal fissure affects many man people. Just had dinner with my in-laws tonight, and my father-in-law, brother-in-law, and sister-in-law and myself all have anal fissures!! That's 4/6...
We all complain of feeling of passing sharded glass during BM, blood on TP, continued pain for next 4-5 hours.
workingonit put it best...
Soft diet for soft poop. Lot's of water, smaller meal size, softer foods all contribute to softer poop. Be wary of Miralax it made me diarrhea so hard the other day and re-tore my fissure. Lube up the anus before pooping. Gently wet wipes and be persistent.
This is a life-long battle. There are NO quick fixes, and a one lazy day or a slip (steak / pizza) and u get a retear.

It does not have to be a life long battle. There is a quick fix LIS or SAD. I ate pizza and wings last night and no problems. If you get tired of ointments, diet and water, losing weight. You will do what all of us, post surgery people did. Either LIS or SAD. When you get to the point of just not being able to deal with the pain, and worry and know you have no other choice, that is when you will end the life long battle.

I dunno,
I mean not everyone gets fixed by LIS, and SAD is hard to find.
Like I have my doubts that LIS would help me as I don't get spasms and my fissure wasn't caused by constipation. It's probably related to giving traumatic birth to my daughter and a weaker external sphincter, so LIS would stand a higher chance of causing incontinence with me.
There are still quite a lot of people that manage to heal themselves with a strict regimen and creams or botox. Then after a year or so, when the skin has toughened up, they can ease up on some of the dietary restrictions, but never fully. There will always be the need for fibre and water/liquid.
I think each person needs to find out what is causing the AF(s) in the first place to determine the right treatment. That's why I am going to get another opinion.
Best to get at least 2 opinions before going for surgery.
-Tanya