Here are some questions I posted in my much shorter note today. As I have had difficulty finding answers to some questions. If you can help, please do:
-Has anyone developed an anal fistula from a fissure and do you have any advice if it can be healed without surgery? What were the signals that you had a fistla and What procedure did you have to undergo to know you had a fistula and not a fissure?
-Is puss normal with a fissure? No one has spoken of this anywhere.
-Has anyone had to manually ease part of your bum back in following a BM and if so do you have any recommendations on what may help this condition? I assume it is weak and inflammed veins around the fissure which may also be a source of puss.
-Did anyone find that daily but firmer stool made the fissure heal quicker? I believe that the messy looser stools made mine worse.
-For those who have had Lateral internal sphincterotomy, did you have a general surgeon perform the procedure or a Colo Rectal Surgeon and what do you experience as the results of surgery?
-For those who have had Fistulotomy what do you experience as the results of surgery? As you had any reoccurance of fissurs or fistula's? What have you experienced as the results of surgery?
-As I normally choose the natural approach to healing, I have chosen not to use a stool softner or a laxative. At this time I am willing to try anything available to heal before deciding on surgery, does a stool softner make soft stool not as wide to pass or just watery? I would consider taking it if allows passage of stool without making it loose.
Before I share my story, I want to thank the people who put this site together. Without your help, support and recommendations I'm not sure where I'd be today. Thank you to everyone for your thoughtful words and details remarks. There are so many questions regarding procedures, treatments, pain remedies and diet, and being analytical I have put myself through them all. My focus has always been to heal myself naturally and develop a diet for life, not just for now. I believed that this would help my healing, as well as give me better habits for future health as I realize this is a long term affliction. I suffered from constipation and hemorrhoids since my early 20's and I decided this wasn't going to work for the rest of my life, especially when I realized what anal fissures were. I had no idea this condition existed!
This is my story.
I've had anal fissures since March 2012. Since March I have never spoken so much about stool, diet and treatments in my life. My husband has been my dearest friend and life partner and his support has helped me through the darkest days, the rest has been shear patience, tears, will power and more ointment than I ever wanted up my ass. My physical and emotional strength have been battered and I am not sure what's next.
Here is the timeline and treatments I have tried, and that have helped. There is so much misinformation on the internet so use them as you see fit for your own means:
Me: Female, age 41, 145 lbs, non-smoker, minimal alcohol, slim build with a personality that likes to keep busy and is driven. Always believe in balance in life, but also have always juggled many different things at one time. Manage stress well and have allot of stress in my life. Exercise regularly, and practice mindfulness.
Me today: Female, age 42, 124 lbs, no dairy, no gluten, no alcohol, no caffeine - slimmer build, not so happy with this but I can't seem to gain back what I've lost, and eating makes for larger Bowel Movements. I work allot less, have reduced stress from work and personal obligations, walk daily and practice mindfulness.
Prior to Anal Fissure Diagnosis.
-I was constipated and experienced a week or so of hemorrhoids about twice per year. Gas and bloating was common for me.
Regular bowel movements for me were every 2 - 3 days. I used Proctosone ointment when things got really bad, and every other available cream available before this.
March 2012 - early signs of fissures which I thought were hemorrhoids and I used Proctosone for about a month prior to my diagnosis in April. If I could redo this time, I would do my best to see a Proctologist or Colo Rectal doctor quickly so that they can prescribe the appropriate medication asap.
April 2012 - Proctologist appointment
- Niphedipine 0.90% prescribed, pea sized amount twice daily into the anal canal.
- Proctologist's recommended dietary tips were: Take 1/2 tsp Metamucil daily then increase to 1 tsp after a week, (drink extra water daily as well), No to Milk, ice cream or yogurt, No Caffeine, No Alcohol, No Vitamin C, No Cola, No citrus fruit or juices (Apple and cranberry are ok), No grapes or their juices, No chocolate. No soap when cleaning. Be gentle when wiping, a wet tissue padding is less abrasive, Keep the anal area dry, Avoid Hot Baths or Showers (lukewarm 5 minute bath or shower is best) Wear 100% cotton underwear and avoid tight clothing.
- I've always had a healthy diet, but removing all dairy and caffeine and adding more water 10 - 12 glasses per day helped. I also kept a journal of my food and fibre and protein intake daily, as I was obsessed with keeping these in check for my health. I also used this to look back and see what I ate that may have affected my stool, gas, or helped with the healing.
- I began taking flax seed oil in April with my self prescribed high fibre & water diet and I believe this led to pellet like stools at times and a BM twice a day sometimes which was not pleasant. When I removed the flax seed oil in May and added in the Naturopathic supplements, & pooping position, my stool improved to one a day.
May 2012 - Bed Ridden, with a pain scale of 10/10 and sweats!!!! Count the minutes daily til the pain was bearable. Sleep when I am not in pain. 3 weeks+ off work.
-One month later I am in so much pain and bedridden. I cannot sit, or function until later in the day. Driving before 4pm is not possible and so painful if required. Perhaps I had not been inserting the niphedipine ointment far up the anal canal enough, perhaps I had an infection, I don't know. Bowel movement are regular and small every day, around 7-9 am. They are quite small as I have been eating allot less and mostly fluids or soft foods, however the severe spasm and pain persists until 7-10pm most days. I do my best to get out for a walk when I can, its a very slow walk and only a few blocks but I want to ensure my bedridden state does not make my bowels less active.
-Proctologist Appointment - Prescribed Antibiotics - Metronidazole. I may have an infection. I took this for 6 weeks, and I was very careful to keep my stool regular with diet and water intake, as anitbiotics can bung you up or give you diarrehea. My condition started to improve slowly within the first 4 weeks of taking it sometime in June.
-Naturopath Appointment - Prescribed for regular stool, and products that aid with digestion: L Glutamine (1/2 tsp per day), Magnesium Glycinate 100-200mg/day (this is good for relaxing muscles, but be careful with this, as it affects ppl differently. I used to take up to 1000/day 1-2 days per month to relieve painful menstruation which worked wonders ~ but also makes you go which I would not want with AF), Probiotics ( I used 1/2 tsp HMF Powder by Genestra mostly. I also used Flora's 50 Billion formula while on antibiotics), Marshmallow Root Tea or Slippery Elm tea (3 glasses/day), Aloe Vera (Inner Fillet gel, 3 tbsp/day - I believe the outer leaflet is a laxative and I have not used this), Fish oil (1 tsp per day - I take NutraSea ). I was also recommended to take Bio-Gest when I ate protein. These pills help in the digestion of protein. I bought the Thorne brand and took it a couple of times but stopped as I do not believe I have a problem digesting protien except for Beef which I have not eaten since March.
-Along with a diet of 27 - 40 grams of fibre [(soluable and insoluable - meaning grains, cooked oatmeal, cooked cornmeal, lots of vegy's ( mostly steamed) apples or pears (1 to 2 /day) per day], no sugar, no caffeine, no alcohol, no dairy, fish mostly and 10 - 12 cups of water I slowly improved. At this time I did not eat any meats (Pork, Beef, Lamb, Turkey, Chicken) as I was concerned about the BM's. Looking back now, I would have stayed away from Beef but all others would have been ok for me, provided they were a low fat cut of meat and were prefferably baked or fried/steamed in extra virgin Olive oil on a low heat.
-Going to the bathroom - in April & May I would sit forward on the toilet so that the stool passed through the anus with less pain as I understand the flow is more restrictive with this position. However often times I would feel I did not eliminate fully, so I'd have to go again which was not pleasant. It was recommended to sit upright on the toilet and if possible with your feet on a stool. This position made for a straighter path for the stool to pass through. I have been using this technique since May and although at first it was more painful, it ensures I only go once a day and I feel like I have eliminated well which I believe is helpful as there is no pressure on the sphincter. Depending on how the position of your fissure this position may help.
-Foods that I used but could have made the problem worse: Nuts (their skins do not get digested and can be abraisive on exit, ground flax seeds - these are an excellent source for fibre when taken with lots of water but make sure you grind them extra well, as I found whole ones in my stool, and they have sharp pointed edges. I removed them from my diet in October 2012 ~ golden flax seeds seem to be softer than dark ones)
- I also used Fissureheal suppositories from Imox which felt a bit like lubricating butter when inserted. They helped take the edge off when nothing else helped. I also inserted Vaseline or fissureheal in the morning before a BM to help slide it out. I still use Vaseline or Virgin Coconut Oil before a BM. I stopped this for a period of time when I was feeling 80% better but have reinstated it. There are other lubircants on the market that are water based and more natural.
June & July - Healing months, with improvement.
-Was able to go to work for 5 - 6 hours per day. In bed or on the couch recovering after a BM til 1pm most days. Revistited the Naturopath a to try and figure out more on the best diet for my body. Introduced a few vitamins to my diet. Part of a regular BM for me was Whole Grain Oatmeal cooked very well in the morning with 3 tbsp unsweetened apple sauce and rice milk. If I made enough I'd just reheat it every day to save time in cooking. From preparing meals and grocery shopping, I have never spent so much time or cooked so much in my life! Take out & eating out whereever I wanted is a thing of the past. Thankfully there are some healthy eating establishments close to home which have saved me when I couln't make a healthy meal.
August - 80% - 85% better! Wow - what an ordeal to get here.
I am so much better than in May when my pain threshold was the highest ever! I began developing loose and explosive stools in August. My diet had not really changed but I believe I had been taken a bit more refined Wheat products. The BM's were painful and they irritated the AF, which made my progress go slowly downhill. I finally went for a Vega test as a recommednation from my Naturopath. This is a test that checks for food sensitivities (another option is a blood test which is considerably more costly, and the Vega Test was helpful for me)The test showed that 3 staples in my daily diet I had food sensitivities to. These may have developed over time, or been present all along. My body showed sensitivity to Gluten along with other contributors including Oats, Kamut, Spelt, Barley , Avocado's and Garlic. I removed these items from my diet including the daily Oatmeal and my stool improved but was still a bit loose. Candida also showed up, so I stay away from sugar, yeast and fermented things which are in many things.
- A part of my bum prolapses (pops out) after every BM close to the area of the fissure (at the back at about 5 o'clock) and I assumed I had an internal Hemorrhoid which was not healing. It was inflamed every day as well as it spasmed at times. I used ice following a BM which was my go to for hemorrhoids for years, and I tried Avenoc a Homeopatich suppository with witch hazel & horse chestnet. This helped alleviate the pain, however my diagnosis may have been wrong. Perhaps this was the fissure aciting up and the Niphedipine may have been better. Not sure now. I can say the Avenoc really helped with the pain. Once inserted and you hold it there it eventually flips on its side and lasts for hours. I read up lately that witch hazel may damage the tissue over time so I have stayed away from using these in October unless I've had a pop out that I can't manually get back in. Avenoc helps to hold it in until the inflamation is down which has been helpful.
Appointment with a Recommened Chinese Doctor
- Diagnosis that my system was damp and recommends that I remove Marshmallow root tea, Slippery Elm Tea, Soy (including soy milk, tofu, soy sauce, edamame), Mushrooms, Red Meat (something I removed in May), Dairy, Vinegar, Sugar, Don't eat late at night, Stay away from refined foods, Sleep well to allow healing. He recommends eating some Okra as a slippery vegetable, minimize the amount of fats in your diet, refrain from eating peanut butter and most nuts & recommends pumpkin seed butter or seeds instead, recommends a gluten free diet, and adds zinc 25mg to the diet.
Naturopath - the supplements and vitamins that improved my condition could be contributing to the loose stool. It was recommended that I remove all supplements except the Probiotics & Fish Oil which I did for 1 week which helped. I slowly reintroduced some vitamins since this time but have stayed off all supplements (noted in May above). As my stool is consistent and regular, I dont believe I require digestive aids which allot of the supplements were good for.
September - Stool has improved!!
-My stool is not explosive and loose, but still soft and messy at the end which I'm still trying to figure out. I believe taking a fibre supplement and decreasing my water intake has helped a bit as well. I've taken a natural fibre supplement some days as well as added Vega One Protein Shake which is made with Stevia instead of sugar and has 15 grams for protein and 6 grams of fibre.
October - Progress is sliding, About 65% Better
- My stool has not been loose since early September which is terrific! It is always good qty, soft and when I need to go I go immediately, and always within 3 hours of waking up and usually right away. Since May I have missed a daily BM only 3-4 days which is a record for me.
Pain subsides daily around 2-4pm, however it is never excruciating except sometimes when cleaning following a BM. This is not as good as it was in July-August when pain had decreased by 12 noon and I felt I had improved to being 80% well.
Now, a part of my bum pops out with every BM (since August) and I have to ease it back in with a wet tissue after spraying with water. I also have had puss on the TP every day following a BM and this has been happening since Sept 3rd, and it is now October 13th. I do not have blood on the TP which I did have at times in August & September, but the puss worries me as its new and it means infection.
New Appointment - Colo Rectal Appointment - Examination report is that I still have a fissure and that the puss means infection of some sort. It is possible that I may have had an absesse in May, and developed an Anal Fistula since that time. Without an examination under anasthesia they cannot say for sure. I was prescribed to take Proctosone daily, following a BM and before going to bed and see if the condition improved within a week. I supplemented with the Niphedipine which has worked in the past and after a week I have not had much change, but maybe a little.
An examination under anasthesia scares the shit out of me. If they find something they will want to perform the necessary procedure and I could wake up a cut sphincter.
I have shared my story because I have learned so much from others and I hope that some of what I have experienced and shared will help you.
I wish you health & strength & courage, and emotional support and will continue to view this site for your comments.
JBird

I am new to the forum, so I don't have answers to many of your questions. I did notice a couple of red flags, though.
You mentioned using Metamucil and starting with 1/2 tsp. The abbreviation for teaspoon is tsp., so I assume that is what you actually mean. A teaspoon of Metamucil isn't enough to do much of anything. My nightly dose is around 2 tbsp. (tablespoons), along with about the same amount of generic MiraLax. The result is bulky, soft stools. I also saw that you used Proctosone for a month. The equivalent medication here is available only by prescription and carries a warning to never use it for more than two consecutive weeks, because it can cause thinning of the anal tissue and make the problem worse. I hope someone can answer the rest of your questions. It looks like you are on the right track to me but there are a lot of folks around with more experience in this area than me.

Thanks for your feedback roadscholar. The reference to the 1/2 tsp of Metamucil was the general recommendation from the proctologist, and he also recommended to increase the Metamucil to 1tsp after a week. Sounds like more is better for your system, which is good to know ~ Thank you. I have seen the warnings regarding proctosone/proctocytle and have used it less because of this. For me its all about weighing the risks of taking action to heal now vs surgery later. Thank you for sharing. :D

Wow! What a story. Thanks for sharing. I don't know exactly what input from others that you might be seekig right now.

Hi Cheryl,
Thanks for your note. If anyone has any feedback to the questions I posted at the top of my note above, that would be amazing. I am trying to figure out if I have an Anal Fistula or a Absess or a Thrombosed Hemorrhoid. I have puss every day and throbing pain centralized around the area I assume the puss is coming from which is quite localized. The pain subsides in the afternoon :D . I believe I also still have a fissure at the base of this. From the reading I have done it appears that puss occurs with either a Fistula or a Thrombosed Hemorrhoid. Has anyone experience this symptom and what was your diagnosis? I'm trying to decide if I need an Examination under Anasthesia to determine this which scares me as they may want to perform a procedure while doing the EUA and I want to be prepared for this. If there are some treatments others recommend I try to rule out one or the other that would give me some piece of mind.
Thanks for asking and for all your kind compassionate words online. JBird

JBird,
I have never had a fistula from an AF, and thankfully, so far have very little knowledge about fistulas. I do not think that you would have discharge (other than bleading from a thrombosed hemmroid). I've had 2 thrombosed hemmroids. They hurt like h*ll, but no discharge. I would go ahead and have an EUA if necessary to learn what is going on with you if you have confidence in your CRS. Nine months is an awfully long time to be suffering as you have been. Maybe some people who have more experience with fistulas can add some thoughts. Good luck and let us know what you learn.

Thanks Cheryl, I am doing my best to get an appointment with a CRS. The wait time here is up to 6 months depending on who you see. I have an appointment with a General Surgeon this week, but I would be more confident having the examination and procedure with a CRS, seeing as that is what they specialize in. The wait of 6 months to get in is a bit of a worry though ~ when weighing the risks of seeing someone sooner or seeing a CRS. Perhaps I can have the EUA with the General Surgeon, and then wait if possible for a CRS to do any necessary procedures. Not sure if this will be possible due to costs, however I'll see this week. Thanks for your feedback and your best wishes :) JBird