Hey guys, this is my first post. I am male, 25, from India. I have had occasional blood in stool and pain for a long time. A year ago I went to gastro and he did flexible sigmoidoscopy. He looked upto hepatic flexure and found nothing bad ( except some small internal hemmies which he said could not be operated or banded due to their smallness). I moved on. But from around that time, I started having irregular, constipated (no idea why, I eat lots of fruit, veggies, whole grains and lots of water!) BMs and due to that it got worse, especially the pain. I went to my family doc now, he gave some stool softners and advised a surgeon. Upon visiting the surgeon I had proctoscopy and he found fissure at 6'o clock and internal hemmies. He advised lateral internal sphincterotomy. He also gave stool softner (psyllium husk fibre supplement) and a nitroglycerin ointment for daily use. I am yet debating the surgery as taking the fiber supplement along with applying nitro helps me get through. But the problem is without the supplement, I am never having regular, normal, BMs. Recently due to some indigestion, I stopped the supplement for two days and the constipation came back (weirdly enough, after starting the supplement again), this time with full throttle! Yesterday I had small bleeding, the fissure is open, my anus ,is throbbing like nuts- a dull pain that's squeezing my anal opening tight! BMs are really painful. Nitro is helping only a li'l.
I am considering surgery but the mail culprit- the constipation is not going away! I never used to have this much constipation and irregularity! Even if I do surgery, what if in future straining tears open another fissure again? I drink plenty of water, try to incorporate as much fiber as possible in my diet, but nothing is working except regular fiber supplement! Do I have to take this for the rest of my life??
I am sorry for the long, incoherent post! I am very confused and worried. please advise! [b]

Hi Atandra,
I have been experiencing the same thing before. I am constipate even by having a lot of fibers and water in my diet. I do take psyllium husk before it makes me regular for BM but then it also make my stool harder and bulky. This is basically what i am taking now:
1) Colostrum tabs ( 2 tabs morning)
2) Magnesium supplement 400mg (1 tab before bed)
3) Miralax/Forlax stool softener (1 sachet before bed)
4) Nitroglycerin
5) lidocaine gel (before BM for pain)
6) 3 liters of plain water per day (drink 500ml right after you woke up in the morning with your empty stomach)
Miralax/forlax is the same thing with different name which the main ingredient is microgol/Polyethylene Glycol.I have reduced miralax intake to half after taking it for almost a month and i have stop using lidocaine gel as now i'm able to handle the pain during BM. For lidocaine gel do not apply it directly to the crack area as it will not cure your cuts.To make you regular you can try Triphala from Himalaya. It is an Ayuverdic medicine. I'm now free from constipation problem which the no 1 enemy for anal fissure.hehe..Good Luck!

So we come to this ever confusing topic once more.
What worked for me when it seemed that the only thing that would release stubborn BMs was a C-section, is when I desperately turned to a liquid diet of mainly fruit juices.
With protein shakes and powders for healing power.
Also it sounds like you may benefit if you try to pick a regular time for BM's in each day, even if there is really no real sensation to go.
I have found that just sitting there with a ever so light sensation to pass gas will often times produce a bile movement too.
HTH