After years of dealing with chronic unexplained GI problems involving things like sudden violent bouts of diarrhea followed by episodes of constipation from dehydration, I finally got myself my first fissure sometime this past year.
Sharp stinging pain in the ass followed by bloodied stools marked that first time and though they have always healed on their own after my GI episode passes, they also always come back when I am having an episode.
Lots of fluids, no caffeine, fiber, lubrication, etc ad nauseum... I know the drill.
Problem is, if it isn't the violent diarrhea episodes that rip me a new one, then the almost inevitable constipation that follows (somehow, no matter what I do, constipation of some level always follows the bouts of intense diarrhea) does.
I am so sick and tired of this; the only thing positive is that I generally never experience much pain in the grand scheme of things as all my preventive measures (especially lubrication) keep it from being too bad.
A pinprick, blood, and if I am dehydrated and lacking minerals and electrolytes (especially magnesium), that infernal sphincter cramping (halted immediately by relaxation techniques and magnesium supplementation).
But it flipping sucks and because I struggle with chronic GI issues involving explosive diarrhea, LIS surgery is not really an option.
I can manage this condition, but is there any way for me to get my non-fissure life back or is this impossible for as long as I have this chronic GI problem?
Ugh. Just UGH.

to the forum, Iced!
I see that you say that you know the drill, but you do not mention whether or not you have seen a CRS or a doctor for your GI condition. What is your chronic GI problem? Do you have Irritable Bowel Syndrome? Having continual diarrhoea is going to keep the area and the fissure irritated, I should imagine.
Do let us know exactly what you have done, so that what advice we can offer can help.
There is a lot of information on here, for all sorts of things, so do use the search facility up above on the right to help with that.
Once again, welcome!

Hi there Savaici! Thanks so much for the welcome; I really appreciate it. :)
Sorry for leaving out some specifics; I was originally writing the post using my mobile device and me and the touchscreen keyboard aren't exactly best friends and so I didn't really elaborate on some things.
If you can excuse the length of this post, I will explain more in detail the nature of my GI problems and the resulting AF.
For as long as I remember, I have neither had problems with diarrhea nor had problems with constipation... or any other GI issue for that matter.
But then, around 6 years ago, that all changed.
6 years ago, after a violent bout of what everyone thought/assumed to be food poisoning (I was seen at the ER and then later by my PCP), I started experiencing unexplained bouts of GI pain.
No gas, no diarrhea, no constipation, but... pain. Sharp, mace-like, right-there-you-can't-miss-it-omg-I-can't-eat-or-even-drink pain. Mid upper left region somewhere.
It started happening once every 3 months or so out of the blue and lasting anywhere from 2-3 weeks and I eventually got an upper endoscopy done to check for ulcers and other upper GI issues and I had ultrasounds and CT scans to check for things like gallstones.
Everything came back normal; so normal and so apparently healthy that the gastroenterologist treated me as if I had been crying wolf when he showed me the results of the both the endoscopy and the USs and CTs.
No ulcers or anything remarkable about the endoscopy and everything normal about the USs and CTs so no gallstones, etc.
So everything looks normal, but the episodic bouts of pain continue scattered amongst months of absolutely no GI issues to speak of and this continues for 4 years - unexplained and undiagnosed though yes, I most definitely was under the care of my PCP - until gradually, other GI issues start coming into play.
Once more, nothing specific about the triggers aside from possibly, chronic fatigue (and yes, I manage a lifelong genetic disorder that predisposes me towards bouts of greater fatigue), and instead of just pain, I start experiencing OTHER GI problems like violent episodes of nausea (which may or may not result in actual vomiting) coupled with equally violent episodes of diarrhea or very loose stools which may or may not be accompanied by bloating.
There's no blood, but more often than not there's mucus and a bad smell, sometimes there's a lot of bile, sometimes it's extraordinarily dark in color to the point of near-black, sometimes it's extraordinarily light in color like clay, sometimes it sinks, sometimes it floats, sometimes the stool is well-formed (just very violent expelled), but mostly it's an explosion of - stuff. Gross. Nasty. WTF. Stuff.
Cold sweats, dizziness, extreme fatigue, losing breath, and muscle weakness frequently accompany these GI episodes and after anywhere from 3 days to a week of GI pain, diarrhea, bloating (if it was there in the first place), constipation then sets in because... well... I'm losing more water than I am taking in and losing additional minerals and whatevers while at it.
The time between these episodes becomes shorter and shorter from 3 months to 2 months to finally once a month and, at one point, every other week.
During this time period - amounting to around a year and currently ongoing - I had stool tests done both occult and otherwise and I had yet another endoscopy done and multiple tests for celiac and other GI/liver/etc issues and of course, nothing showed up.
I went gluten free (maybe it was food sensitivity) and weeded out whatever remaining additive-laced foods in my diet that was left (very little) and then rebalanced my carbs to protein to fats to greens ratios (to see if I was perhaps sensitive to any of those) and well... nothing turned up there, either, and my celiac tests and stool tests continually came back negative for whatever it is that they're testing for. No parasites, no infections (though at the beginning, my doctor was wondering if I just had a tendency to get food poisoning... but once a month? Yeah, I don't think so.), just... a whole lot of nothing aside from clinical evidence of GI problems and distress.
NOTHING save for me usually feeling more tired than normal has ever been a 'constant' in triggering these episodes. I kept an extensive food and things-I've-done-today journal to try and see if my PCP and I could wrangle out any triggers, but nothing came up save for feeling more tired than I normally might.
About a year and a half into this whole GI-episodes-with-lots-of-GI-problems shenanigans-that-nobody-knows-where-it's-coming-from, all the episodes of violent diarrhea/loose stools followed by constipation finally take their toll and I experience the stinging pain and blood of my first AF and my PCP visually confirms the diagnosis and instructs me on how to manage it.
Increase fiber intake, drink more fluids (to balance the fiber), drink less diuretics (wasn't drinking much to begin with, but I did cut out caffeine), smaller and more frequent meals (was already a recommendation because of my pre-existing GI problems), regular exercise (already a recommendation), stool softeners if I need it to prevent the constipation (contraindication if I start out with horrible diarrhea though), sitz baths for the healing, lidocaine ointment for the pain if it's bad (the pain is more than manageable unless I'm getting the charlie horse up my arse pain which is seldom), lubrication to help ease the passage of BMs when constipated and to help prevent retearing...
Once the GI episode passes, so does the AF for the most part... but once the GI episode flares up again, here comes the AF. Not necessarily after the first bout of diarrhea, but at some point, it makes its appearance (reappearance as it were) known and it has so far reared its ugly head each and every time I've had a bad GI episode thus far.
In fact, as I type this, I am in the middle of finishing up a bad GI episode and though I retore my AF, I'm also healing up.
And... that's where I currently am.
In terms of treating the GI episodes, we've tried probiotics (useful post-antibiotics, but that's kind of it and we did some kind of test for candida overgrowth when we did a bunch of infection-related tests but that was a negative), dietary changes (helps to make BMs more regular and frequent with smaller balanced meals, but regularity - save for the GI episodes - was never an issue), and even antidepressants and benzos to try and alleviate any possible depression and/or anxiety issues.
If anything, the antidepressants and the benzos made everything -worse- as the sluggishness that came with them slowed my GI system down to a creeping pace and I STILL got diarrhea and I did NOT feel any better. Good for helping me to sleep when I was in the middle of having pains because of the drowsiness but that was it.
My doctor tentatively diagnosed me with IBS after about a year into my/these GI problems (where the diarrhea started showing up) and is pushing me to get a colonoscopy done to rule out/check for Crohn's and whatever other possible IBDs and other lower GI-related abnormalities especially now that I'm experiencing AFs and absolutely zero resolution in terms of my GI episodes (in fact they're only getting worse).
Not fun and not looking forward to it especially after what kinds of GI problems I tend to have and especially NOT while I'm having AF problems on top of it all. Imagining an enema when I'm already prone to diarrhea and being inflated full of gas is just - NO. UGH. UGH UGH UGH.
The last time I saw my doctor, we incidentally discovered that my Vitamin D levels - where once quite normal - are now at 12 - severely deficient as the accepted norm is 30s - and where my sodium and some other electrolytes and minerals were balanced before, they're also now unbalanced. My doctor's concern is that I'm not absorbing nutrition as well as I ought to be (from either malabsorption issues or from simply losing it all to the diarrhea) so we're monitoring these things while I'm on a prescription level of supplements.
The AF is the better-managed problem of the two; just by being regular and consistent with everything has hastened the healing when the retears happen and has helped the retears be less painful. In a lot of ways, at least in terms of the pain, I am lucky because the pain is one of the least of my concerns, but having an AF and especially one that essentially gets retorn with some amount of regularity just stinks.
Like I said, maybe one bout of diarrhea isn't going to do me in, but after multiple bouts and/or an episode of constipation later, a retear is almost inevitable.
My doctor mentioned surgery as the 'permanent' solution if my AF becomes chronic, but because of my diarrhea, he's rather hesitant to push for it and has instead pushed for more natural healing alternatives.
Things that have worked to help me tear less/have milder AF retear episodes:
- LOTS of fluids
- Minimizing diarrhea/loose stools when possible (minimizes acid which is aggravating to sensitive tissue)
- Orally ingested lubrication (a tablespoon of organic coconut oil)
- Regular rectal lubrication (organic coconut oil is fantastic and it is soothing)
- Not straining/pushing (thankfully, unless I get suddenly caught up in the middle of an anal charlie horse, I usually don't have this issue)
- Relaxing during BMs
- Gentle with wiping
Things that have worked to help me heal faster:
- Regular rectal lubrication
- Eating blander foods while having an AF episode
- Sitz baths
- Gentle wiping
- Minimizing pressure on my arse
- Regular exercise
- Eating smaller meals (to ensure there are BMs, but reduce the quantity/bulk a bit)
I guess if I could stop the diarrhea and the constipation that comes with my GI episodes without one aggravating the other (HA! stopping diarrhea if not careful = triggering constipation, stopping constipation if not careful = triggering loose stools - what a mess!), then I would be mostly home-free in terms of 'curing' my AF once and for all, but without being able to do this, I can only do preventive measures and hope for the best.
Which... I guess I can do, but...
I guess it just would be nice if I didn't have to deal with AFs on top of my current health issues is all.
Anyhow, so that's that.
Thanks for reading and thanks for listening and I am all ears if anyone has ideas or wants to comment.