I have been suffering from anal fissure for almost a year. The first time, it never totally healed but I managed to get it under control with very careful diet. However, out of the blue, it has started to cause me a lot of agony again, I am even thinking seriously about quitting my job and get it sorted out properly (but am worried that I will get even more depressed without a job to distract me from my pain).

In the past few weeks, I have been having BM that takes forever to come out. I have the urge, and the poo is already there, but the peristalsis had either stopped or not enough to push it out without me pushing so hard that I start to shake (I am not straining at the opening, but rather, pushing internally from further up - if that makes sense?). Needless to say, it is very traumatizing to my AF and makes it bleed everytime and remain very painful for the rest of the day.

When the stool finally comes out though, I found that they are not massively big or hard. I would say they are about type3/4 on the Bristol scale. I have passed this type before without this much difficulty. I am already taking lactulose daily. I take coconut oil and almost only eat the following: boiled egg, cereal and milk, porridge, boiled veggies, fruits, and smoked salmon and lots of water. I used to have mostly “type 5” stool with the same diet but these days my gut has changed even though my routine (one BM every morning) hasn’t changed. But even with type3/4 stool, I never needed to push so hard!

Back then, the first one was always harder and took longer, but the rest used to just slide out without too much effort. But these days, I have to push hard for every bit. It feels as if my rectum had stopped contracting once the poo reached the opening, or my body has somehow forgotten how to poo!

I wonder if anyone has any tips.. and what else I could do to reduce my poo to type5?

Hi East,
I'm really sorry to read of your issues.
Have you considered discussing this issue with a standard & sympathetic GP? I'm just wondering if you have become so stressed by all of this that mentally, this is just impacting on your BMs in a big way - Stress alone can make it so hard to "go" because it makes you so tense & the fear almost makes you seize up at times. It's a horrible thing to have to deal with.
That shaking feeling you describe makes me feel you have some real anxiety when you go to the toilet, because I've also experienced this to some extent myself. I just know when I am feeling really relaxed, my body & mind are relaxed, that it seems to make things so much easier.
Even if you regularly maintain a similar diet, sometimes BMs are affected by other issues and not every day is the same unfortunately. It's also easy to get caught up in a cycle of too much worry and angst at times like this and possibly a GP could suggest some methods of relaxation possibly some medication or advice that might help you?....
Your poop type sounds OK in itself & trying to change your diet might not be the best help if you are already anxious - it could lead to much runnier stools or fluctuations between harder stools and softer ones too.
These are just some thoughts but it's possible you might just need to deal with things more mentally & become a little more relaxed about your situation.
I used to find Olive Oil very helpful for easing stool evacuation (taken orally at night time) & these days I also swear by Magnesium supplements to make things a lot softer.....
I do notice a strong link for myself personally when I am really tense & stressed out. It makes my BMs much more of a challenge even though I tend to have great soft stools most of the time.
All the very best in trying to sort this out & I hope you start to feel much better soon :)

I agree that stress is a huge thing that could affect the whole system. My last retear was due to stress. I started to do meditation few times a day to relax and also repeating self mantras that I am healing. and I am doing before bms as well. I believe it helps! I am still on high fibre diet, prunes and stool softener. It helps to maintain consistency of bm and lubricating with vaseline each time before bm helps to traumatizing less the area. hope it helps , wishing you start getting well soon!

I think I know the place you are and been there. I assume the shaking is due to the concentration/stress of trying to get it out, applying force but trying to be careful to be not too forceful? And you get it so far but the pain/anxiety takes away the feeling of needing to go.
What helped me personally was a visit to the doctors. I wasn't quite sure what I had and this made me very afraid of going to the loo, anxious. When I knew more, although the doctor couldn't exactly see it, but it wasn't haemorrhoids, I was able to visualise and actually I thought it's just like a papercut. Hence I felt more relaxed about it. The doctor wasn't too concerned as I told him the first time I had this was 4 years earlier after jogging (running now causes an instant tear I think)

Stress I feel is a big factor. My previous fissure flare up was during a stressful time although i think I hadn't healed from the previous time fully (just 3 months earlier). I then managed to be pretty much fissure free for the best part of 1 year 5 months although could always feel it's presence. I even went through a period of bad constipation with no tear - not so much hard stool but just bunged - wanted to go but couldn't! However this year I moved house and although didn't feel that stressed about it, the fissure irritated just before the move and then split after I had moved in, about a week after, while trying to get back into a routine of eating the right foods. I had no furniture at first as I moved out of a fully furnished house and my own furniture was 200 miles away in another property and had some other worries. Now unfortunately I'm struggling to heal and seem to re-tear partially once a week but nowhere near the last time over 1.5 years ago and also not as bad as when I first re-teared after moving into my new home. For me IBS doesn't help - I can get constipated even eating the right foods sometimes! I can also feel like I need to go, but also don't(I sit on loo and have no feeling), hence I sometimes feel I have forgotten how to go to the loo, or forgotten how to recognise the urge to go to the loo.

So if you haven't seen a doctor, please do. In fact if you have maybe you should pop back for another chat and explain your issue. I think many might eventually need an operation so worth keeping in contact with a doctor over the matter. My dad had the same issue and had his fixed in 1987. Definitely try to relax a bit (much easier said than done I know). Although the pain can be severe, it is, just a reasonably small tear, that's how I try to look at it .....so I push it through the pain barrier :) (joking!), but it helps me to relax more.

Thank you all for your replies. Yes I am definitely the nervous type, and I really hate to be this way! I tend to overthink everything and it is really not helping! e.g. I would debate with myself whether to have half or 1/3 sachet of Fybogel, when in fact, as I am slowly learning from your replies, things (e.g. poo) do not always turn out as expected.

It is also affecting my sleep as I usually have BM first thing in the morning, and I keep waking up dreading it as it gets closer and closer to BM time.. sometimes the urge came when I was still in bed, and I would rush to get everything ready for BM (hot water for drinking, washing my hands, lubricating with Vaseline, silencing my mobile in case I get disturbed, even pulling the towel off the hook in case it falls and shock me.. etc) So you get the idea how stressed/ OCD I am over this!

Sometimes, I even wonder if my AF may be linked to my personality type in the first place. Because I think I eat healthy, and my BM can not be more regular. I am highly disciplined (and obsessive) but yet my AF won’t go away. The trouble is, like Superfissure says, sometimes AF flares up due to stress even though you don’t particularly feel stressed.

I have been to the GP about 6times. I got referred to a CRS - saw her once, which was traumatizing (she made me bleed by forcing the proctoscope and I had not bled for weeks at that point). She found a fissure, but referred me to have a colonoscopy to rule out the cause of bleeding from further up the system. Thankfully, all the biopsies came back normal, so they discharged me.

Unfortunately, my relapse happened a week *after* the colonoscopy. A week *before* the colonoscopy I developed an itching in my back side and front (tested for bacteria and yeast – negative), so I wonder if that maybe due to my anxiety for the colonoscopy. I think whatever caused the itching (e.g. dryness, thinning of skin?) may also be linked to my new AF. As of today - a month after the colonoscopy - I still have both the AF (internal bleeding, pain) and itching!! I would be happy if only the itching goes away!!

I feel that either my opening has become really narrow/ swollen, or that I have really forgotten how to relax and “go”. I have another CRS appointment on 18Nov.. I tried to request an EUA (exam under anesthesia) but they need to see me again first as they have officially discharged me after colonoscopy.

Superfissure: did your dad have LIS and did it get fixed permanently? Would you consider having an LIS too?

ETO: what type of Magnesium supplements do you take? I read it in a recent post too but it doesn’t specify the dosage etc.

I guess the greatest pain of my AF is the constant worry and paranoia over what to eat, and what to do about it. And I burst into tears every now and then. I can think of it as a paper cut and I can bear the pain, but I am worrying that it may get infected and become an abcess or fistula, which is a lot more complicated to fix. So I am thinking maybe I should just go for an LIS before it has any chance to develop into an abcess/ fistula, which will most definitely require surgery. Am I right? (but of course the thought of having an LIS scares me to death)

ETO: you once told me that abcess and fistula are not as bad as AF itself?!! How could this be?)

I am really sorry for my negativity and constant worries, but I try to be positive and it really helps to talk through it here. (but I will go back to the GP again and see what she says about my anxiety problem..) Actually, I have started getting acupuncture, which aims to treat overall health issues (incl. anxiety) Thank you so much for all your replies and for this forum! I wish you all AF-free and pain-free soon!! xxx

My doctor stated that an operation was really a last resort and done rarely. However, I feel if it impacts a life too much then might as well try it so I may push for an operation even if I have to go private just to get it done. I will dread it too and probably wouldn't sleep the night before but heck if it comes to it I'll get it done so hoepfully can forget about fissures for the rest of my life

What do you fear about the LIS? The operation or the potential side effects post op?

I believe my dad had the LIS but he does not remember the details of the operation, but either that or a removal of the fissure or whatever else they might have done in the 80's. He had suffered for years he tells me. He was told he would be in pain after the operation and during the first few BM's but he says he was fine and had no pain and has not had a problem since. Bowel control is totally fine too. He's now 76. I believe his was more external as sweat and soap irritated his but neither affects mine.

I feel my opening is too narrow too, can actually feel like that while going to the loo sometimes. For most of my adult life I've always had fairly loose stools. With the IBS and/or age they're a bit bigger these days. Maybe going loose for years caused my butt to get smaller :). Or maybe it's psychological, stress or whatever causing a tighter opening or at least not helping. Given my dad had an issue I wonder if it can also be heriditary

I definitely feel your pain. Luckily I've not had bleeding much but the one or two flareups I have had which has involved bleeding I know it's mega painful. I once described it as trying to push out a bulb shape - like a light bulb or wine glass. It feels massive but when you look down it's fairly normal sized!

Did your GP give you anything for it. Mine gave me (well I paid for) Sheriproct ointment. It's got a good shelf life and I used it recently. I think it helps although not using it at the moment. It can only be used for about a week though but lubricates, has antiseptic properties and I think nums the area.

East,
My goodness, reading your posts reminded me of me !! It's uncanny - The OCD/ the sleep disruption.... everything echoes the way I was a year or so ago. It's horrid & I have to say my GP prescribed AD's for me as a temporary spell which helped unbelievably in my case. Your personality sounds just like mine. It's kind of reassuring to find someone just like me here!!
I am more convinced than ever it's stress creating more issues for you than you need! .......
Not knowing when you really need to go......stressing about every little thing you put in your mouth.......Please find a sympathetic GP for a good chat - I do think it's anxiety, which can lead to depression over it all (I know - I sank deeply)
I take a standard 300mg Magnesium tablet - Just a supermarket own brand, nothing expensive or fancy & I have great results with it. It actually ended up replacing my stool softener in the end too. I take this every night with a large glass of water before bed & have no issues ever with my morning BM.
Please don't stress that your fissure will lead to anything else. It doesn't happen very often & generally people seem to have one or the other. My abscess/ fistula was totally unrelated to the fissure - purely bad luck.
For me the Fistula & abscess were so easily treatable (not nice when happening) but simple surgery took care of both. Now there is no sign I ever suffered these things because I caught them quickly & treated them at a very small & simple stage (not every one is this lucky, I do appreciate that)
The reason I do believe they are not so bad is because once treated, many are successfully dealt with and do not tend to recur, pretty much the end of it all. Chronic fissures on the other hand, are more painful, both mentally & physically, they are relentless, unpredictable and slow healers. If they do heal, there always remains a fear you can retear.
This is why (in my case) I would have the fistula over the fissure any day! Over a year on, I rarely think about the fistula - it's in the past but the fissure never will be entirely. It's healed yes, but even today, I have to be really careful not to aggravate the scar tissue, which never becomes acutely painful like it once was, but can be sore on occasion or twinge just to remind me of what I went through.......
I turned to deep breathing techniques, positive affirmations & meditation to help me through & these things do help if you practice them enough. Acupuncture is definitely worth a shot!
This site was so important for me at my worst times, so don't be afraid to keep coming back to gain some reassurance & help calm your mental anguish.
Main thing is you will get through this for sure, but being positive & trying to relax about it all is so so important in the meantime.......:)

Superfissure: All my fissures are internal too, which makes it even more unsettling, as there is no way of assessing it except by DRE, which is often impossible due to pain! and you can’t see it properly anyway!
About LIS, I am not too worried about faecal incontinence (probably because I have never suffered it!) but if it guarantees pain-free and stress-free BM then, it can’t be worse than what I am suffering now! (but I guess if there is leaking, it maybe irritating and itchy) I guess my biggest fear of LIS is, what if I go through all the pain of LIS and it doesn’t fix my problem! Having said that, I think I will also endure AF for a while before I will seriously consider taking the plunge of LIS.
I am the same as you! I used to have loose stool most of the time (i.e. easy to pass). Now I probably have ‘healthier’ stool, but unfortunately I don’t have a matching healthy butt to pass them without excrutiating pain and bleeding. What do you take to control your ‘poo type’?

Yes my GP prescribed something new every time I visit(!): GTN ointment, Proctofoam (which I never used), Proctocedyl suppositories, lactulous, Fybogel. I also make coconut oil suppositories, and have just ordered Dr Wheatgrass, and bought Manuka honey.

I am thinking of canceling the CRS appointment.. as I really don’t think I can relax enough for the proctoscope to go in when my AF is currently active. I often suspect that the tight opening is more due to “tense muscle” rather than the opening being actually narrow. Sometimes when I look down after BM, the size often doesn't match with how I felt during BM or what I felt I had passed... I think the internal spinchter muscle must be highly complex and the CNS feedback system must be complicated.

ETO , it is reassuring to read that I am not (or not the only one who is) crazy over this! I wouldn’t mind taking AD or anti-anxiety medication, as long as it doesn’t cause constipation or something counter-productive to AF treatment.. It would be better if it causes drowsiness, which will probably help me sleep better. I just bought some Magnesium tablet today (50mg per tablet), but I haven’t taken it yet as I think I may be getting stomach cramp from lactulose (which seems to be not so effective on me as it used to). But I will take one before I go to bed. I will try to relax and take it easy.

thank you so much!!! xxx

I don't really do anything to control the poo type but I just eat a lot of fruit and veg most days. With IBS it seems to just vary anyway. I've not used it recently but while I had it under control for 1.5 years I drank a glass of innocent soothie juice each evening(the dark red one of mango one), as well as my normal intake of fruit duing the day.I do sometimes take 3/4 of one tablespoon of extra virgin olive oil which can help.

I definitely have to avoid pastry products and too much meat/dairy products. I had a few treats the weekend and an unplanned pastry meal at my parents house and still paying for it today. Been to the loo multiple times and getting smoother to pass but oh the pain