Hello!

I've been suffering from an anal fissure for about 2.5 years, since November 2014. I've always had a weird digestive system, but of course when you hit 30 everything starts to fall apart. When I got the first fissure my GP thought it was hems and gave me a steroid suppository which my body rejected very quickly. It took 2 more months for me to hit rock bottom while visiting my boyfriend's parents for the first time over Christmas. I managed to get an emergency appointment with a GI nurse and she prescribed rectiv which cleared up the first fissure. Over the following year it would "rear" it's head. I gradually figured out that bulking my stool was causing the problem and then switched over to a paleo-like diet which I am still following.

In July 2016 the fissure came back, my GI prescribed diltiazem which did nothing for me and then told me to seek out a CRS since I didn't want to get a colon/endoscopy with her. I saw the CRS and he prescribed me a compounded nitroglycerin ointment which cleared up the problem.. but then it came back.. and healed.. and back.. and healed.

While all of this has been going on I've been trying to figure out WHY I'm constipated. I know my period cycle is for sure to blame, it's more likely I'll have hard stools a week before my period and it's very difficult to heal during that time, too. Right after my period is optimal healing time. Over the last couple years I figured out I have Hashimoto's disease (thyroid autoimmunity) and a mild stomach autoimmunity as well (linked to inadequate B12 absorption and lower stomach acid). I've been seeing an acupuncturist and a naturopath but neither really know what to do about the fissure.

I know that my digestion has improved and I have pretty normal BMs.. so why the heck is the fissure still so awful? It turns out AFs run in the family. My dad had one (acute), and my mom's sister and father had them their entire life. I don't really know how my aunt deals with it, but she's finally found a lifestyle that's worked for her. I'm not a large person.. so I'm kind of thinking my tubing is just too small (I also have a tight chest which has squished my heart a little). No one has gotten surgery for it.

What helps the most for me:
Diet: When the fissure is active I do best with only above ground vegetables and meat (except things like steak and dry burgers). I try to avoid coffee and alcohol as well.. but to be honest I haven't really seen a difference with eliminating coffee. When the fissure is healed I can re-introduce more fiber.. but grains are completely off the table for me. The hardest thing has been drinking enough water which I think is the real crux of the matter.. if I get dried out for too many days in a row it's the worst thing ever.
Supplements (oral): 300mg magnesium (thinking I should take more), 2TBS aloe vera juice 3-4 times a day, digestive enzymes (I have 2, one with and one without HCL/Ox bile), 1000mg Vitamin C 2x a day, 4000-6000iu D3, Methyl-B12 (which I can absorb OK). I also take a Motility agent (MotilPro by pure encapsulation) at night which has made a huge difference in the reliability of my BMs.
Supplements (on fissure): FissureHeal by Forces of Nature 2x a day between nitro (not seeing results) and coconut oil. I used to use coconut oil + vitamin E suppositories but they started irritating my upper rectum so I stopped doing them. I did find that they helped..
Meds: Colace 2x a day, Nitro 3x a day (BEFORE I go, mid-afternoon, before bed)

I've been wanting to do Pelvic Floor therapy but I never have enough time between healings. I'm thinking about doing a Botox treatment.. and then if it's successful going in for a 2nd round in 3 months.. and then at 6 months doing pelvic floor therapy. Anyone have experience with this idea? Do AFs increase in size as the years go on making them even harder to treat? Will it ever really heal?

Pelvic floor therapy doesn't need to wait until you are healed. I'm doing it now to help my healing along and it's helped to relax my tight muscles. I had botox too about 5 weeks ago and while it's helped a lot it's not a miracle cure and you must keep BMs soft.

I think fissures develop scar tissue over time which makes it hard to heal them fully. That's why they keep coming back because the muscle around them is still very tight.