This may be a little early to be considered a success story yet, but I have had anal fissures off and on for about 8 years now, and I have never gone 4 months without bleeding so this feels like a new lease on life! I decided to come back and share because even though I was never an active poster here, reading everyones threads really helped me with some ideas and to feel a little less alone.
To start, I am currently a 30 year old cis-woman.
Firstly, here are some things I tried, but didn't really work:
1. When I first got diagnosed I was given diltiazem cream. This worked really well and I had immediate relief for about 3 weeks, until I got dermatitis from it and was forced to stop.
2. I had the nitroglycerin cream. This also worked fairly well, but I just couldn't hack the side effects. I used it twice a day as recommended, and the headaches and dizziness made it both hard to do work, and hard to sleep at night, which compounded making it hard to work again. I tried to push through it, but I ended up taking a lot of acetomenophin just to get by and I wasn't happy about doing that so I stopped it as well. I also had one 'accident' as well from having no sphincter tone as I think it relaxed a bit too much.
3. I don't want to say that it didn't work, but I had an appointment with a surgeon at one point to do a fissurectomy and botox. After my initial consultation though, the surgeon said that he is happy to do the procedure, but I needed to find the source of my problem or it will likely just come back again. In between the consult and the surgery I thought about it more and decided to cancel my appointment.
I don't think I had true chronic fissures, despite how long I have had them. Mostly because every time they came back they weren't always in the same place and sometimes I would even have two at the same time. So I agreed with the doc... if I was getting multiple, just fixing the active one at the time for surgery would be a temporary fix and I didn't want to go through the pain and recovery time just to be back at square one again.
So here is what I ended up doing. First was to find the cause:
1. Start a BM diary. I kept a religious diary of my poop consistency and pain levels for about 2 years. I found it best using an app on my phone. The one I used was called PoopQuest. It isn't free, but has quite a low price and for the quality of the app I think it was worth it. It sort of 'gamified' it which is funny but it worked for me. You have your little poops you enter living in this world and the weather changes based on the quality of the poop (if its loose, its a rainstorm, if constipated the world becomes a desert), and at the end of each week your poops battle a 'boss' and if you had enough good poops a week you beat the boss earning rewards and such. Super silly, but it kept me using it!
2. Find the triggers. You can do this through elimination diets, or food diaries alongside your BM diary. I personally found that beets, despite my love for them, make me very constipated. Coffee was a direct 1:1 ratio of causing bleeding when I poop. It just made things come out a bit too violently and would tear me every time, so I have completely eliminated it.
Other than that, I couldn't really find a cause. Until after a few months of looking at my BM diary and finding it very cyclical. I decided to get a menstrual cycle tracker and lo and behold the times where I would have bad bowel movements and bleeding were in line from about 1 week before my period till a couple days after it started.
So I found my source! A couple foods, but definitely my period. But how do I stop something like my period from causing my fissures?
First, I upped my fibre and water intake. I kept track of foods with fibre and their fibre content and made sure to hit minimum 30g of fibre a day and 3L of water. I used psyllium supplement. I did this consistently through the month.
A week before my period I would start taking an osmotic laxative, like macrogol. I would stop it after my period started, because I didn't want to be taking it consistently longterm.
I never strained on the toilet, and if I could, I used my shower to wash up after instead of toilet paper.
I kept sudocrem on hand as it helps with the pain and healing a bit, as well as 'lubricating' the area some.
This was mostly getting it by, but what made me have the most recent turn that has been the breakthrough has been 2 things
1. I got a toilet bidet attachment, one of those under the toilet seat style ones. Particularly one with both a cold and hot water hookup. The warm water was essential, as the warm water (as hot as I could handle) coupled with the pressure from it relaxed my sphincter. I use it before I go to relax everything, and then after to again relax and clean everything up. I would find that a spasm would shut my sphincter before fully voiding everything, and having the warm water pressure would relax it again to release the last bit.
I am sure this isn't much different than a sitz bath to be honest, but I found the water pressure really made a big deal.
Additionally, if you have the pressure there long enough some does get inside your bowel and it is like a small enema. This really helps when I am constipated, as it loosens up whatever is in there without me needing to strain it out.
2. Cannabutter lube (aka. weed lube). I have recently been getting into homemade edibles for recreational purposes, and was looking for other ways to use my coconut oil cannabutter and stumbled into weed lube. I was excited for my sex life, haha, but then I particularly found this recipe after reading it it was a game changer. I'll share the link, but summary someone in the comments recommended it for women with vulvadynia (painful sex) and that this lube would help relax the smooth muscles in the vulva/vagina and hopefully make sex more pleasant for theses women. And a lightbulb went off to try it out for relaxing my anal sphincter. Particularly because the two prescriptions I got worked really well for me but I couldn't hack the side effects.
I am fairly sure the recipe calls for the cannabis to be made in liquid coconut oil, but mine was already made in solid coconut oil, so it never 'whipped up' soft but solidified back hard like the coconut oil/cocoa butter does. But that is fine because it is able to be in perfect suppository shape now!
https://wakeandbake.co/i-dare-you-homemade-weed-lube/
The lubricating effects of the coconut oil helps, and I am fairly sure the cannabis is relaxing. I never feel high like I do when I take it orally as an edible, but I do get a very mild head pain not too different than what I get from the nitroglycerin, but like 50x more mild. This makes me think that it is having that relaxing effect on smooth muscles without being too much to cause those splitting headaches.
I try to use this twice a day if I can remember. Its hard to remember now when it is not a constant reminder in my behind though!
And with all of that I have really been feeling great. I am not going to consider myself out of the woods yet, but I am hopeful! I am excited to try a small amount of coffee maybe a year down the road and hope that I have a healthy enough anus to deal with it again, as that is what I am really missing!
I hope this helps anyone that might have been like me years ago and reading this website for help! I hope I continue onto the road of recovery.