I am 44 and 6 months post op Gastric Sleeve Surgery. I think that my high protein, low carb lifestyle has cause me to have an anal fissure. I've never had any issues like this before, not even hemorrhoids after child birth. I can honestly say that this is the worst ongoing pain that I have ever experienced. I self-diagnosed myself when googling all of my symptoms, then went to the doctor to confirm it. He prescribed me Rectiv but it doesn't seem to be helping. I asked my primary doctor for anti-depressants because they are also muscle relaxers, thinking this would help my sphincter muscle spasms but it just made me loopy and constipated. I have a very demanding job and I can't function like this. It's so weird because on days that I don't have a BM I feel normal and have no pain at all. But when I have a BM, even though the pain of the BM is usually not excruciating, about 30 minutes to 1 hr later, I am dying of throbbing, burning, pulsing, stabbing pain that is unbearable. I have tried everything over the counter and spent hundreds of dollars on "miracle cures for anal fissures" but nothing is working for me. I have an appointment with my surgeon next week and I am going to ask if he can cauterize them. I have heard bad things about cutting the sphincter muscle and also about botox. All I know is that my quality of life sucks right now and I can't live like this much longer. I need relief. I have tried manuka honey with basil oil, virgin olive oil, vaseline, any and all lidocaine creams. Heck, I've even went to the sex to shops and bought numbing cream but nothing has worked. All of it just burns. I have lost 70 lbs and have been feeling great and now this has really knocked me down. Some are doing high fiber which confuses me because fiber makes your stool hard. Some are doing low fiber and laxatives. I'm so confused. Has anyone had success with having the fissures cauterized? I"m scared to have my sphincter muscle cut because I've heard the success rate isn't great with that surgery.

Hi there and sorry you are dealing with so much pain. LIS actually has the highest rate of success in treating fissures, but it's certainly a scary surgery to do. Botox is very safe in comparison and is fully reversible as it wears off in 3 months. Cauterizing I haven't heard of, but I think it's called fissurectomy. Don't lose hope. Try and find a colorectal doctor you trust to do the right treatment for you.

I am sorry you are suffering right now KLG267. I am not sure where you heard that having your sphincter muscle cut doesn't have a great success rate. The procedure has a 90-95% success rate and it was a life changer for me. Sure it can have some complications but those tend to be rare. Definitely see a colorectal surgeon (don't worry - it doesn't mean you will have surgery, it's what proctologists are called now).

So sorry you are suffering. This forum has really helped me even though there are a lot of contradictory opinions. Try to figure out which ones work for you. For me Botox has really helped. I had no improvement until I got it . Now it seems to be getting better. My symptoms are like yours. Pain is worse after a BM rather than during it. I also tried all sorts of creams and none helped at all. The only thing that relieves the pain is heat. I got a heat pad from Amazon that I heat up in the microwave then sit on it. Others have used a water bottle. Fortunately, I work from home. I don't think I could have handled going to a job with the pain I was in. Hope you get better!

Here is what I wrote to someone else:

Get a bidet bottle (Home Depot has them in a lovely purple ) so you don't have to wipe other than pat dry (Don't spray too hard or pull apart to much given the wound).

Stay active (within reason). Don't over sit, spend the day lying down, or stand all the time. Sadly, your body will listen to you: The less you do the more pain you will get from doing very little. You may have a bit more pain from upregulating activity, but you'll either be moving up or moving down (Don't do or continue the latter). Avoid any strenuous activity (i.e., lifting, quick moves, etc.)

Very important to stay calm and relaxed, doing some mindfulness and making sure you are relaxing all those small muscles that surround the muscle out of your control. You may actually get increased pain twinges when doing so from allowing more blood flow into the sphincter, but this will bring more healing. I do yoga everyday, stretching without over stretching the surrounding pelvic muscles.

Metamucil. Metamucil. It may sound counter-productive, but you don't want cow patty waste (no matter how much this is the preference almost all of us have unsuccessfully tried). It moves way too fast and tears rather than allowing the sphincter to slowly open for bulkier (yet soft formed 1/2" to 3/4") stools. Fibre does NOT cause "hard" stools if you drink enough non-caffeinated liquids. Again, soft and slow.

NEVER NEVER PUSH! For now (and maybe forever), you are better off having slow moving softies. You will literally feel full of $#!t. Remember, you have likely kept things soooo mushy that you are no longer used to the feeling of a full large colon. As long as things are still coming out and remain soft yet formed, it will keep coming.

A good night's sleep. The internal sphincter generally relaxes when you sleep. Get a good sleep each night. Not sure what to say about sleep meds (They can be quite counter-productive due to tolerance and some find it worsens gut issues). Don't sleep too much because then you will not sleep at night. Naps will also likely interfere with nighttime sleep, but I've had many a chronic pain patient (I'm in a different area than this) tell me that a quick nap resets their daytime pain (probably the muscles relaxing). I do find a quick nap can help me on those tight/bad days, but a poor/disturbed (kids startling) nap can make my pain worse.