Hello friends,
My name is Lee. A few years back, I was diagnosed with having hemorrhoids, received Proctofoam from my gyno & nowadays when they come, I don't even bother with the foam, just wait them out. On February 6th, 2011 I had a terrible upset stomach (possibly something I ate? maybe a bug?) but regardless I was up half the night with diarrhea & vomiting. I knew a hemorrhoid was gonna result from all that & sure enough within the next 24 hours, there it was (or so I thought). This particular hemorrhoid seemed way worse than others I had so I opted not to "wait this one out". Bought the Prep H cream, then Tucks wipes, then A&D ointment but things just got worse. I never had bleeding hemorrhoids before this one but I knew it happens. But then BM's became a nightmare, like passing razor blades! Desperate for relief, I drove to the ER where a Dr. did a finger check & confirmed I had an internal hemorrhoid & gave me Anusol suppositories. The next day, I followed up (his advice) with a local surgeon who specialized in this matter. He said he could see me that afternoon! He diagnosed me with an anal fissure & told me to stop the Anusol because, "We want as little going in/out of there as possible." This doctor also disagrees with the scores of people on a high fiber diet. He says it's great for overall colon/GI health but for fissures...all that "going" is not your ultimate goal & will not assist with healing.
I am sure I will soon be fired because I spend half my day in the office bathroom & the other half researching fissures. I know most of the sites say: high fiber, lots of water, sitz baths & stool softeners. My doctor like I said, is against the high fiber & also thinks the nitroglycerin cream could cause lightheadedness, low blood pressure & many other side effects. It seems no matter what anybody does...it takes a serious amount of time. I recently read that the anti-fungal cream for athletes foot/jock itch named Tinactine works. Called my doctor, he has never had any experience with this and does not condone me using it but I swear that if somebody told me jumping off the Brooklyn Bridge could help, I'd drive to NY right now. How on earth is everybody dealing with this? The pain is mind-blowing! I can't concentrate on my job, can't have sexual relations with my new boyfriend (and can't explain why either), can't go to the damn bathroom, I'm mad!! I hate this fissure, it is ruining my life! Can somebody please list the miracle cure-all that i am so desperately searching for? Help!

Hey there, you've come to the right place!
I've never heard a doc say that a high fibre diet is not needed, though saying that I can well understand about the "coming out" not helping with healing, I once said a while back that I'd be more than happy to have my arse sewn up and poop in a bag if it meant rid of the damn pain, so there may be some logic in what your doc said.
I had to quit work because of my fissure and like you sexual relations don't really enter the equation, life does revolve around the bathroom with an active fissure, I used to spend hours and hours in there and at one point was thinking of moving a TV and my laptop in there, seriously though, fissures wreak havoc on your life, I haven't come across anyone that can handle a full on fissure!
The only real permanent measure for curing a fissure is surgery but that doesn't come with any guarantees either, it is by no means a quick fix solution but has high success rates, maybe this is what you need.
I hope you enjoy your stay here on the forum, you'll find it very informative with plenty of good stories.

Aww, sorry to hear that How are you managing your pain during BMs?
I'm a first-time newbie too, and have the exact same concerns about life being ruined (being fired from work, dumped by the new guy I'm seeing etc). I am MAD...when not crying that is.
Just out of curiosity, what was your doc's recommendation regarding "as little going in/out as possible"? I was considering a liquid diet for minimal BMs, but not sure if that will help or hurt. I kinda agree with the doc though, since that was my experience the first few days....bulk = bigger stools = pain. I didn't have good luck with rough insoluble fiber. Life has been slightly better eating really soft nursing home food like mushy over-boiled veggies and applesauce.
What is the consistency of your BM's if you don't mind me asking? Wow, weirdly inappropriate question to be asking a stranger

Welcome here! I think you will need this forum, seeing as you are in pain and that your doctor has given you some advice that I personally would question (being an internet educated proctosphincteranologist myself!... in other words, these are my own humble opinions).
First off, you want to get your stools soft... for this a lot of people here find miralax/movicol useful (though for some people it makes stools too soft). A lot of people also take a fiber supplement. Steve just put a good post on fiber under the Diet section, explaining why fiber is good. For me, getting stools soft made the difference between the razor pain and lack of razor pain during BM.
It will take you a little time to figure out what your own personal mix is to manage your fissure, but with a little trial and error, you'll find it. A lot of people start out with a full dose of the miralax at night (or else divide it during the day) and adjust down or up from there as needed. It takes a few days to kick in.
Then, hot baths. Drink water. Eat fruit and veg and no red meat. Avoid seeds, nuts and other "sharp" foods.
The hem creams often contain hydrocortisone, which thins the skin after 2 weeks use, and this is not good for healing the skin around a fissure. The other creams which your doctor should have prescribed are either diltiazem, rectogesic or niphedipine (something like that). You can read about those here.
If you can manage to do these things while your fissure is less than 6 weeks old, then you have a good chance of healing it up.
I found it impossible to go to work too, at least for a 2 month window where the pain was the worst. Is there any way you can get some sick time? If you have spasms, and must be away from home, then sitting on a heating pad (or microwavable wheat bag) gives some relief.
Hope you can heal this!

Hi TLB! Love your name.
I'm so sorry you're having these problems...I can't imagine trying to date with this going on :( . And being worried about getting fired...oh no! If you really need your job and you really like your boyfriend, you just might have to come clean. Yes, it is very embarrassing. But it gets easier. My fissure started with childbirth, so I just tell people that giving birth caused a rectal tear that won't heal. Not that I'm telling everyone--it's a select few!
Obviously that's not your situation, but you can probably invent a story that's a bit vague and less embarrassing to you. Most people won't want to hear all the details anyway. You could even let them think it's a gynecological problem....it's really none of their damn business but obviously you may want to excuse yourself so you don't lose your job.
I don't like what your doctor had to say either. You need the right cream NOW while your fissure is still in the acute phase. I didn't get the right cream, and that could be part of the reason why I still have fissures five years later and am now about to have surgery. If he's worried about nitro (and it is nasty stuff, truly) there are alternatives like diltiazem and nifedipene. I have used the nitro and it no longer gives me headaches, but yes I do feel dizzy at times. I think your doctor is just a little too conservative.
The fiber thing, he may have a point--Metamucil really bulks the stools and makes them too big for me to pass without tearing. But there are other fibers to take that don't make the stools bigger and make you go ten times a day, like Benefiber. For me, I don't notice Benefiber being helpful all that much. I just take small doses of Miralax and eat fruits and veggies.
With the right diet and the right cream, you just might beat this before it turns chronic! Best wishes!!

Bumbutt wrote:(being an internet educated proctosphincteranologist myself!... in other words, these are my own humble opinions).

Ah, but the advice I've gotten here has been so much more spot-on and helpful than anything a doctor has told me!!! Apparantly treating anal fissures involves some sort of voodoo black magic that only other sufferers understand. For a 'common' problem it sure is a mystery to most doctors.

Thank you StevePain, Sadgirl, Bumbutt & Alpinestrawberry for your replies! It really is comforting to hear from other people with the same problem because unless you've had a fissure, you just couldn't possibly understand, and I know you guys do :)
StevePain: I can't imagine you'd sit for hours & hours on end in the john...that must've been awful! I guess if I was doing that, I'd move the TV set in too but I can barely pee on the toilet, the pressure is too much. I straddle, half standing to pee, even if I pee down my leg...I'll just shower off. Beats the pain!
Sadgirl: I'm really not managing my pain DURING the BM's but by jumping into a Sitz bath right after. It helps alot when I'm in the tub but all this bathing has my skin dried out. I can't just sit in half a tub of hot water, the rest of me is shivering, so I fill it. Now I have dry, scaly skin. The other night I tried to counteract that with a body lotion. WHOO bad mistake! Next am, after my BM, jumped into the bathtub....Oh the burning pain. Decided dry skin isn't that bad after all. My doctor's recommendation was to drink plenty of fluids, use Colace twice a day, Sitz baths & low fiber diet. He basically said no suppositories going into the butt & no high fiber diet coming out of the butt. He also prescribed something called dibucaine which was only available (at 6 pharmacies) by special ordering it so, the pharmacist spoke to Dr & it was switched to Lydocaine which btw, does nothing. The consistency is too water-like once I've applied it on my "hot butt". It's a mess & it doesn't alleviate the pain at all anyways. I thought just as you did...why not fast or do a liquid diet? but I've read when stool sits in the colon, the water depletes from it (hard stool) & you sure don't want to be constipated so I think we'd better just try to keep our stools regular but softer. With Colace twice a day, I still had hard stools...I upped it to 3 x day, so far so good. They say it should be the consistency of toothpaste or soft serve ice cream. Finally, I got that part down.
Bumbutt: thank you, I will search for Steve's fiber post because i'm very interested in why fiber is good. To be honest...I'm really not listening to my doctor because it seems these websites know more than he does about this matter and who knows if he's ever even had a fissure. Last night I applied Tinactin (size of a pea) on my butt. It still hurts but I'm hopeful. People say it clears up with that stuff & I'm so desperate to feel just a hair better. I need that "light at the end of the tunnel" because it's been like 3 weeks and sadly, I see no change at all. It worries me that if Tinactin is ingested, call the Poison Control Center. I mean technically, it is entering my blood stream through my cut butt, am i poisoning myself? Guess time will tell. Please do not write on my tombstone that I died this way! LOL I do have spasms, sometimes it pulsates so bad it feels my heart is beating in my butt! Gonna try your heating pad advice, since the warm sitz baths help, that makes perfect sense, thank you!
Alpinestrawberry: I love your name too! I do have not sick time but vacation days to use however I'll be damned if i waste them on my butt in Connecticut when I can use them in FLA or the Caribbean! LOL Seriously speaking, I did take a day off to see the Dr. but my company has just merged with another & we're all hoping to keep our jobs. It's just not 'the time' to be missing, ya know? I do need the right cream now, you're right! That is why I called the Dr. yesterday inquiring about both Tinactin & Nitro....he gave both a thumbs down but I went ahead with the Tinactin anyhow. It's only been applied twice: last night & this morning so I will have to update again in a few days.
Sorry if this reply seems "rushed". I'm trying my best to respond in between work orders. Thanks again to all!

here is a million dollar answer to your question regarding healing fissure
TIME
it takes time to heal a fissure. most simple fissure (not much pain , light burning) heal in a week or so. if you have major one which you do (the broken glass pain) you are looking at atleast 1 month to get to 80% or so healing where you dont have any pain or discomfort say 30 mins after your BM. to completely heal it will probably take months
bottom line you have to be very patient. healing will be very gradual and WILL have setbacks. you to have persist through them. make sure your stools are soft (take colace , lost fruits and veggies) , drinks tons of water (atleast 3 lts). sitz bath are very useful and also light walking.
good luck

Hey there,
Sorry you are in so much pain. Your bm problems sound similar to what mine were for months with my fissure. My sphincter was so tight and in spasm after I got my fissure that I couldn't have a proper BM. I would go and barely any would come out.
I don't think you necessarily need to eat tons of fiber but get a fair amount that will help keep your bms regular. Too much fiber can definitely back fire on you with a fissure.... The main thing is to drink plenty of water with the fiber or you can become constipated.
I took around 5 colace a day before changing to the miralax. I didn't get the best results with colace and it didn't matter if I took two or five! It was about the same either way. That may be something to consider?!
Also, there are many foods that you need to avoid while having your fissure which is as important as eating the right ones!! I had to learn the hard way unfortunately!
Hopefully you will get one of the fissure ointments and heal this soon before it becomes chronic but if it comes to the surgery, don't be afraid! I had it and have had really good results
:)

I came back online to tell people NOT to try Tinactin. I applied it two times: night & morning. I'm on fire. My butt stings & burns & itches 100 times worse than before. Sharp shooting "knife" pains too! Who ever thought the pain could get worse? IT CAN!
I took the day off work (again) & I'm going to a new dr. today at 2:30pm (a colorectal surgeon). I no longer have a little blood, my butt is bleeding terribly before/during/after a BM. Not a little, almost pours out of my butt when I push, which is not to say I'm straining in any way because I wait & wait until I'm sure I have to go but let's face it...it still requires at least a tiny push. When I do, blood oozes out of me like a siv! To thegreat_in: Thank you, I do realize it takes time, I was just hopeful maybe it'd clear up quickly, being my first fissure. That is not the case.
Thinking back, my friends told me for years that I must have a GI issue, God I wish I would've looked into that sooner. If only I got that under control, maybe this would've never happened. I just got "used" to & lived with upset stomachs, diahrrea & constipation. I never even bothered to limit dairy or anything, just if I got an upset stomach, I sat on the toilet with diahrrea...when it was over, I'd eat another piece of cheesecake. I'm an idiot who just ate what I wanted & dealt with whatever came out the other end. Now I will be on a high fibre diet for the rest of my life. Do you really think I will never pass a hard stool again FOREVER? Thats impossible and yet if I do, the fissure will return. It's hopeless, I can't stop crying. :( and Dawn...maybe I need to switch from Colace to Miralax. I'll ask the new Dr. today at 2:30pm & if it comes to surgery...I will try not to be afraid. Thank you!!!!