First thanks for this forum...strength in numbers :) , i'm a 42 year old male and throughout my adult life on occasions when i pass a stool it has sort of scratched me on exit so to speak, like a little knife like stab, anyway i might get a little streak of blood but that would be it.
Anyway about 3 months ago i had a tough time on one occasion going to the loo and ever since then i've had some irritation down there at the rear of my backside.I did have a haemarroid there and thought that that maybe the problem but the irritation didn't really feel like a hamarroid....anyway i've gone through various creams including GTN which gave me a banging head but gave up on it.
For the first time in the last couple of days on examination i could see the little cut/tear just under my rear, i was struck with the hole like appearance of it and was worried it was a fistula...the doc has looked at it and said it's not really in the right place for it to be a fistula (it is too close to my anal canal) and he thinks it is 90% a fissure.
The thing is though, the whole time i've suffered i have only suffered irritation as opposed to the horror like pain most seem to suffer with...is it possible to have a fissure and not really be in massive pain.
cheers

incidentally , i'm back on the GTH and my head is currently killing me

GTN i should say

So sorry the GNT is hurting your head Frankel,
My AF doesn't cause me the excruciating pain others talk about. I figure it is because I don't get the muscle spasms they get.
It just kinda twinges or feels sore, especially just after a BM.
So I think my lucky stars!
Well somewhat lucky eh?
Anyways,
Is the doc you are seeing a Colon Rectal Surgeon (CRS)?
If not, you should think about switching, IMO.
There are other topicals you can be prescribed other than GNT. I am on Nifedipine and am finally having some luck with it. It is less likely to give headaches.
-woi

Hi Frankel: is the GTN 0.2 % sweetie? if it's higher, that is why ur having headaches son.. and also if ur applying it as indicated - just a pea size amount is needed.. Take care and plz read others posts here.. They are truly helpful in this painful journey..
Also - are u doing the eating right/drinking water/ and stool softeners? These help also in keeping the stools soft and thus help alleviate the pain and help the fissures heal..
God bless u and may He heal us all..

great forum this...so nice to get feedback off people...mine is 0.4%...this stuff is brutal isn't it, i did put on the 2.5cm it says, i will put on less next time....within 1 minute of application i feel a whoosh through my head :-) but i will persist with it for the time being as my rear often feels as tight as a drum!!
i am being referred to a specialist in any case as i've had it for about 3 months without resolution....as i say though i do not in any way suffer horrendous pain...it's more like an irritation you get like when you've wiped too much, this is why i am concerned it's a fistula rather than a fissure as i can see a tiny hole rather than a distinct tear....but as i said my doctor said that fistulas are generally further up the side of the buttocks, mine is positioned just behind the opening at the back part of the rectum....perhaps that's why i don't get the real pain as it's just off the muscle as opposed to on it.
my diet has never been good, i never eat greens and rarely get round to eating fruit, i am drinking stacks of water though.....i think that i have maybe unwittingly been strengthening my sphinkter muscle through the years as as stated above every now and then i get a little scratch feeling when i pass a stool and because of that i often find myself sort of teasing it out...pushing and pulling kind of!!!!! giving my rear a good work out in the process.
thanks again....this really does help.

this may sound like a strange question but as i still am not completely sure that it is a fissure i have (waiting for an appointment with a crs as i type) what type of pain do you get, as i said before mine isn't really pain...just a sharp short of irritation i can best describe as if i have several grains of sand stuck around the entrance to my rear and they are grinding against it sort of....also if i had a fistula....shouldn't that be leaking puss or general type of muck...my cut/tear simply spots blood from time to time.
cheers

frankel,
With regards to the GTN it depends on which type you have. In the UK the only licenced ointment is 0.4% Rectogesic GTN which must be applied internally twice a day - as you state the correct dosage is 2.5cm, you can start with a smaller dosage to manage the headaches but for it to work effectively you need the full dose really.
The headaches are a pain but after a week or so they tend to calm down or go away. Some people take Nurofen or parcetemol to calm the headache.
(0.2% GTN applies to the US version which is applied externally three times a day)
Davo

ohh I half answered you there sorry :)
I personally dont have a fistula but these are the symptoms as described by the NHS:
The symptoms of an anal fistula can include:
•a throbbing, constant pain that may be worse when you sit down, move around, pass stools or cough
•pus or blood when passing stools
•irritation of the skin around the anus (the opening where waste leaves the body)
•itchiness around the anus
•a high temperature (fever) of 38°C (100.4°F) or over
As for a fissure you would normally experience a sharp knife edged pain during bowel movements and this is followed by the spasms which can give a sharp burning sensation for 3-4 hours (sometimes longer) following the bowel movement.

cheers davo, the knife like pain is something i have had every so often when passing a stool for many years, i think that i have a particularly sensitive/weak piece of skin that is the problem.....it's funny as when i sit down i don't get any problems at all.