Hello all,
I'm new to the forum, and new to this fissure stuff. (If that's indeed what I have) A few months ago I started to have painful bowel movements, often with blood. It stayed for a few weeks then stopped and things were normal for a week or two. Then again, I felt the pain, (usually starts in the morning bc thats my biggest Bowel movement) It also for some reason affects my urination, makes it difficult and I often have the urge to urinate when I don't have to. (Awful!) So, I went to the doctor and he looked at my anus (embarrassing) and didn't see anything. (He said it must be deep in there) So he gave me some ointment to put on it before BM's (which didn't help) He also told me to eat prunes. The last thing he did was give me a prescription for a Colonoscopy and said it was up to me if I wanted to go through with it. I am really not a fan of doing this, so I waited a week or two and the pain stopped again. But yesterday morning, I had a really big BM and it was magically back. So my question is...since I most likely have an anal fissure, would the Colonoscopy be a waste of time? Since I already know what the problem is? Or do you all recommend that I go have it done? I really cringe at the though of having to do that. Also, do you recommend taking an over the counter stool softener? Thank you all for your help..............

Hi DynaMike...

So sorry you are having pain. It does sound a lot like a fissure. The colonoscopy is a tough call. If you do have a fissure, the cleaning out process as well as the procedure itself could be pretty irritating, and may make an already painful problem worse. The reasons for doing a colonoscopy are twofold, to look for cancer or polyps and to look for signs of inflammation found in conditions like Crohn's disease that can make people more susceptible to fissures. If your level of concern in ruling these things out is high, it's an obvious choice. If not, there are other ways to get a fissure diagnosed, but even those probably aren't that necessary, as most CRS will feel ok about diagnosing based on symptoms alone. But you can have an anoscopy done that looks just at the anal canal and doesn't require the cleaning out. This can be done with or without sedation depending on your level of pain at the time.
You don't mention what type of ointment your doctor prescribed, but generally what you want to use is nitroglycerin, nifedipine or diltiazem. If you have a fissure, these medicines will help relax the internal anal sphincter and bring better circulation to the area to promote healing. Warm baths after bowel movements and several times a day also give pain relief and promote healing by increasing circulation. Sitting on a warm heating pad can also help. Short applications of ice followed by heat also helps with pain and increased circulation to assist healing.
Keeping bowel movements soft and easy to pass with no straining is essential, regardless of what is causing your anal pain. This usually requires a combination of diet changes and the use of some kind of stool softener such as Colace or Miralax. This is the part that just requires a lot of experimentation because different things work for different people and everyone is so different.
Take some time to read through some of the discussions. The people here are awesome and share a lot about what has worked for them.
You don't mention what kind of doctor you saw, but you really want to be evaluated by a specialist in colorectal surgery. It doesn't mean you need surgery. These are the doctors who specialize in these kinds of problems and will be the best at diagnosing and treating you for the pain you are having.
Best wishes for a speedy recovery!

Thank you so so much for taking the time to respond Jr2. I really appreciate it. Tonight, I will try the heating pad, I never thought of that. I usually take showers after BM's to let the hot water run down there, I don't have a bath tub. However, I do have a hot tub so I'll be using that more often. Tonight, I will also make a trip to the store and buy some Colace or Miralax.
I saw my primary care physician about my problem and what he prescribed was Lidocaine Hydro Viscous 2%. He didn't say it will help healing, he just said it will help BM's be more smooth, but since my problem seems to be deeper inside, its hard to get the ointment "in" far enough. I'm still deciding on the colonoscopy, perhaps I will go see my doc again and ask him about the anoscopy, it doesn't sound as awful as the colonoscopy does. Anyway, thanks again, you are very knowledgeable!

I had an anal fissure for years that did not respond to conservative treatment, but was completely fixed by a successful lateral internal sphincterotomy.
At the advice of my GP and proctologist, I had a routine exploratory colonoscopy 7 weeks ago. The doc removed a polyp (turned out to be benign, of course) from high up in my rectum near my colon, which never would heal and ended up splitting all the way down to my anus. This has been the most painful and disturbing thing that has ever happened to me in my life, since I was completely healthy when I went in for the procedure. Fortunately, through some advice from my doc and many recommendations I found on this forum, I am going on 2 weeks pain free and believe that I am finally healed again. But I have lost 30 pounds and my diet is forever changed. I will never again go back to the types of foods that could create another recurrence.
Do what you think is best. I will NEVER have another colonoscopy.

Hi DynaMike
oh, you're very welcome. Unfortunately the knowledge comes with years of experience, but if it helps someone else to find some relief I'm happy for that.
This is a really painful problem to deal with, and it often recurs, so it's important to find the right regimen that works for your body.
the lidocaine can sometimes help some people with the pain, but it won't help with healing. Also, it can cause skin irritation, so be careful with it. The anoscopy can be intolerable for some people with severe fissure pain, but a good CRS will perform it with the patient sedated so that you don't have to endure the pain.
Is your hot tub chlorinated? If it is, be careful as the chlorine can really dry out the skin in that area and make it even more fragile.

Thank you for sharing Bill. I'm so glad you are living pain free. I am hoping to figure this out, but I don't want to irritate or enlarge the possible cut/fissure I might have by doing a colonoscopy. I suppose I have a tough choice to make. Jr2 the hot tub is chloronated, I plan on showering right after and putting something on it. Do you recommend anything? Vaseline? Lotion? The other day, I grabbed some Preperation H but never used it because it says do not use if you are on medication for blood pressure, which I am. Good thing I read the directions!

yes, anything emollient to protect your skin... Pretty much whatever is friendly for your skin... Vaseline is fine. There are lots of options out there. You might like to try some other things if you don't like the Vaseline. Some people like coconut oil or olive oil. Emu oil or jojoba oil are nice because they are similar to the natural oils in the skin, and emu oil also anti inflammatory effects. Aloe Vera gel can also be really soothing. I like Aubrey Organics that i get at the health food store because it has no alcohol in it. Pure lanolin is also soothing, but can be a bit difficult to apply.
The ironic thing is that mostly it's best to stay away from the hemorrhoid aisle at the store. Those creams have vasoconstrictors in them that you don't want for a fissure (as you don't want for high blood pressure either) and actually probably aren't that great for hemorrhoids either.

Your a wise one! Thanks again, I have Aloe Vera Gel, so I'll try that...