How do Anal Fissures Heal?

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How do Anal Fissures Heal?

Postby Anonymon » 16 Apr 2013, 10:09

Particularly with the internal ones like mine, I'm wondering if anyone knows. Some skin wounds heal by the area more or less remaining 'open,' and new skin or tissue forms over the top. So if the skin ripped like this - \/, the cut heals into something like this - \-/.
Other areas that cut into \/ get pulled together again and heal back like they were, \/ becoming | again, as if they were stitched back together.
Since fissures, at least internal ones, aren't being held together to heal in that way, does anyone know which way they heal? Does a healed fissure thereafter contribute to a marginally wider anal cavity lining in that way? Does any of this make sense?
I'm mainly interested in knowing whether my ass is hereafter weaker, or stronger, once it has all healed up for a significant period of time, and/or if elasticity of the area is lost.
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Re: How do Anal Fissures Heal?

Postby CrackinUp » 16 Apr 2013, 11:47

They heal slowly. I have heard a few people say they scab over but I have no idea if this is actually the case.
I have also read you are back to 40% strength after 3 months and 80% after 2 years. I'm not to the 3 months stage yet... does make me slightly nervous!
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Re: How do Anal Fissures Heal?

Postby jr2 » 16 Apr 2013, 17:51

In an ideal world, the fissure should heal the way other open wounds heal in the body, from the bottom of the wound up. Essentially, the wound is "filled in" . We have had a couple of board members whose fissures tried to heal sort of top down, which left them with a kind of fistula that needed to be unroofed.
Unfortunately, because stool has to pass through the anal area so often, the fissure is constantly stressed, stretched, scraped, and dirtied, so the healing process can really go haywire in different ways.
The area will never be as strong as it was prior to ever having a fissure, and generally speaking people who have had a fissure will likely always be more vulnerable to them. But yes, the greater amount of time that goes by, the area does get stronger, remodeled, and there will be varying degrees of scarring depending on the individual, the severity, duration, etc.
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Re: How do Anal Fissures Heal?

Postby Luka » 17 Apr 2013, 00:47

I wonder about this myself. I know I've read that acute fissures are small and are more linear. Chronic fissures are larger and deeper and have a sentinel pile. They are also more boat-shaped, or "V"-shaped, as Anonymon said. I can understand how acute fissures heal (with the tear healing over in a linear fashion), but not so much chronic fissures, especially ones that are internal. I'm guessing they just eventually (and VERY slowly) fill in with tissue and close, like any other wound.
I've also read online from one CRS that all fissures will eventually heal, with or without surgery. It's just a matter of how long you're willing to wait and how long you can stand the pain if you want to avoid surgery. Some have more pain than others with their chronic fissures. Having to have bowel movements every day or nearly every day just puts more strain on the area, making it so much harder to heal. Combine that with the internal sphincter spasms preventing good blood flow and pushing against the fissure, and it's even more difficult to heal. That's why LIS is so successful (for most people). There's also a buildup of scar tissue that can impede healing if the fissure has healed and re-opened many times.
I'm curious: do they stitch up the fissure at all during LIS? I know some people have gotten stitches, so I'm curious. Or maybe that's just the LIS incision site. I would just think having stitches in that area would be near impossible to maintain due to having bowel movements every day.
All I know is that healing can be a very, very slow process because of all of the above-mentioned factors, especially if you've had the fissure for a long time. It's incredibly frustrating with all the ups and downs. You just have to remain hopeful, as difficult as that is sometimes.
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: How do Anal Fissures Heal?

Postby jr2 » 17 Apr 2013, 09:51

I actually do believe even longstanding, chronic fissures will eventually heal, both because in my 25 or so years of dealing with fissures that come and stay awhile (sometimes a very very long while) and then heal, and stay healed for awhile before resurfacing (because I have such severe digestive dysfunction), and because I've talked to enough people with severe wide ulcers with a buildup of scar tissue so bad as to cause ridges in their stool who have healed and stayed healed.
It bothers me that colorectal surgeons generally tell people their fissure will never heal without surgery. I don't have any problem with surgery. It's a really great option to have available. But for a doctor to tell a patient it is not possible for their fissure to heal without surgery puts that patient in the position of feeling they have no choice and no hope if they don't have the surgery done and that doesn't feel like a truly informed decision to me.
They don't stitch up the fissure. There are two different types of LIS performed, one is called "open" and one is called "closed". Different surgeons choose different techniques. Generally, the closed LIS does not require stitches and generally the open procedure does.
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Re: How do Anal Fissures Heal?

Postby Luka » 17 Apr 2013, 13:07

Thank you jr2 for that valuable information. I feel a lot more hopeful after reading what you said. : ) I know I've read the same online from a few CRS's about chronic fissures and how they will eventually heal even if you don't get the surgery. It's just a matter of time and how well you take care of yourself (good diet, good bowel habits, etc.). It is great to have surgery as an option, though, especially for those that have a lot of horrible pain daily.
As I've said before on this forum, I currently don't have health insurance and can't afford surgery right now, so I'm doing my best to be patient and let mine heal on its own. And, to be honest, surgery scares the heck out of me. After reading peoples' experiences on this forum about it, I'm skeptical about getting it for myself. You never know what might happen and the recovery process really scares me. I could be lucky and have very little pain afterward, but then again, I could be unlucky and have a ton of horrible pain, possibly a lot more than I have now. I just don't want to take that chance right now since my pain is currently manageable.
I know it's a very slow process, but since I don't have much pain now (just aches and occasional stinging after some bowel movements that can last a few hours), I'm willing to see how I do without surgery. Diltiazem has helped a lot, too, to relax the muscle. Of course, if I had excruciating pain on a regular basis (like I did in the beginning of my fissure, although it was off and on), I would obviously feel differently and want to get the surgery right away.
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: How do Anal Fissures Heal?

Postby owmybum » 17 Apr 2013, 13:56

The Crs I saw last week told me that all fissures will eventually heal... No one has them for life.
I have had mine for two years now though.... Surely if it was going to heal, it would have done so by now??? Image
fissure after hem banding and tag removal feb 11
Pelvic floor therapy
Diltiazem
Botox June 13
Nitro
Internal flap July 14
EUA and polyps removed Nov 14
Diagnosed with neuropathy Jan 15
Diagnosed with HS EDS type 3 (causes poor wound healing )
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Re: How do Anal Fissures Heal?

Postby Ever the Optimist » 17 Apr 2013, 15:17

Hi all,
Really interesting post here!
I've had mine for 1 year and 4 months exactly now and tbh, most of the time, I don't even know it's there anymore. I do have stages when I get the odd twinge (always PRE BM too!) which I always take as a warning now to make sure I don't strain in anyway. Afterwards the twinge is gone - it's almost like as the pressure builds up in my anus with all the fecal matter, I feel it sitting on top of the fissure! and the fissure responds by letting me know it's still there. Can anyone relate to this???! It's weird.....It's extremely comforting to know that they can eventually heal and I guess, just teaching us to look after our bottoms in the meantime and ever after too.....After reading about the wonders of Virgin Raw Organic Coconut Oil, I finally ordered some off Amazon and I have to say it is amazing stuff. Since using it over the last two weeks, that twinge has grealy reduced and it really seems to be helping! It is so soothing and a wonderful natural moisturiser. OMB - maybe worth a shot???......
Jnr2, I'm really saddened to read you have been suffering with these for 25 years or so and I remember reading that surgery is not an option in your case? How have you managed these? I think I remember you find dilation extremely helpful? I'm sorry you have suffered for so long with these but truly respect your attitude towards it all and your amazing knowledge about it all. Thanks for being there for all of us. x
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: How do Anal Fissures Heal?

Postby jr2 » 17 Apr 2013, 17:45

OMB... maybe, maybe not. It depends on so many things and is different for every person and every fissure. I knew of a lady who had hers for 17 years and then it finally healed. Again, I'm not saying surgery isn't a great option, and geez, who wants to have to live with this for years and years waiting for whatever magical combination of things makes the body finally click into healing mode. I'm just generally saying that fissures are more complicated than just a muscle that is too tight. There are lots of people who suffer with severe anal stenosis who never get fissures.
ETO... The two top rated surgeons in my area both independently told me surgery wasn't a good option for me. Over the many years I've developed a routine for myself that I posted in another thread awhile back. It does include dilating at home. My biggest problem is I have such severe digestive problems that there is a lot of wear and tear on the area. Thank you so much for your sweet comments. I always love reading your posts too because they are so true to your screen name. Being in this together really helps us all.
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Re: How do Anal Fissures Heal?

Postby Luka » 18 Apr 2013, 18:03

Ever the Optimist: I've tried extra virgin coconut oil before (also ordered it from Amazon), but it stings the area, so I stopped using it. Do you get stinging when applying it? I've heard it has a lot of healing properties, so I'd like to keep using it, but I've been a little afraid since it does tend to sting me for some reason.
jr2: Do you have IBD or IBS? Is that why you can't get LIS?
Thank you all for your support and stories of healing. It really lifts my spirits and gives me hope that this will, eventually, heal. : )
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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