When I was ~12-13 years of age I developed anal fissures, though at the time, I did not know what was happening to me. Extraordinarily uncomfortable, itchy, painful, and at that age, they were a source of distress and shame greater than I believe would be the case as an adult as I was having these problems during puberty etc (yay).

The cause of my anal fissures, undoubtedly, was related to an overly busy school schedule with track/field participation, basketball, poor diet, and dehydration leading to the formation of very large difficult to pass stools, which lead to a fissure, which lead to swollen tags which caused more fissures, etc. At the time, all I knew was that I had a problem "down there" but did not know any terminology or what was technically happening.

After a few weeks without sleeping from the jolting-prickly-itch and swelling in the anus region finally forced me to break down and speak to my parents about this "embarrassing" issue. Doctors, misdiagnoses, cremes, pain killers, failure. Specialists, proper diagnoses, eventual surgery, pain, discomfort, more pain, more discomfort, vicious cycles of relapse, more surgery, nitro creme experiments, lots of money down the toilet, nothing was working long term. I suffered with chronic "prickly/swollen/bleeding" anus after bowel movements for many years. I was skating by on "barely acceptable" quality of life on many days and basically just trying to ignore the pain and live. I lost faith in the medical system in my teens because I discovered they did not have useful solutions to any of my medical problems (also had chronic sinus problems, and a medical system that failed to offer any useful long term solutions). Didn't help that the most effective means of regularity for me was when I picked up smoking at age 17... My Fissure issues became much less problematic through my late teens and early 20s while smoking.

Do not pick up smoking to fix your butt hole. Stimulants like nicotine/caffeine are a great way to get the bowels moving on a daily basis (or multiple times a day), but the long term health risks associated with smoking are obviously not beneficial. I have since quit smoking/drinking and am able to maintain a healthy bum without smoking. It would be "easy" to use regularity as an "excuse" to smoke but I do not encourage this.

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At age 30 now, I can say I have been largely fissure free and pain free now for several years. It occurred to me that I should probably share some of the things I finally discovered over the years to maintaining a healthy, pain free anus. Sadly, it took well over a decade to find the real source of my failed recovery and endless regressions through my teens and early 20s.

The primary source of my eventual success in dealing with anal fissures was the discovery of fecal matter in the anal canal (beyond the anus) after a bowel movement. No amount of superficial wiping will remove this fecal matter, and leaving it just inside the anus where "topical" cleaning procedures do not reach, seems to be a significant source of problems for healing an existing fissure, general discomfort, and can even lead to the formation of new fissures. The waste material left behind in the anal canal by traditional exterior wiping will set me up for a regression in anus health every time. It may be useful at this time to do an internet search for a diagram of the anus/rectum area. The "anal canal," by my understanding, is the region just inside the Anus, leading to the rectum. I believe this region and its cleanliness (or lack thereof) to be a major player in this whole debacle.

The "ideal" solution to this problem, would be to find a diet that consistently produces ultra-healthy properly formed stools. The ideal stool for anus health in my experience is actually a fast passing large stool with no "messy" surface. You've probably had a few in your life, but in my experience I have never managed to figure out what specific foods consistently aid me in the development of these "perfect passing" stools. I have meat/cheese in my diet so it is unlikely I will ever be able to develop these "ideal" stools with any consistency but if you are interested, this is one possible approach to solving the fissure problem, as it solves the cleanliness issues inside the anal canal that seem to be a major factor in anus health based on my experience. If you can figure out a diet that passes a "perfect plopper" every time (you know the type, when you go to wipe and there's no mess to clean up!, that's the "perfect plopper"), then you could probably stop reading the rest of my advise/experience/success-story here and now. Get on that diet, and stay on it for the rest of your life. If you're like me and haven't figured out that magic recipe, and/or really don't care to because you want to be able to eat more than peanut-butter-bananas for the rest of your life, then keep reading...

After a "traditional" messy western diet BM, I can not stress the importance of the following procedure enough: Perform the traditional "dry wiping" with TP a few times to get the majority of the external mess cleaned up, then fold a flush-able wet wipe in half (the generics are typically best as they tend not to contain any irritating perfumes or anything), use a finger to carefully press the wet-wipe into the anus with a gentle swirling motion. Along the length of a folded wet-wipe I will generally do this 3 times, and if I have passed an especially messy stool, I will get another wipe and repeat the procedure (a visual inspection of the wipe after each insertion is a good idea, as this will tell you a lot about how much cleaning there is left to do). This should all be followed up with thorough but gentle exterior cleaning as well, WITH wet wipes. The "depth" of insertion required to get the region cleaned that is of most importance will probably vary from person to person, and I actually suspect there may be a link to anal fissure issues and anal canal shape/length etc that causes this region not to pass stools as cleanly as ideal. For me, cleaning the "pocket" just behind the anus by inserting the wet wipe/finger ~1-2cm is all that is necessary.

If I miss this procedure after any BM, I am likely to get itchy, irritated, sore, and may even develop a fissure at the following BM or by sitting incorrectly or something. The fecal material that remains after a BM in the region just inside the anus (in the anal canal to anus transition area) is the primary source of my fissure problems. Learning to "clean" myself properly after a BM, quickly led to a cycle of improvement in anus health, and eventually long term "ideal" anus health with no significant anus issues for the last few years (any issues have been very acute). Daily showering with plenty of "under carriage" cleaning is also important as hygiene plays a major factor in good healing, but getting the anal canal free of fecal debris after a BM is the most important issue. The package of flush-able wet-wipes goes with me on trips or any scenario where I won't make my daily "home" BM. In an "emergency," (public restroom) a dampened paper towel folded to a few layers thick (prepare this before entering the stall) can suffice (and most commercial plumbing will have no problem swallowing a paper towel or 2)


Getting back to the diet issue, taking note of which specific foods caused my lower digestive system to react badly and form unusually messy, difficult to pass stools was very important to my success story. You may not want to go "nuts" with a "perfect plopper" diet, but I believe it's important to discover the major "triggers" for an uncomfortable bowel movement. Keeping in mind that "large" size stools are actually not specifically unhealthy if they pass freely without strain. In fact, a large but fast/easy to pass stool is a healthy "stretch" for the anus/sphincter. Nothing wrong with large stools if they pass freely. The stools that are most apt to cause anus problems (fissures, irritation, etc), are those that move very slowly due to having very poor texture, wrong consistency, and/or a lack of natural lubrication. Often these are the messy BMs that are more like "piping" (see cake decoration) where the rectum/colon is the bag of material, and the anal canal and anus is like the "decorative tip." These BMs are the most destructive to your Anus and Anal Canal region even though they often "appear" in the toilet as "small/long/soft."

MANY doctors prescribe stool softeners and or laxatives as part of a procedure to solve fissures. I used these products often in my attempts to solve anal fissures to no avail. My experience is that these products should only ever be used to alleviate serious constipation. Regularly passing excessively soft ribbons of feces is actually counter-productive to the healing process. A large well formed but clean passing stool is better than strings of soft fecal-frosting. Looking back on my experience seeing "butt-doc" specialists when I was a teen, there was only ONE doctor who made the case for solid stools for better anal/anus health, the rest were all saying the opposite. Looking back on it, there's a reason he was at the "top" of his field, being one of the major go-to specialists for anus/anal health issues for professional athletes where results were expected. At the time, he only added confusion to my problem for me, but I now understand what he was trying to articulate through my own personal experience. My experience leads me to believe that this doctor was absolutely correct.

Making a "short list" of foods to avoid was the most practical solution for me. For me, Milk, Ice Cream, Raw bell peppers, GrapeFruit, ,Kiwi, sometime pineapple and watermelon, as well as any beverages containing these (like the soft drink "squirt") and a few other odds and ends, will trigger a bad series of BMs that can be destructive.

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The specific cleanliness routine I have shared above, as well as paying attention to diet, is not a surefire solution to an existing fissure, but in my experience will speed up recovery of a fissure dramatically when combined with other effective helpers. I believe that healing an existing fissure over the course of a couple-few days with frequent soaking and massage to prevent scab tissue from causing more problems is probably one of the best approaches to combine with the anal-canal cleaning and diet adjustments. I was reading another success story here at AF.org and he/she appears to be using a similar approach but is actually aiming for gentle frequent exfoliation to promote cell growth without scabbing. I think that may actually be a better way to to describe what I have done in the past to quickly heal up problems. Taking tylenol or ibprofen every 4-6 hours while working through a heal may also help, as pain management is apt to help reduce involuntary sphincter spasm.

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I hope that someone may find some useful ideas from my experience. As someone who has been crippled with pain in tears from AF issues at times, If my success can help just 1 person alleviate the "prickling itch of doom" then this will have been worth the time.

Best of luck out there and Regards,
-Eric

Thankyou so much for your detailed post Eric.
It's very interesting the whole poo consistency debate, and I can see the benefits of a larger formed ' clean stool' but when you are fissured and experiencing the burning pain every bm.... You want to do everything you can to minimise impact so to speak.
I wish I had the balls to ease up on the movicol and see what happens.

Long may your healed butt continue!

OMB xxx

Interesting post, thank you. I think it's all too painful there for me to wipe inside but I am using lots and lots of warm water to clean myself up and relax the area after the loo. Not having the luxury of a bidet, I hang over the bath taps to wash. Obviously I could not do this away from home but I've been in so much pain that I do not leave home. In the far east, I've seen toilets you squat over which have showers for cleaning up afterwards- no sitting on the throne and no harsh dry toilet paper! I'm applying coconut oil with vitamin E several times a day which is soothing & lubricating.

Cannot agree more with importance of a 'good wipe'. BM that's not followed by a good wipe almost 100% of re-tear as far as my AF is concerned.