Hi all. I'm new here and come seeking your expert help!

I've suffered from recurrent anal fissures for about 7 years now. However, I can't seem to get a proper diagnosis and therefore a treatment plan. The problem is that they only occur for a couple of days each month, so often they aren't present when I get to see a doctor, and when they are there, they're quite superficial so the doctor is often a bit dismissive.

I know this isn't a typical fissure, where you get one opening and have to work out how best to deal with it. These are different little fissures opening up each day around the time of my period, lasting for a couple of days. Then they heal up completely, I have about 2 weeks of the month feeling normal, then they come back again next period.

I saw a colo-rectal specialist about 5 years ago. He did an examination and discharged me back to my GP immediately.

The GP wondered if I might have a dermatological issue instead. The dermatologist I saw was also dismissive and (in his words) there was "nothing there that he could treat". However, i persevered and saw a private dermatologist who thought I might have intertrigo as a result of a fungal infection. Unfortunately the meds haven't worked, so I'm sitting here in pain again I'm seeing the dermatologist again next week, but am feeling disheartened.

Do you think it would be worth going back to the colo-rectal specialist?

Can you schedule an appointment with your CRS during or right after your period? If they are that predictable, it would give him/her something to look at. Try to see a woman, who might have more insight into the effects of hormones and cycle on your body?

A few other women here have mentioned their fissures are worse around their periods. You could do a search on this forum to try to find out more. I don't think anyone knows why it happens though.

Do you think you are more tense, or more constipated, or have harder stools, during your period?
I know that once my fissure was more less healed, I would only get pain if I was feeling stressed out. Sometimes I wouldn't realise I was stressed until I felt the pain in my anus, and I'd have to force myself to relax and be calm. So it's worth thinking about whether you get stressed out/PMS, and whether you typically hold a lot of tension in your bottom (I clench my buttocks when I'm tense).

It does also sound as if the skin of your anus might be fragile. How old are you? Could you have oestrogen deficiency? I tried an oestrogen supplement on my anus when it seemed the fissure would never heal 100%, and I have to say that after a few weeks of Estrace, I feel as though I am completely totally healed (touch wood, cross fingers etc etc). I was lucky my doctor would prescribe it, because I think many docs don't approve of oestrogen supplements. I'm 52, and I still have my periods, but it seemed like I needed some extra oestrogen in that important place. Worth a try.

Thank you so much for your reply.

I'm 35 years old. I've had two children in the last three years, and each time the fissures have been ok during pregnancy / just after childbirth, but have gotten really really bad after stopping breastfeeding. The doctors seem to just attribute this to 'fissures get worse during pregnancy'.

I'll definitely look up other posts about fissures around periods. I don't think I get tense before it happens. If anything, I get tense afterwards! Sometimes the fissuring happens before my period and I know to go check the calendar and see if my period is due. Apols if this is TMI, but i've actually had quite loose stool during my last couple of periods. Not sure why.

I do wonder if it's hormonal in some way. I might ask my GP directly next time I have an appointment. I'm glad you've found something that works for you :)

My fissure is healed but I'm still having burning nerve pain. It is def worse during my cycle. I feel like the whole area gets swollen during that time and more sensitive. I would try to see a CRS who is a woman as was suggested by Scientist.
Hand in there!!

DecemberGirl, I have just read your post from March this year. I too have superficial fissures. I have a lot of them but can never heal them before another one appears. I was told by CRS that my skin is thin. I too have seen a dermatologist about a year ago and like you was told the skin inside is different to outside and he couldn't help. I also suspect hormones and am going to ask dr to look at my hormone levels. I am 49 and still have periods but erratically nowadays. Are you improving now and what treatment are you having now if any? copycats

I keep meaning to come back and update, but I don't really have any progress to report

I thought I had a breakthrough when my dermatologist gave me Zovirax to see if I might have Herpes Simplex, and it stopped the fissuring for a week or so - first time in 7 years! But then my blood test was negative, which really confused us.

But at about the same time I started getting bad internal pain on passing stool and my derm said she needed to refer me to a gastroenterologist. I had a sigmoidoscopy that revealed some polyps that were removed and the pain resolved, but the fissures were unaffected. The gastroenterologist referred me to a colo-rectal surgeon who was very nice but couldn't help, and has referred me back to the derm! lol - around and around I go :)

One small breakthrough - a combination of diltiazem used continually (so preventative rather than just healing) and fibre supplements (Fybogel) have definitely helped reduce the fissuring, although I still get a few when my skin gets very red and sore. I'm now convinced I have a skin infection of some sort that is making my skin more prone to cracking. The redness goes right up between my buttocks, and I've noticed that the skin can slightly split there too. (I've just realised I didn't even mention this part of my symptoms in my original post - it's such a minor inconvenience compared to the fissuring that i just didn't think to mention it. But I normally get a day or two of red, sore perianal skin a couple of days before the fissuring returns.)

I actually have a new theory (but no evidence yet to prove one way or another) - Group B Strep. My GP mentioned it had come up on a vaginal swab when I had a persistent yeast infection I was trying to get rid of, and me being as curious as I am, I googled it when I got home. The symptoms are almost identical to mine: http://adc.bmj.com/content/70/2/145.full.pdf

"oedematous perianal skin and cracking on parting the buttocks, forming superficial multiple fissuring"

It mostly affects babies and children, but it can more rarely affect adults (http://www.ncbi.nlm.nih.gov/pubmed/23216793). I have a GP appointment next Tues to see what they think of my theory. I'll come back and update :)

DecemberGirl, I am so sorry you are still fighting this. Isnt is wrong that we have to research and trawl the internet to find a diagnosis. Its all we want isn't it? There has to be some reason for it. Keep going, stray strong even when you want to just throw the towel in. I would be very interested to hear what your gp says about Group B Strep. Does the gp test for this or should the dermatologist have routinely does this? My superficial fissures are internal and feel quite high up. The CRS I saw recently said they were "very superficial". Does he know how sore a superficial fissure is? I had Botox recently and thought I was making progress but yesterday I felt it again all day. I have my period and have always found set backs occur around this time. Are you in the UK like me?

all the stuff in this thread sounds exactly like what i have, except i am male! so it cant be related to periods/pregnancy etc.
i had been back and forth to a CRS for ages till i got referred to a dermatologist, who ofcourse could not diagnose me with anything, i got given ''liquid parrafin'' and anti fungal steroid cream.
these combined have brought some relief, however the parrafin has stained all my underwear and a couple of pairs of jeans. vivienne westwood and true religion no less !
i dont think i will ever be off the parrafin, as im convinced this is what has helped with the relief, however i am still getting flare ups of redness, and every couple of weeks i bleed for a day or two.
i just want to know whats wrong with me

Copycats - yes, I'm UK. My fissures are right at the anal entrance, so very much on the borderline between derm and CRS! The CRS didn't think botox would be any use to me because the fissures heal up by themselves... it's just that they always come back

I'm not sure who would test for Group B strep in this sort of scenario, or how they'd do it. It came up on a vaginal swab by the GP, but obv that area is quite wet whereas swabbing around my buttocks wouldn't be... so not sure how effective that sort of swabbing is? I think it might be better if the GP gives me some antibiotics against GBS to see if it improves my symptoms... but I'll wait and see what they say.

Jay - Your symptoms do sound very similar to mine. I've gone through just about all the different possible steroid creams that my derm can think of, and some strong anti-fungal tablets, but all to no effect. I don't think I've tried liquid parrafin...

Have either of you considered infections? My research suggests that numerous recurrent fissures (rather than one fissure that keeps reopening) can be associated with STDs, CMV, herpes simplex and some other infections. I've only been tested for herpes simplex so far (because I don't have other symptoms that would be typical of STDs), but I think I'm going to push for some further tests.

That's very interesting. I always get like a sore split that runs up the length of my butt crack. I just thought my skin was so fragile down there that's why it splits. I have been diagnosed with ehlers danlos syndrome though... Which is a connective tissue disorder.