Hi there everyone,

I'm Sam, I'm a student, and I've had an anal fissure for what must be about 6 or 7 years now. When I first went to see the doctor aged about 14 it was diagnosed as a fissure straight away and I was prescribed rectogesic, but it gave me terrible headaches and I had to stop using it before I saw any change. I then started to use anusol, at my dad's advice (he having had a fissure himself in the past), which never fully healed it but definitely soothed it and made it manageable. And because I was lazy, I just left it at that for a bit, using anusol relatively often but without any particular regularity. Sometimes the fissure was worse than other times, but it was generally alright.

Over the last few years it's been getting worse though. When it started to get really painful again I went to see the doctor, was (eventually) prescribed diltiazem, which seemed to be marginally effective, but made my anus incredibly sore which forced me to stop using it. I was referred to a colorectal surgeon, but the fissure was annoyingly behaving itself the week I went to see him, but he agreed I could try a botox injection when I explained that it's often worse than what he saw. I've not had the injection yet, but hopefully it'll be organised soon...

Anyway, what I really want to ask about is the fact that, having started properly treating it again, it only seems to have gotten worse. It's always been painful, of course, but more recently BMs are quite simply agony, and wiping afterwards is even worse. It seems to me that as well as getting pain from the cut, the whole anus area is really sore. Anusol helps with the soreness, but not with healing. I'm a vegan, and my fibre intake is quite large, so I have BMs at least three or four times a day - which is tedious and painful. Has anyone got any advice about how I can help it heal until I have the botox?

I'd also like to extend a query about anal sex. Some of the doctors I've seen haven't seemed to really know much about fissures and so would sort of vaguely say "yeah, don't do it". This does seem to make sense. But I've actually found in the past that, as long as we've used copious lubrication, the fissure improves marginally afterwards - through relaxing or whatever, I don't know... Does anyone have any light to shed on this? I mean, right now it's far, far to sore to even think about putting anything penis-sized anywhere near it, but it is something I would like to do again at some point...

I lead a relatively active lifestyle - I run and do yoga pretty much every day. Has anybody found that these affect fissures at all? Because I have had a suspicion that some of the more spread-leg-esque yoga positions might be stretching the fissure unadvisedly. Any thoughts?

Thanks for reading all that!

Hi Sam.

I'm vegan myself (well 99%) and I'm dealing with one of the worst fissures I have ever had. Which has been confusing for me over the last few years because I am never constipated and I eat a better diet than anyone I know (other than my wife.) Even before I was vegan I ate extremely well so there is no constipation theory with me.

I run as well and last week I did have some issues. Never during the run it seems like after. It was going into an agonizing burning spasm after my run. Couldn't tell if sweat down there was kicking it off or what. Not sure if you have dealt with the spasms. I never really have before but Im thinking because any of my previous fissures were never as deep as this one. So this week I am doing my runs later in the day (usually when the spasms have really calmed down).
Ran 5 today and all was well. But this thing is so unpredictable, who knows what tomorrow will bring.

Through really diving in this time around and trying to fully understand fissures, Im starting to believe my issues are problems with my muscle down there. Wether it be at stressful times or just other muscles that cause it to tighten which then rip open a fissure, which then causes spasms that now make the fissure open more and so on. Weird thing is, I never had a fissure until I took up running 6 years ago. My CRS, didnt even want to hear that theory. But Im thinking I know my body better than her.

The Anal sex thing actual makes sense. the tight sphincter muscle is tight and now allowing the fissure to heal. Anal sex is like stretching out a tight calf muscle in all reality. So its getting that muscle to calm down a bit. There's a huge thread on here about dilation and people having success. It actually makes sense, lol but I haven't went that route.

I have another CRS appointment in a couple weeks. If there has been no improvement, im gonna start considering botox.

Hi Thrace, sorry you have been having these problems for so long.
I have a couple of thoughts. One is that anusol is a hydrocortisone. Long term use of HC can thin the skin. It relieves the inflammation and makes you feel better, but it may be very bad for actual healing if used for a long time. Diltiazem is pretty notorious on this forum for causing irritation and itching (it did me). I would recommend switching to nifedipine which seems to have far fewer side effects. Alternatively, since it's been years since you've tried nitro (rectogesic), you could try it again. You may be less sensitive to headaches than you were at 14 years old. Also, I found with nitro that if I started with absolutely tiny amounts and gradually worked up to a pea-sized blob, I avoided the headaches. It was so so worth it.

The other thought is about your diet. Have you looked into how much soluble vs insoluble fibre you are eating? I found that taking too much fibre was very irritating to my anus. Not just the frequency but the sheer bulk of the stool. Try eating less insoluble fibre and see if it improves things.

Thirdly, I agree with Frank that in your case anal sex might be similar to anal dilatation. I'm happy for you because we've had posts from gay men who are desperate, due to anal sex being impossible for them. Just be really really careful. (I know you said you are careful.)

I wish you all the best......keep us posted.

Thanks both for your advice!

With regards to dietary issues, for some reason, despite the fact that my fibre consumption is high, I often find it less than easy to pass stools. I'm rarely, if ever, able to relax and just "let it go", and often find myself pushing quite hard (not straining at constipation levels, but still pushing more than I think I probably should). I don't think I've ever experienced quite the same spasms as you have, Frank (they sound horrible, sorry to hear it!), but I do wonder if the sphincter is, for some reason, unnecessarily tight/clenched/tensed a lot of the time, and refuses to be relaxed - leading to further tearing, particularly during BMs, I think. Does anybody have any experience in this area? Is there some way one can get it to chill out a bit? I have had some success with meditation which includes relaxing of muscles - but the inner sphincter being semi-involuntary means it's a little difficult to affect. Maybe I should just practise more...

With regards to the soreness that I've been experiencing ever since the Diltiazem Debacle, over the last couple of days I've tried Sudocrem on the external part of the anus, inspired by a post on the forum, with good results (obviously it's still extremely early days, but so far so good). Thanks for the advice re anusol and nitroglycerine, Scientist - I'll lay off the anusol for sure now, I'm pretty sure it sounds like that'll be part of the problem! Next time I speak to a doctor I'll ask about rectogesic again.

Thanks both again! I was so happy to find this forum, and your advice is really helpful.

Unfortunately the internal anal sphincter is entirely involuntary, and you cannot just tell it to open. I asked my CRS a couple of times about using biofeedback to try to relax it. You can learn to change your heartbeat, brainwaves and skin conductance, so why not the sphincter? But he didn't seem to know anything about it. I still think it should be possible though.

Maybe you should back off the fibre. It could be that the sheer bulk of it is making it difficult to pass stools, and traumatising your anus. You could try, as an experiment, cutting back on the fibre and using miralax. The miralax makes your stools soft without bulking them. I know we are all trained to think that the more fibre the better, but that's not true for everyone.

I hope that helps.

Thanks again Scientist. I'll have a go at reducing fibre generally, and have a look for miralax.