the following represents my opinions from many years of experience
my current condition i havent had a bleed in as long as i can remember, my skin tag is about 1/8 in apx, i dont have pain anymore just aches that last for a few hours, and sometimes not at all after going
bottom line best thing to start with is ibuprofen (pain relief) and magnesium pill(softener)! (warning take care when using ibuprofen too much can cause stomach ulcers and always take with some food)(but I talked to my doctor on how much I can take per day and he said some high number and he said that i could keep taking it for the rest of my life if i wanted to(feel it out kind of thing not everybody is the same, but i only take 0-3 pills every other day)
when you feel the pain here is what is happening
you have a fissure(cut) and you upset it by going to the bathroom it responds by expanding the tissues down there and so much so that it creates the "skin tag" or a bulgy thing that sticks out, this expansion is what is causing the pain its to much pressure on it which causes the pain. ibuprofen is a anti inflammatory which I believe means it thins your blood making it harder for your body to make these inflamed tissues thus less pain.
I made a post many years ago on this forum, I have mostly overcome the anal fissure but have had years of minor aches and small pains depending on how well I was doing, but not even close to what it was at the beginning, but in those many years I have been experimenting with how to do it better every time, to be clear thou I have never had spasms but I think that my techniques can fix even that.
original thread hemerhoid-cream-and-other-tricks-t7668.html (this information is my original experiments so they are my original thoughts but some of them i have been using for years but below is my better adapted techniques i recommend trying my newest techniques first!)
when I started taking ibuprofen many years ago it really was the turning point for me getting better, because it holds back the hard inflammations that make the pain, the amount that I personally take is no more than 4 pills per day and I take them 1 pill at a time in 3-4 hour increments, but I am allot more healed than most so I think you need to figure out cautiously how much you should take(stomach ulcers) and always take with some food I was told by the nurse to take at least some crackers with it, or up to like 4 hours after eating(but I still eat a few handfuls of food of whatever)
so above and beyond the ibuprofen I have many techniques that I have learnt over the years to reduce the reopening of the cut per say which I haven't had a bleed in as long as I can remember (many many years) but if you do don't get upset just think about what happened and how you can do it better next time.
here is my current going to the bathroom(2)
here are my rules: 1 don't let it lead 2. be patient(take an hour if you have to) 3. be careful before and after you go to try not to upset the fissure(how you move around) 4. if hard be patient once it starts going it comes faster after time(ill discuss how to deal with hard poo shortly) 5. the 2nd ibuprofen pill timing is critical it keeps the expansion down if you time it right (generally at 3 hours after the 1st one) 6. have magnesium pill on time(softener) 7. when showering be gentile washing that area 8. be careful wiping
first off I go to the bathroom every other day I do have urges but I just pucker my rear end and hold it in which sometimes takes some effort and other times not(I talked to my doctor and he didn't seem to think that's an issue even to a 3 day sometimes) one technique I just developed is to arch your back and (and stomach out) stretch both my arms back, or to sit down and it compacts it
I use magnesium complex triple magnesium pills by I think brand is Swanson this is a very effective softener, very, I eat whatever I want whatsoever, and I take 1 pill every other day unless my poo gets hard (hard poo techniques ill discuss shortly) in that case I take one more pill its just a pill you take and its very effective. I personally don't pay attn to fiber at all.
hard poo
if I have a hard poo day what I do is I carefully apply some pressure(hover) trying to not upset my fissure until it feels like its coming approaching the anus some(anus opened some by turd, then I do what I call a turd wipe, take some toilet paper and carefully piece a chunk out, then you have a gap up there now so again carefully slowly(extra careful now because of the gap) get more poo up and repeat and repeat until it just comes out more naturally or if it gets to the point where it sticking out I help it along with a piece of toilet paper by lightly pressing against the stuck out turd and motioning it outwards, its much easier this way than having your anus do this work, and thus more satisfying because its much more relieving than your anus doing it, if it pieces off then just repeat above.
regular poo procedure( I have progressed allot this works for me, but you be the judge if it works for you or modify it to your situation)
(the better you do these techniques the less pain you will receive during the day) before i have an urge i apply petroleum jelly on and around the "skin tag" area any bumps so that my poo doesn't rub against it hard(i just started doing this and it has spurred another super healing event i think its great now)
I start going the bathroom by standing up I believe this creates a more narrower anus and helps cause less temporary damage. I try to always never let it lead this is too fast and causes stings that causes pain after. I have a technique that helps fight the urges that is I try to slowly apply some pressure and hover with some pressure(poo is really soft if you think about it) but when you first start the urge comes very quickly so I try to apply some pressure as soon and as carefully as possible and then when the urge comes I first arch my back (stomach out) and stretch my arms backwards, then until the urge starts to take over then I let go of the pressure I have applied some or all and the turd will then go backwards in the anus fighting against the urge(do just the amount needed only if you can get by with just letting off half the pressure then do that until the urge is stopped) then when the urge is stopped I slowly let my arms back and slowly unarch my back, I after some don't stand perfectly strait up but lean over just a little(not much 10-15 degree angle(a guess)) by putting my hand on a near by countertop. I repeat this step each time I get a urge(never let it lead if you can help it)then when its stopped I slowly again apply some pressure and hover there till the turd starts working it way out, in this process I let it get my rear end very turdy(messy) I figure id rather do more wiping and feel better during the day than have a pain day. the key here is be patient take 30m to 1hour if you have too. I figure it better than a pain day and you will give it a better chance of healing (and yes I have come along way my skin tag as reduced to about 1/8-1/16 of an inch). so next I just keep hovering and get it to come out gently(as your progress the urges become easier with the backwards turd technique) then when it is coming out a bit into my butt cheeks then I lean back and sit down and let it drop and if the pressure that you have applied already continues the turding then let it but do not pressure it more just let it finish carefully and paying attn to stings if it stings then slow it down or stop and work it slowly and carefully past it, when it stops then I stand up again and repeat all that again, until I have completed(I takes me 30m-45m to go to the bathroom but its worth the healing potential and less pain during the day)
now for wiping, I have learnt that wiping the wrong way can cause problems also with pain, so be gentle wiping, I get rid of the bulk of the poo and wait for wiping my anus till last. when I was really going through the pain I just resorted to using wet toilet paper. take 1 piece of toilet paper fold it several times until its about 7/8 apx (not exact) then dedicate a small bottle with some water in it and pour some water until the paper is wet then carefully wipe the anus and repeat until it piece is white after then take dry toilet paper and carefully dry the area. I actually still use the wet wipe as that last step, what I do now is dry wipe it all gently including the anus but to finish the anus I use a wet wipe or 2 and then dry it and done
on the magnesium pill I don't want my poo to be too soft but half way between hard and soft where I can control it, so I take 1 pill every other day unless I have a hard poo then I take another one, I eat whatever I want and I don't pay any attention to my fiber at all.
now after I go I will wait until I feel the first sign of pain coming then take a ibuprofen pill at that point. I only do this because I want to minimize pill usage, but for best results take a pill just after you poo. I wait because I may have a day where I don't have to take any pills just minor pressure not much ache at all(because im very healed)(im more dealing with aches really not pain, i did however when i first got this years ago have strong pain all day long until evening)
also my doctor prescribed for me hydrocortisone 2.5% and I apply it to the area that hurts and it does help some in pain relief. the thing is after I apply it and the come back again later and apply it again, it feels good to wipe it off something about apply light pressure to the area must temporarily relieve some of the pressure and cause a temporarily relief of pain. so I wipe it off purposely trying to relieve some aches(my version of pain)
I have had many phases in my healing even at some points where I haven't had pain or aches for a month several times, but as it heals the skin tag wants to shrink and get healed and it gets so tight that during the day when your walking around it will all of a sudden sting I believe what is happening is the pressure(not pain) is to much that it finally bursts and then at that point the skin tag becomes smaller(you may have increased problems after this but this is a good thing just keep your hope up and heal it again and repeat) I have had many such bursts it takes time and as it get smaller the problems become less and less but you still need to be careful don't get to confident this is where you could cause it to loose some progress(if this happens learn from your mistake and just try again it will get back to where you were before (may take a month)
my success is because I never gave up hope when I made a mistake even a costly one I just thought about what happened and how I could improve it the next time I am in that same situation
if you take anything from this at all at minimum use the ibuprofen and magnesium pills this is universally a good thing no matter what
I still feel that I will be fully healed at some point
these techniques that I just shard with you are actually the newest version of my techniques so they are new for me too, they are a accumulative techniques that I have been using for years but this is the perfected version of those techniques, I used to squeeze the poo, but I feel its better the way I described it above.(I am always thinking about and changing my techniques to improve upon them) I have had anal fissure for probably 5-10 years now but im mostly healed now and had the worst of it be done at the 1-2 year mark(as I leant how to deal with it)
years ago when I was still bleeding I used hemerroidal cream to shrink the skin tag(only until it stopped bleeding(as in days) then I stopped because it became painful to use when it started sealing up, but I think maybe ibuprofen probably is better than doing that now that I think about it. but im not sure.
i hope this helps you if you have questions I will try to maybe come back to answer them
i was detailed in this, because it is very detailed process and years of accumulation of the process.