First of all, my sincere THANKS to those who initiated and are maintaining this website. You have no idea how deep you are touching the lives of many who are suffering one of the most painful condition of our body.
Coming to my story, I am a 29 year old female and developed this condition - Anal Fissure (AF) nearly 4 months back. Just like most of you, I had no idea something could go wrong in that area. To tell the truth, if there was one area in my body which I have never seen in my whole life, it would be that. But the whole story changed one fine day, the experience which I never want to recall even in my worst dream. But I am a person who believes everything in life happens for a reason. The situation made me study and research and learn and do trial and error and do whatever it takes to come back to my normal life. I am writing below some of the important things I learned in my AF journey, which I really hope someone out there would find of any help.
Doctors’ advices and experiences
The initial pain I had was 9 out of a scale of 10. My pain tolerance is fairly high. I visited a Colon Rectal Surgeon (CRS) after 2 weeks (got appointment only for then) who gave me Nifedipine 0.3 % - to apply topically 3 times daily, outside. I used for 3 weeks with NO improvement or no sign of improvement. She also prescribed to do warm sitz baths and eat fiber. The further options the doc had was Botox and Surgery, both which I did not want to do (personal decision). I consulted another more experienced doc after 4 weeks from there. By then, I had a small sentinel skin tag developed at the base of the major fissure at 6 O’clock position. The size of a rice grain. She told me to give the fissure time to heal and consider surgery only after another 4 weeks from there. She gave me a list of food and the exact fiber content of the foods and prescribed 8 - 10 glasses of fluids and warm sitz baths. Of course, all that helped me a lot and pain level started subsiding.
Knowledge is power
I do not intend to bombard with so much info about AF and all here. You can just get that by googling. In one sentence, an AF is a tear in the lining of the lower rectum (anal sphincter muscle) that causes pain during bowel movements. Here, I am sharing some things which helped me a lot to understand what is going on and why and how we can counter that reason.
1. Knowing the reason for the occurrence of AF: There are different reasons - passing of large hard stool, diarrhea, any kind of trauma etc. Understanding our particular reason will help us to immediately do the necessary to stop that reason. My reason was passing of large hard stool. Normally my BMs are very regular, everyday first thing in the morning. But one day, I had to get up very early morning to go to a dance class and I did not get the natural urge to go. Hence I went to the dance class with a full bowel. That whole day, I did not get the urge and next day, Voila, AF !
Lesson learned: Do not practice dance or any workout / physical activity with a full bowel.
2. Knowing the nature of the fissure: An AF itself can be of different nature - mild external tear with/without some blood spots, internal tear with/without blood, external plus internal tears, presence of a sentinel tag etc. Of course, a doctor is the right person to diagnose and tell us what exactly is going on there. But most probably we will get the appointment after one or 2 weeks. In case of a fresh AF, every DAY is important because every single day passing without understanding what is going on will worsen the condition. So what we can do is during the very next BM, try to relax, close your eyes, take nice deep breaths and try to understand the source of the pain - is it just from the brim of the anus or is it from inside or is it both ? Also, after BM and cleaning, look with a magnifying glass or ask your partner to visually check the area very gently and understand what is going on.
In my case, the pain was both internal and external, but mainly from inside. So whatever I applied outside did not help me at all. After I understood that, I made a mixture of Manuka Honey (MGO 400+), Extra Virgin Olive oil, Sweet Basil oil and Vitamin E oil, thanks to Kate and Louisa who had the big heart to post about it. I applied this mixture after BM and before bed time. To my surprise, after one or 2 days of application of this mixture, the pain came down from 9 to 6 ish.
Exact detail of the mixture - I took a ј tsp from the measuring spoons and took honey in almost half of it, filled the other half with 2-3 drops of basil and rest with equal olive and Vit E oils. I then transferred the mixture to a tablespoon for the convenience of mixing. Know that honey will not mix with oils, but still giving a gentle mix will be good, I feel. And then I used an eye dropper to insert the mixture inside the rectum. It had a smooth tapered end. Of course, my partner helped to insert the mixture carefully.
Manuka honey - Excellent wound healing property, anti-inflammatory, anti bacterial properties which helps reduce pain and inflammation.
Basil oil - Improves blood circulation, relieves pain, treats infections. This is a VERY concentrated essential oil. So be careful to use only a few drops (1-3) and ALWAYS use with a carrier oil.
Olive oil - Used as a carrier oil to carry the other ingredients. It also has wound healing properties.
Vitamin E oil - Soothes dryness and itching
I did this for 3-4 weeks and my pain came down to 3 ish. After that, suppositories made out of pure coconut oil was enough. I bought plastic suppository molds through online (I will tell the brand name upon request, do not want to market anything here). It cost me only $20 for 100 of them. Then I filled the molds with coconut oil and kept in fridge/freezer. Inserted them just before a BM and at bedtime. It helped me a lot to ease the pain. Remember, ONE day passed without much friction on the AF is one extra day for the body to heal the wound. On the contrary, I felt that, one day passed with much friction and re-tear takes at least a week to get back to that same stage. Tricky huh ?!
Lesson Learned: If the fissure / pain is internal, the medicine or natural remedy should reach the internal fissures by applying inside
3. Knowing the process of ‘going’: Just like many of you, I did not know (or to put it frankly, I did not feel the need to know) the exact process of ‘going’. My dad was kind enough to explain that to me. Rectum is the final part of our digestive tract - final end of large intestine. And when we ‘go’, it happens by a wave-like muscular contraction known as peristalsis movement. So, the feces moves from the rectum through the anal sphincter muscles by the peristalsis of the sphincter muscles. Sometimes, we all feel the urge to strain during BM. This is natural and gentle strain is fine. But when we have an AF, we try to get rid of the stuff as soon as possible and gets a stronger urge to strain. This worsens the condition because when we strain, the pressure we apply directly exerts on the tear and allows the tear to open up more and worsen. So, it is VERY important to understand not to strain during BM. Do not stress out yourself by thinking too much before a BM, just try to go with a relaxed mind, closing the eyes helped me, take nice deep breaths during, and most importantly trying NOT to strain. If necessary apply only gentle strain.
This whole thing is VERY important especially in the initial days of an AF, when the cuts are fresh and pain is at its peak. Another thing is, squatting. I am an Indian and Indian toilets are designed to ‘go’ in a squatting position which is the natural defecating position of humans. When we sit on western toilets, the anal muscles are not getting enough opening or expansion it needs. So, try to achieve a squatting position. I did it by using a step in front and keeping the feet elevated on the step. Another benefit I noticed when squatting is that it helps to completely evacuate the bowel naturally in one sitting as opposed to getting frequent urge to go in the same day.
Lesson Learned: Do not strain during BM and practice squatting
4. Know about cleaning: It is very important to keep the area clean, but at the same time do not over-do it. Change the toilet tissue paper to a very soft one. Use the tissue to only clean the initial waste matters - max one or 2 times very gently. I kept a mug of water handy and after I am done, I carefully poured water through the backside, so that the running water itself will do the initial cleaning and I had to use the tissue just one or 2 times very gently. I did the rest of the cleaning in the tub with water and mild unscented female cleanser. It is VERY important not to use any soaps or shower gels because the harsh chemicals can irritate the fissures. I changed my soap to baby soap and shampoo to baby shampoo.
I had this question of what to do after urination. We are drinking tons of water everyday and hence has to urinate every now and then ! And I can speak for women, there is a chance that some drops may get to the anal area as well. So, initially I wiped with medicated wipe after every urination. But then, it was too much of wiping and cleaning because of the frequency of urination. Then I decided to drop it and just keep a single soft tissue between the cheeks to absorb anything and that helped me.
Lesson Learned: Do not use strong soaps and gels on the AF. Do not over-clean.
5. Knowing what to eat: I would say, this is the MOST important of all in the healing journey. The reason AF heal so poorly and slowly is because of the very location of the tear and the friction happening everyday during BM. If the same tear happened in our arm or leg, it would heal may be, the next day for good ! We can't do anything about the location. But what we CAN do is to reduce the friction on the AF during every BM. This is by controlling the texture of the stool. The most tricky part in my journey was to perfect the PERFECT stool. We do not want it to be hard, we do not want it to be watery (beware, being watery is as dangerous as being hard). We want it to be the consistency of an ointment. This is where the food and water comes into play. Considering that stool is the by-product of what we eat and drink, as a rule-of-thumb, avoid any hard food, if you feel the food to be hard in your fingers, it is probably not good for AF. My second doctor, who is very experienced in the field, told me, it is very easy to say “eat lot of fiber” , but most of the time we have no clue what food contains fiber and how much. So she gave me a list of foods and the fiber content and told me to formulate a diet that will give me 25 - 30 grams of fiber per day. I can try to scan and post if any of you need. Or, google will also give you that. I literally took a piece of paper and started writing down my diet for the day which would give me that much fiber at the same time, minimal solid food to reduce the quantity of the stool. And for fluid intake, it is easy to say “drink lot of water”, but difficult to keep track. I kept a piece of paper where I will literally count with tally mark every time I drank a glass of fluid and made sure that it reached 8 -10 by the end of the day. I just needed to do it for couple of days and then my body knew what to drink when. After a few days of trial and error, you will know a diet that will give you that magical stool !
About Metamucil / fiber supplement - This is a personal opinion. Both my docs told me to take one tablespoon with water. But what I observed, like many others did in this forum, is that taking that much metamucil made my stool super bulky and did the fissure more harm than good. So, I gradually started to reduce and now I am only taking half a teaspoon or so. The psyllium contained in the supplement has the ability to expand upto ten times its original size in the availability of water. In order to understand that, dissolve a tablespoon in a glass of water and check the water after a few hours. it would become a very thick paste.
6. Knowing the texture of the stool: There are three things that we should keep in mind. The stool should be Soft, Bulky and Slippery. Let me share with you my thoughts on the 3 qualities.
Soft - All the fiber that you eat is going to make sure the stool is soft, especially soluble fibers (check point # 7). About using stool softeners - I used for a week or so, it did not have any particular effect on me and I did not want to addict my body to using them. So I stopped them and got the softening from the natural foods. What helped me - prunes, papaya, metamucil etc.
Bulky - All the insoluble fiber will make sure the stool is bulky. What helped me - broccoli , wheat bran, grapes etc.
Slippery - It is very important that the stool be slippery enough so that it slides easily through the canal without any straining. I realized this after a while and once I made the necessary correction, it was really the beginning of my healing path. What helped me - take one tablespoon of Olive oil with lunch and dinner. It is very unpleasant to drink the oil as such. So, I mixed it with steamed broccoli or asparagus and sprinkled some salt to make a tasty food ! I also took Cod Liver oil pill after dinner (The bottle said the dosage is 3, I started with 1 and increased to 2 whenever I felt the need). This acts as an anti-inflammatory on the mucous membranes and also provides vitamin A and vitamin D which are crucial for tissue healing. I also took clarified butter - known as Ghee (Indian butter). It can be bought in any Asian/Indian grocery stores and will have the texture of a thick soup. I mixed 2 tsp of Ghee in a glass of warm milk and had right before bedtime. This lubricates the intestines and facilitates an easy bowel movement in the morning.
A magical tip: One or two tsp of ghee first thing in the morning followed immediately with hot water will promptly produce a bowel movement. I tried this if I did not get the natural urge to go in the morning and it worked every time !
7. Knowing the difference between soluble fiber and insoluble fiber: When it comes to AF, every source and every doctor’s first prescription is to have a high-fiber diet. Before jumping up and loading our body with tons of fiber we should understand why and what it does to our colon. Simply put, fibers are the components which is not digested by our colon and it is carried with trapped water and other wastes to the rectum creating a properly formed, soft and bulky stool.
But as with anything good in life, in my experience, too much fiber is also not good to heal an AF. A balance is what we need to achieve. The chart and forming a diet as explained in point # 5 will help to achieve this. Another important thing is to understand that all fibers are not the same. There is 2 types - Soluble (dissolves in water) and Insoluble (does not dissolve in water). Mostly all natural sources will have both - rule of thumb - skins are made of Insoluble and flesh is made of Soluble. Metamucil is soluble fiber. If you are wondering I am digging a little too much, wait ! This really helped me to control the texture of my stool. What I learned is:
Soluble fiber - binds with fatty acids, lengthens the time to empty the stomach which takes away the frequent urge for a BM within a single day, forms a gel in the colon. +ve End result - makes the stool SOFT. -ve End Result - Makes the stool too loose
Insoluble Fiber - It is like a dry sponge soaking water inside the colon, prevents constipation, adds bulk to the stool, keeps regularity. +ve End result - Makes the stool well formed/bulky. -ve End result - Stool too much bulky/size
Once we understand this, we can make the necessary corrections to adjust the texture of our stool. Keep observing the stool texture until you achieve the comfortable one. (It’s ok to look at it .. :O ) And if it helps, write down the different food that you are eating and whether it is predominantly soluble/insoluble.
8. Knowing the problems and giving right solutions: I learned that once an AF becomes chronic and long term, the internal anal sphincter muscles go into a constant state of spasm, which hinders the healing. We can feel this during a BM if we get a sense that the sphincter is not expanding as much as it used to or if the canal is really tight. Other problems are because of high-fiber diet, the body is not getting enough vitamins necessary for wound healing and tissue repair. The solutions that worked for me are:
For spasm - I took Magnesium pills (400 mg). Magnesium is very beneficial to reduce muscle spasms. Initially, I had too much spasm, so I started with 1, increased to 2 per day and then reduced to 1 when I felt the spasm is reduced. Magnesium also traps water, so it also helps to keep the stool soft.
Vitamins - I took Vitamin C tablets (500 mg). Vit C is the most important vitamin that aids in wound healing. As said already, I took Cod Liver oil pill after dinner (The bottle said the dosage is 3, I started with 1 and increased to 2 whenever I felt the need). This acts as an anti-inflammatory on the mucous membranes and also provides vitamin A and vitamin D which are crucial for tissue healing.
9. Knowing the importance of physical activity: This is a very sensitive area and we should be careful about our physical activities. Poor blood circulation in that area is one reason of poor healing of an AF. Some things can be done to increase the blood circulation naturally.
Sitz baths - Obviously, taking warm sitz baths helped me a lot to ease the pain and discomfort throughout my journey. One thing out of my experience is - doctor asked me to take them in “as HOT as you can tolerate” water. I found out after several sitz that nice warm water works better than HOT water. It might be personal, but something to think about. I used the portable one which we can fit on the toilet and kept a mug of hot water handy to carefully mix in small amounts to retain the warmth of the water in intervals. I did initially 3-4 times a day for 15 min and then reduced to 2 and then to one (after BM) and now I do not do.
Warm baths - I read somewhere about the benefits of taking warm baths. A nice warm bath can increase the overall blood circulation of the body. It is just going to the shower (I did with a shower cap on) and taking a bath for 10-15 minutes in soft mode of shower and just doing gentle body movements in the running water without the use of any soap or detergent. I sometimes replaced my evening sitz bath with a warm bath.
Warning: We will have a tendency to crank up the heat once we are in the warm water, especially in winter. Do not crank up too much that you end up standing in hot water. The thing is, the heat that the rest of the body can tolerate will be too much for the super-sensitive tissues of the anus.
Exercise - Any form of GENTLE workout is very beneficial to increase the blood flow to that area. I did gentle walking for 10-15 minutes every day (since it is winter, I did in my living room).
Avoid any workout that would give direct pressure to that area. If you are into Yoga or know the poses, some of the beneficial poses are: Camel, Bow, Wheel, Locust, Hero etc. Anybody can practice Hero’s pose which I found very helpful. It is nothing but kneeling and then sitting on your heels. Be careful not to pull your butt cheeks apart while you sit but if needed, gently help with hands to keep the cheeks together. (Just google Hero’s pose, you will get an image). Try to do with loose clothing. When we sit like this, the heels act as pressure points on the buttocks (NOT directly on the anus) and thus gives lot of blood supply to all the genital organs. If you want to understand this concept, press the inside of your left thumb with the right and see the blood flow around. Sit with a nice long spine and try to keep the palms relaxed on the knees and take nice breaths. Sit for like 10 minutes or so.
Warning: If you have a sentinel tag, sitting like this may not be a good idea, because all that extra blood supply can help to swell the tag.
Sleeping position - This may not be really important. But, I feel it helped me. Depending on the position of the fissure on the anal dial, it may be a good idea to adjust the sleeping position accordingly. My fissure was mainly at 6 O’clock and 12 O’clock. So, I made sure that I do not sleep on the back, which will exert direct pressure on my fissures. I changed my sleeping position to either side or front.
10. Knowing the emotional journey: AF is definitely a roller coaster of emotions - especially of pain, sadness, helplessness, frustration and confusion. The source of all these emotions, I felt, is the realization of inability to do the TWO most primary needs of our life comfortably- eating and ‘going’. Thankfully, the word depression was not in my dictionary, until before AF. Even now, I do not want to use that word, but I admit, I was sad - extremely sad. But experiences taught me so much. My advice is, if you feel like letting it out, LET IT OUT. If you want to cry, cry as much as you want. Letting the emotion out is a cleansing process for our emotional body. If we try to keep our sadness inside without letting it out or expressing, that will feed toxic to our emotional body and we will become depressed. Talk to your partner or best friend and express all that you feel on a daily basis. Cleanse it out whenever you feel the need.
And we all tend to set a time frame for any sickness thinking I will or should get better by a day or a week or a month. Well, for an AF, I have learned to count the progress in months (or at the best, weeks). For me, the progress went like this: 1st Month - EXTREME pain, 2nd month - Pain, 3rd month - healing started, End of 3rd month - healed and re-tear, 4th Month - Again Healed (I hope it is for good ! )
Some other things that helped me are:
- Clip the nails and file and keep the fingers smooth always. We do not want to give one more reason for the fissure to worsen. Also, ask the partner who is helping us with meds to do so.
- Avoid tea, coffee, non-veg, spicy foods, bakeries, chocolates... Don’t worry. We can enjoy all of them some time after we see the light at the end of this tunnel... :)
- Depending on what the problem is for a particular day, I gave the necessary correction instead of following a strict routine of food and meds.
- Once I got a diet that worked for me which gave me a perfect stool, I more or less stuck to the same diet until I healed completely. (I can post that diet here if anybody is interested)
- Understand that every human body is different and something which worked wonders on one body may not do the same for another. So, do not get disappointed if something is not working for your body. Give at least a week before giving up on one remedy.
- Try to set a good biological clock for eating and ‘going’.
- Try to minimise the usage of foreign bodies (q-tips, cotton buds, eye dropper etc. ) as much as possible and use only when absolutely necessary. For me, using q-tip inside worsened the fissure.
- If you ever read or wondered about using garlic as a suppository, a word of warning - I tried and it worsened the fissure. The garlic is too strong for an AF.
- Skin test anything before applying directly on the AF, for any allergic reaction.
- If you have a sentinel tag, know that it is located directly below the major fissure. So, apart from protecting the AF, it practically acts as a handle to the fissure, which when disturbed causes to re-tear the fissure. So, DO NOT rub on the tag. Handle it super gently. It will shrink as the AF heals. (For those who don’t know, a sentinel tag is a small skin growth, formed from muscle tissues out of unsuccessful attempts of the body to heal the fissure over and over.)
- Beans/Peas are a good source of fiber. At the same time, they create a lot of gas. I found that passing of too much gas can delay the healing process. So, soak the beans/peas in water overnight with enough room for them to swell, drain the water in the morning, rinse well in water and use. It will help a lot to reduce the gas. Also, another thing I learned is, Grapes, a good source of fiber also creates gas. One tip to get rid of the gas is, make a juice with just enough water, pour in a glass and let it rest for couple of minutes. You can see and hear the air bubbles escaping on the surface.
My experience of Re-tear after Complete healing:
OK, So finally at the mid of the 3rd month of AF, my pain became ZERO (from 9) and BM became very comfortable, no blood spots, nothing. It went like that for 5 days. I followed all the same food and routines. But on the 7th day, it re-tore. My conclusion is, even after everything got healed and perfect, I continued to do the warm sitz baths and the warm baths. That may have made the fissure weak and soft again. So, when I am healing this time, I have stopped the sitz baths and the long warm baths. Stopped all the suppositories except for the coconut oil one before BM. The pain is back to ZERO and I hope everything goes fine and smooth and there will not be any re-tears. I am ready to get liberated and I am ready to see that light at the end of the tunnel !
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A BIG part of the healing journey is hope, hope, hope. Do not lose hope. We are not alone, we may feel so, but we are not. And NEVER underestimate the healing power of our body. Human body is designed to heal the wounds. It is just because of the location and frequent friction that it is taking a little longer than any other part in the body. We will provide all the nutrients and necessary components that the body needs to heal, we will avoid anything that will hinder the healing and then we will leave it up to God. Prayers - lots and lots of prayers will help us keep the faith and hope going in our healing journey. God is the best listener.
I totally completely feel the pain that you are going through and my sincere hopes and prayers for each one of you in your healing journey. You WILL heal, it is just a matter of time and patience. I hope this journal of mine helps to ease the suffering of someone out there or at least help to give you a new hope. Do not hesitate to ask me anything that you have in mind. I will try my level best to answer within the limit of my knowledge. I sincerely request you to keep me in your prayers to have a fissure-free life ahead.
My best wishes to all of you and God bless you all.
for your time. - AF Angel
PS: I am not a doctor or medical professional. These are some of the things that worked for my body. Please use your discretion when trying any remedy mentioned here.
