5 years of chronic but may be healing

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5 years of chronic but may be healing

Postby Stingeyringey » 05 Feb 2021, 18:25

Hi all,

Long-time forum reader – first time poster. Anal fissure diagnosed while undergoing THD surgery (Very effective I must say. One caveat: TAKE NSAIDS whatever you are told or you WILL have oedema) for haemorrhoids 4 years ago. Since then I’ve been in a cycle of “get prescribed nitro – use – stay the course – hurrah I’m healed! Re-tear 2-4 months later” with occasional slight variations on the theme where you can replace “Nitro” with “Diltiazem”. It’s safe to say it classes as “chronic” right now; got the sentinel tag to prove it n’ all! It should be noted I am Male, early 30’s, reasonably active, posterior fissure, so the following might not be as helpful to others

I wanted to share with you all an approach I think might be effective, or at least several things together that I think have definitely helped keep my fissure from bleeding for the last 6-ish months – I wish I’d known about them sooner tbh.

This is going to be a fairly long post because I just want to information dump on you some things that I really think help. It’s a miserable and pointless condition that you wouldn’t wish on anyone as it simply seems such pointless suffering. I am going to reason out why I think they work to you because I’m trying to be as convincing as I can. Just like many of you, I’d stick almost anything up my ass to heal this without surgery, so I have also poured over the suggestions of people on here about e.g., sticking manuka honey up there. I always thought this was hippy dippy but, even though it doesn’t appear in my method, I’m starting to think that may work for some people – details follow

To summarize what I’ve done: Magnesium citrate to get stool like soft scoopy ice cream (400 grammes at breakfast for my 260 pounds 6 foot male body) followed by trying to eat generally healthily (no overdosing on fibre, no fretting about exact proportions, more on that later) exercise, bowel retraining (sounds complex but basically endng up pooping every day, or at least every other day), better toilet posture, wet wipes, point the shower at your anus, and just sometimes finger pressure on the posterior peri anal area when pooping.

All the above has sufficed to prevent bleeding for FAR longer than any other method. I hope that if this keeps up the chornic ulcer (what a chronic fissure technically is) may be healed in another 18 months (total of two years).

I really think I now need to go into what I think an anal fissure is now to back up my arguments for why this will work for a lot of people, so I’ll subtitle the sections. If you want to know more about my method skip to “Method I use detail”: below.

What is an anal fissure:

If you’ve read a lot of medical journals about anal fissures, you’ll notice a lot of them say “the aetiology of anal fissure is poorly understood” i.e. they literally don’t know WHY some people get anal fissures, and some don’t, some do and they heal quickly, and some do and they turn chronic. But I will summarize some of the points of view I’ve read, and they all actually seem to dovetail into each other

1. You have a tight ass. No, not the spasm AFTER the fissure. You ALREADY have a tight ass. It was noted anal momentary scores were higher in ALL patients, relative to the mean, with any fissure, painful or not, and whether the inner sphincter appeared to be contracting or not. It was also noted that nervous individuals have more of these problems. It has also been established that nervous individuals literally have tight asses. And that stress tightens your asshole, not for the 5 minutes you have it, but for hours afterwards. Imagine what someone who is stressed for six hours a day experiences
2. You had a hard bowel movement, or a very soft i.e. almost liquid bowel movement/ you also tried to force that hard bowel movement For most of us it was probably hard (I remember the one that caused mine! I’m sure we all kick ourselves) and this combined with your tight inner and outer sphincter, ablated the anoderm progressively or tore it in one go.
3. “Hold on! You just said it could be a liquid bowel movement! How does that make sense?”
Apparently this also puzzles doctors, but it doesn’t puzzle me, having some experience in hydraulic engineering. Forcing liquid through a tight seal can result in pressure that can cut stone. Hydraulic cleaning hose tips have to be made of titanium sometimes – hence ablation of the anoderm, forcing liquid stool out
4. But returning to the likely more common “large and hard” stool, the posterior area of the peri anal area (i.e. toward your spine side, not your belly side, which is “anterior”) is poorly supported not only with blood supply (more on this briefly) but also with MUSCLE. It tends to distend FAR more than the anterior side. To OVER stretch.
5: If you have some bad toilet habits you probably forced that hard stool out. This is a bloody terrible idea. Most of us now know not to strain but do you know why? Your inner sphincter literally RELAXES when you take a comfortable poop. Hence the pleasant yawning sensation. The reason you probably have to force it out is because you have been hanging on to your poop or it’s arrived so slowly and slow dryly, or dried out so much it hasn’t tickled the nerves (and/or you’ve been suppressing them) that trigger an automatic series of reflexes that RELAX THE INNER SPHINCTER. Guess what happens when it hasn’t been relaxed.
6. A summary of the start of the fissure: Probably something like this – your toilet habits are bad, you have a large stool, you were tight assed anyway, you force it past a closed sphincter, this either begins a process of ablation or if it’s the size of a nike trainer, outright tears the posterior anoderm because that area is literally not relaxed, because an automatic reflex of defecation hasn’t triggered or you’ve suppressed it too many times, and then it stretches that posterior area far more than anywhere else and bang, knife in the ass sensation.

The all too common posterior anal fissure noted after a hard bowel movement cometh

What is a fissure part 2 – why won’t it bloody well go away?

7. But it goes on
8. Chronicity can now develop. This literally is defined as “acute fissure, but it’s gone on for 8 weeks or more (actually a bit more to it, but it’s niche info). This will be most of us here, but why?
9. Go back to point number one, you may have a naturally tight butthole, inner sphincter and out, this will mean less blood flow to the area from the inferior rectal artery, that supplying the posterior peri anal area. A tiny little artery. But you are probably all familiar with or at least remember the “spasm”. A constant pressing, urgent, nagging, twisted and burning pain in the area of the fissure. This is the entire sphincter, inner and outer, contracting to try and protect a wound. Tight ass on top of a tight ass.
10. This is why creams like nitro etc are supposed to be effective in many cases, and at the very least relieve pain and the operation is simple – Nitric Oxide donors cause smooth muscle relaxation (i.e. the inner sphincter, it is “smooth” i.e. involuntarily controlled muscle) and cause arteries to widen. Half the spasm not under your control is now relaxed, blood flow increased, crushing pain of a wound being squeezed is alleviated, outer sphincter can also now relax, wound can start healing, or can be completely healed by the otherwise poor amount of blood flow.
11. Hopefully, for you, it’s now over. Eat your bloody vegetables, apply the cream twice a day even if you THINK you’re healed for the full course, try to never suppress the urge to defecate again for long and pity the rest of us poor sods who it is not over for. Read the rest of this guide to make sure you’re never so silly again. I hope you never have to come here again; I really do.
12. But it goes on (for many of us) why?
13. It’s probably a combination of many things

a. Aforesaid poor bowel habits occasioning large and dry stool. You have to get yourself used to moving your bowels with some regularity. Doesn’t matter what else you do, if you only poop once a week it WILL be large and probably dry (as even the rectum sucks water from stool)

b. You don’t eat right, occasioning poor fissure healing large and dry stool and straining. You are what you eat? Are you getting your vitamin c? But don’t go too overboard (as some of us have) and eat nought but fibre. Diet is an extremely complex topic and I’m literally going to give it it’s own little subsection right here, but a major part of the upcoming “my method” section concerns taking magnesium to make SURE you never have a hard, large or dry stool – anyway -

b.1) You do need fibre. Too much fibre can constipate you if it’s not balanced with water. Too much water can wash sodium and other elements from your gut which are actually HOLDING the water there. Caffeine can cause you to urinate the water out even if you don’t drink too much. We are sentence three of this subsection and you are already having to let go of the idea that “I’ll just eat lots of bran! And drink water!” I did that and hurt myself even worse.
b.2) don’t just stop eating meat and fat. Meat and fat are the strongest causes of peristalsis (contraction of the gut, gut contents moving along) and peristalsis is what deposits stool into the rectum in regular quantities TRIGGER the reflexive urge to defecate that you want to cultivate. Protein is also necessary for tissue repair. Damaged tissue like, say, a chronic fissure.
b.3) A lack of any carbohydrates will also make you feel less like exercise, which will help heal the fissure (see many references below).
b.4. A wide and varied diet helps you get all sorts of vitamins and minerals essential for tissue repair
b.5. In short, do not just go “FIBREEE TIMEEEE”. Cut coffee, tea, cigarettes, alcohol and all other drugs out of your diet (as you should do for ten million reasons) and eat a balanced diet with some useful Grease, fat and salt in it. Drink a LARGE glass of water with all four meals of the day, or as many as it takes to make your pee light yellow (if it’s fully clear you may be washing salt out of your body. I remember seeing a poster reminding recruits of this in an infantry training centre) No salts will likely produce hard stool.
b.6) I urge you to remember, it’s not as simple as “get more fibre” but it IS as simple as “eat balanced and get more veggies”.

c. Poor toileting habits occasioning straining. We would almost certainly all be better of squatting to poop. When you think about it your anus is DESIGNED for this. How do other mammals’ poop? How can a human possibly poop without smearing it all over themselves without a toilet, a device that wasn’t present for tens of thousands of years of our evolution? Hint hint: You squatted. If you had never NOT used a toilet in your life and you had to poop, you’d squat instinctively and your anatomy is built around that. Look up “The ano rectal angle” on google image searches and you’ll note there’s a kink in your rectum, likely there to prevent you easily fouling yourself when standing up. Squatting straightens it. Unfortunately, most of us don’t want to squat over a pot, or cannot emplace a squatting floor toilet in our house. I’ve see some convincing arguments that poor people in third world countries simply never get fissures because even when constipated, an easy defecation reflex is triggered by squatting down – the sphincter always relaxes and defecation is never forced past a closed inner sphincter. Think about it: Suppose you really needed to poop, but didn’t want to poop your pants – what’s the LAST thing you do, sit and even worse SQUAT. You STAND and CLENCH. You can see children doing it.
A halfway house available for the rest of us includes putting your feet on a pile of phone books. Even doing the following can help a lot: Sit up straight, relax into the poop, point your feet on the floor i.e. up on tip toe to get your knees a bit higher, lean forward slightly with and squeeze your stomach muscles in a little. You’re straightening your ano rectal angle without stressing, and not trying to force a stool past a closed sphincter using a Valsalva manoeuvre (i.e. normal “straining” which includes holding your breath). This method helps encourage the automatic reflex to kick in and your inner sphincter to “yawn” as it were.

d. Poor circulation of the blood in the area, occasioning healing that is too slow, either as a result of a naturally tight ass, or recurrent spasm, or lack of exercise, or too much sitting, not enough relaxing in a bath, smoking etc etc: This may be a long one – so you poop regularly, it’s soft and bulky (perfect diet or magnesium or both, whatever) but there healing just isn’t happening fast enough. That’s what NITRO is supposed to help with right? And it does. Even if you’re just BUILT tight the inferior rectal artery widens with nitro, so helps it heal. And the operation most of us fear, lateral internal sphincterotomy is aimed at one simple idea – improve circulation by making sure a spasm can NEVER strangle that small blood supply again. I can’t help noticing that if you were built tightly that it would ALSO permanently reduce resting pressure in the lower half of the inner sphincter (good surgeons now only cut the lower half, as it decreases chances of incontinence). Low and behold, it is successful at preventing fissure pain and bleeding in almost 97% of cases. Often now called “the gold standard” of curative measures. But if you’re reading this you likely fear being in the 3%, so what else can you do? See the “my method” section for more, but its not like you CAN’T get more blood flowing there to allow it to heal itself. There are half a dozen ways – LIS is just a damn near guarantee of higher blood flow in perpetuity.

e. You overstretch your posterior peri anal area a lot when defecating due to a large stool. There’s help for that, again, see “my method”.

F. A capital f, to denote various esoteric and harder to prove theories. There has been some recent academic speculation that yes, as some of us have suspected, the wound itself, being smeared in poop on a regular basis, may heal poorly and slowly due to simple bacteria. Some surgeons have claimed 90% cure rates even for chronic fissures by regularly applying iodine (a simple disinfectant). It is hard to see why they would lie. Iodine is cheap to manufacture, and almost unbranded it’s so common. Other have claimed healing with clove oil application. Some research on chronic wounds indicates that some people experience constant debilitating wound inflammation from common body bacteria that have no effect on others with wounds whatsoever. I can’t help noticing several people on here have claimed healing from manuka honey suppositories (self-made it seems). Manuka honey has been known for 2000 years to act as a disinfectant. Strongly supported studies advocate it’s use in chronic wounds NOT in the anoderm. Is the anoderm any different? Maybe this is why this method, and others (clove oil, zinc creams, etc) have supposedly worked for some people but not other people. Consider the following: perhaps some people’s fissures are all good to heal, due to all the measures they’ve taken, and only don’t heal because they are of that class of people who develop wounds that hate faecal or other body bacteria – which would easily be carried to the anus by sweat running down the back. Now throw in the fact that gut bacteria, which has been found to vary widely in individuals (and is at the centre of cutting-edge medical research) will inevitably find its way to the wound……and sticking mankua honey up your ass is starting to look pretty sensible isn’t it? I’m not saying it will work for you, quite the opposite. I am suggesting that a possible cure to chronic anal fissure (i.e. anti-bacterial agents layered on the wound) may be being totally ignored because it simply VARIES too much from person to person for there to be a good study yet. If you think doctors couldn’t miss something so obvious, then I would have to disagree with you. I believe there are many examples of things like this going under the radar.


My Methods:

That was a long speech for what’s now going to be a very short paragraph about what I’ve done that’s stopped me bleeding or having any pain for the last 6 months, without nitro or anything else. I am hopeful that in 18 months I will be able to come back here and tell you I’m healed. 2 years to heal a chronic ulcer apparently – here’s what I’m doing:

1. TAKE MAGNESIUM. Do it in the morning or whatever, at 188 centimetres tall and 80 kilos, I need 400 mg. Turns your poop into soft scoop ice cream and helps make sure you never, ever, tear the anoderm again with a less than perfect “soft poop” diet. Means you can eat the meat and fat that will trigger the peristalsis that will get you into the habit of REGULAR pooping. I’ve seen a lot of posts on here, but one thread I’d direct you to is literally just titled “MAGNESIUM MAGNESIUM MAGNESIUM” lol. Essentially we are using it as stool softener? Why not use branded stool softeners? Well, really we shouldn’t even be using magnesium, but if I’m going to eat something that the body likely isn’t expecting, and hasn’t evolved for, for months, I’m not going to eat five more pointless and dubious ingredients. 400mg of magnesium for six months, daily, and I don’t feel any weird side effects so far….
2. REGULAR POOPING. Get in the habit. Don’t ignore the urge unless you really must. Don’t snack, eat 3-4 square meals to make it a habit (3-4 bursts of peristaltic movement. Snacking sometimes doesn’t cause peristalsis AT ALL). This will also make it easy to >
3. EAT A HEALTHY DIET. Gotta get those vitamins and protein to heal
4. GET EXERCISE, AS PART OF THE PLAN TO INCREASE BLOODFLOW AND CAUSE HEALING: As I said in the above “what is an anal fissure”, the LIS operation is just a measure to make sure either your naturally tight anus, or naturally tight and occasionally spasming anus NEVER lowers it’s own blood supply again. Haven’t doctors told us for years that exercise can increase blood flow, improve wound healing, better your mood etc? I shall relate this anecdote to you my fissure disappeared for 5 months once without nitro or any of this I lost my desk job and ended up working in a warehouse. I walked for six hours a day – I daresay this constituted exercise lol I lost 6 pounds a week eating cake every day (metaphorically, but I ate garbage). That was actually the problem, I got smug and thought “it’s gone”. Back to desk job Y HALLO THAR>? REMEMBER ME? I honestly think we could cure our fissures WALKING six hours a day but do we have time for that? NO. If you’re a N.E.E.T. I recommend it, excellent weight loss effects too. Also, you could crack nuts on my legs and buttocks.
4. DON’T STRAIN. Really feel like it’s going to be hard to get out? Put glycerine suppositories up there – they draw water to the where they are, softening the end of the stool and crucially the incoming water will trigger the automatic defecation reflex, allowing the spincter to relax, helping prevent straining. Point your feet, straighten back, relax, lean forward with straight back just a little, press stomach in
5. IF ITS COMING OUT SIDEWAYS, OR STRETCHING YOU A LOT – FINGER SUPPORT. Not so long ago some doctor in Singapore came to the “overstretching” theory as regards posterior fissures and proposed a toilet seat design that supported this area. He claimed a 98% healing rate of all fissure types with it. Possibly he was fibbing (Find the device here, https://www.stressnomore.co.uk/colorec-premium-toilet-seat-for-anal-fissures-92451.html and is mentioned here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2999245/, but anatomically he probably has a point. He let slip in his academic papers that just using one finger in the right place was found to achieve the same thing And I can tell you that just recently I had two unexpectedly awkward bowel movements. I’ll be honest and tell you I was panicking a bit, and realized I was straining without even thinking about it. I put my finger about 1cm “above” the posterior of the spincter (in terms of place think about travelling from your spincter to your tail bone. It’s on that line), leant forward a little bit, and literally FELT the stool change position, re-orientate, and leave with 50-60% less effort than I was previously making. I think that doctor had a point


Some Closing Thoughts:

-I’ve come to the end of my post. I wanted to point out what I understand a fissure to be to support my arguments for what I think might help your fissure.

-Those with anterior fissures will likely benefit LESS from this but I still think it has some mileage in it. For those of you who do, most of whom would be ladies, I recommend looking of VY advancement flap surgery, and accepting nothing less.

-I want to emphasize that I think all the measures outlined above MAY heal even chronic fissures. This is the longest I’ve been without one in these years without having to resort to medically prescribed creams. Others of you will be further along the road, or perhaps you have more scar tissue, and perhaps it won’t work as well (maybe I’ve got too much scar tissue! Maybe it will just re-tear again after I stop taking magnesium in 18 odd months) but I’m reasonably certain that if I had caught my fissure early and used all the above methods then I may have healed it right then! I urge you to pass along these tips and your own to anyone who has an anal fissure who you know and spare them the long pain we have all enjoyed. I had the pleasure of being able to advise my sister over one my niece had, and I was so pleased to see her healed just from grinding some stool softener into her milk.

-For those seeking recipes for some ointment or potion to put on their anus to solve this I’d say “give it a whirl”. You can see my reasoning above for how it may, in some people’s cases be bacteria alone preventing final healing of the chronic fissure. I don’t see any reason why someone couldn’t mix honey suppositories (think it has to be a suppository tbh :D, tried smearing some on just once and it didn’t go well – got everywhere!) AND something like nitro on the external sphincter. I can’t imagine it causing a problem, but try it on a day off first so you can douche it out or whatever – I’m not a medical professional and this advance should not be taken as such (muh legal disclaimer)

-Maybe Try sitz baths with a tonne of salt in them if you credit the bacteria in wound theory. Salt is massively antibacterial. I knew a guy who healed chronic LEG ulcers simply by swimming the sea every day for 2 months in summer (2 months is all we get in England viz hot weather :D)

If you don’t have a bidet, you can always clean your ass very thoroughly with wet-wipes, have your daily shower, and use the shower heads to make sure your SQUEAKY clean down there (watch its not HOT, this will only irritate, try warm, and I mean just wash it over the outside, don’t stick the hose up there or anything) as any sort of pruritus or anything like that probably doesn’t help at all. Also, as has been noted by many doctors, do not insert or rub any soap right on there

- Found some more evidence about anti-microbial agents being involved in healing fissure wounds
https://www.researchgate.net/publication/49632323_Novel_use_of_povidone_iodine_in_fissure-IN-ANO

- If I start bleeding again at any point in my routine I’m going to try some “Hemoclin” (I think it’s antimicrobial ages ago and I bought some but never got round to using it) or possibly some iodine type solutions on a wet wipe to see if this anti-microbial angle

-Seen some people on here and elsewhere point out that BEING stressed about it will tighten your ass up more, and have definitely noticed in the past that when I had a re-tear and I just went “meh, I’m doing well otherwise and I’m well armed with nitro if it gets worse [hint hint, always try and get a couple of tubes prescribed and then SAVE one] it would re-heal MUCH quicker then when I was down. Always try to cultivate a “this will pass” attitude

-Another thought occurs. At one point I actually had a small external hemmarhoid (not sure how that happened, and it’s the only one I ever had) I reasoned that massaging what is essentially a small vein with trapped blood in it would be more likely to move it along. I did so once a day in a hot bath and after three days it was gone. SURELY massaging the peri-anal area will encourage blood flow back there? The following is about internal massage, but I bet any sort would help. The study is about ACUTE fissures, but its worth remembering that what heals an acute fissure is what heals chronic fissures – increased bloodflow through decrease of hypertonicity. In the LIS for chronic fissures that’s achieved by cutting muscle permamently, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479997/

And that’s all I have for now. Long time reader of the forums, first time poster, I’ll be back to see if anyone wants to shoot me down as utterly wrongheaded about something (I’d be interested to know) or to see if anyone has any questions. I’ll definitely be back if I find I’ve forgotten something and I shall be sure to come back and give you periodic updates if my method is still working.
Stingeyringey
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Re: 5 years of chronic but may be healing

Postby Lalap » 02 Mar 2021, 15:49

Wow - think you make some really excellent points here. I haven’t been on the forum in a while - when I looked back at my last post I saw it was 2013! At that time I was having a pretty bad time of it that took me to a CRS, who did a really quick exam and was like yeah I see some hemorrhoids and your fissure doesn’t look too bad here’s some cream hope you get better, yada yada. But I actually have a pretty good history going back to somewhere in my early 20s of fissures. Since 2013 I’ve been doing okay with the occasional flare up, but then in 2020 I ended up going back to a different CRS in absolute agony due to pain and an inability to get things under control. In the end (ha) I figured I must have also had a thrombosed hemorrhoid(s) and somehow in between using some creams for that and changing a few habits I got things under control. The Diltiazem she prescribed didn’t seem to help much so I honestly didn’t use it much so it’s a miracle I healed. She really couldn’t do much of an exam and didn’t see any fissure (good God how I have no idea as I felt like it was enormous!) That’s the worst it’s ever been. But now I’m going through another bad bout about a year later. It’s been several weeks with a relatively good day where I’m hopeful followed by a really bad day a couple of days later. I’m having similar pain and pressure in the area so am thinking once again I have hemorrhoids acting up. I also have 2-3 skin tags due to previous chronic fissures so that adds another layer of complexity. Somehow I think these 2 conditions make things harder to heal - did you come across anything in your research about that?

I’m going to reread your post this evening and will provably have a few other comments or questions but just wanted to quickly say thank you and I agree with a lot of what you say!
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Re: 5 years of chronic but may be healing

Postby Rich44 » 04 Mar 2021, 12:31

Wow Stingeyringey - what a post! I agree with (and have lived with) many of the things you are talking about. You are so right about the tension/tightness in the sphincter being a major part of why and how a fissure forms and sticks around. I even had a major muscle spasm issue (levator ani I guess) that only went away when I quit my job 5 years ago. But there is no doubt the stress from that job likely contributed to me having a tight sphincter and the chronic fissure. The anaorectal manometry test I had done prior to my LIS confirmed I was off the charts tight. I also am exploring the relationship between water intake and sodium to find the right balance. Like you said, sometimes too much water can backfire if you don't have enough salt.
Chronic Fissure June 2014 - October 2020
Botox, skin tag removed - February 2015
Levator Ani September 2014 - February 2016 (caused by stress - left my job, cured!)
Lateral Internal Sphincterectomy, skin tags removed - October 2020
Fissure 100% healed!
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Re: 5 years of chronic but may be healing

Postby Rich44 » 04 Mar 2021, 12:33

Wow Stingeyringey - what a post! I agree with (and have lived with) many of the things you are talking about. You are so right about the tension/tightness in the sphincter being a major part of why and how a fissure forms and sticks around. I even had a major muscle spasm issue (levator ani I guess) that only went away when I quit my job 5 years ago. But there is no doubt the stress from that job likely contributed to me having a tight sphincter and the chronic fissure. The anaorectal manometry test I had done prior to my LIS confirmed I was off the charts tight. I also am exploring the relationship between water intake and sodium to find the right balance. Like you said, sometimes too much water can backfire if you don't have enough salt.
Chronic Fissure June 2014 - October 2020
Botox, skin tag removed - February 2015
Levator Ani September 2014 - February 2016 (caused by stress - left my job, cured!)
Lateral Internal Sphincterectomy, skin tags removed - October 2020
Fissure 100% healed!
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Re: 5 years of chronic but may be healing

Postby Stingeyringey » 07 Apr 2021, 16:00

Sorry Laplap, don't really understand what you're saying - are you saying you STILL have a fissure or not?

As regards your problem with hemmaroids (damned if I spelled that right, I dont think I ever have) if you think you have a persistent returning problem with them then I can strongly recommend THD surgery for them. I think THAT is becoming the new gold standard for them. Travel to get it if you must.
It bascally consists of slightly ligaturing some arterial vessels supplying the hemmaroids further up the bowel, by detecting them with a ultrasound probe, thus calming them down into normal sized pad. I had it and it was an immediate cure.
Top tip, because healthcare professionals can sometimes be off-the-scales stupid: Taking NSAIDS like paracetamol is NOT optional after the surgery. Take one every few hours because you WILL develop oedema (swelling from "injury") in your rectum. These drugs reduce it Meaning you can't defecate. Meaning you will may end up constipated for 5-6 days for the swelling blocking bowel movement. This actually happened to me. Unbelievable. Unbelievable the cretin they employ in hospitals sometimes. I was explicitly told they were optional "if I had pain". I didn't actually have ANY pain (and what a contrast that is to the horror stories of full hemmaroidectomies) and so took none for 3 days. Only by LOOKING UP the most detailed notes on the surgery did I find out they were mandatory. Just pure ragefuel to be honest.
I did have severe concerns later that the tying off of these arteries may have slowed blood supply to my spincter (thus making the fissure unhealable!) but after examining some medical textbooks, the arteries that supply the spincter are nowhere near (nay, unaccesible from) the rectum itself. So no fear there for now.
Hemmaroids and fissures are definitely connected, because having a tight anus, poor toileting etc (see my original post) begets BOTH at the same time.
Please expand upon what else you'd like to know

Rich44

- Good to know you agree with some of my theorizing.

You say you had LIS when you discovered you were off the charts tight. Why are you still concerned with sodium and water intake etc? Do you find the fissure returns some times despite this? I'm sorry to say I find that slightly depressing.

I wouldn't worry over much about "balancing" it. Salt your food a little at dinner and drink a glass of water with every meal would seem to do it about right. For soft stool I've recently found a big glass of water with a heaped tablespoon of psyllium in it once a day has done more than anything to give me consistent, rarely hard stool.


_+_+_+_+_(BREAK)+_+_+_+_+

Since I posted my original post I was, surprise surprise, actually seen by a NHS consultant about my fissure (near the end of Lockdown in the U.K. and I had been on the waiting list for 6 months). I'll be brief so as not to bore anyone.

Give him my history, tell him that, like my original post, I'd been fissure free for 6 months ONLY by taking magnesium and living better. Say I'm concerned about staying on 400mg of magnesium forever

- Up on the table you go
- Without asking permission, gives my anus a thorough probing. (somewhat rude, I thought)
- Spends about thirty seconds examining me with benefit of the probe
- "Well I can't see anything there now" (I wonder how he missed the obvious sentinel pile. Does this count as nothing?) "It looks like it's healed well up. Yes, on the whole you shouldn't be messing with your blood chemistry and magnesium will end up being habit forming! I recommend Lepicol, take it daily for the next few years! And even if it did come back we'd just use botox, that's very effective! I've only ever had to do LIS twice in my whole career. Bye now"
- Mr consultant ends what has been a 6 minute meeting (including anal probing) and presumably passes go and collects 500 pounds for "detailed consultation with mr. stingeyringey"

*Now, to be fair, the lepicol, which is just psyllium with some good gut bacteria in it, has been pretty effective, and I would recommend anyone of us here takes it because it does the BEST job of getting consistently soft stool, and if far easier than banging through huge quantities of bran flakes etc. It's useful soluble fibre. Some people say it's objectionable just soaked in water, but to me it tastes like nothing

But I am somewhat peeved. I did as he instructed. Gave up the six months I'd had fissure free on 400mg of mag in the mornings. For a while, all goes well, I eat stupidly a week ago and lo and behold, a little blood on the toilet paper. Then the next day a LOT more blood, with some un-placable burning sensation. From some close examination (see next paragprah) it almost looks like a large stool caused a small cut outside the anterior edge of my spincter (not a reopening of the posterior fissure that has been all the trouble these long years).

I've actually bought a anal speculum (not yet arrived) and a Fibre optic camera (surprisingly good quality close up. Very reasonable at 50 quid on amazon) because now I WOULD LIKE A LOOK. I have so very little trust left in the sheer disinterest many medical practitioners have. I wonder now, if he even looked properly at my spincter. 30 seconds, I kid you not. When the anal speculum arrives, i will have my first detailed look at my possibly-extant-possibly-healed posterior fissure.

The following days will show clearly whether this is some minor external cut on the anteriror of my sphincter or a true reopening of the posterior fissue. I will be able to visually inspect it and also, sadly, as we all know, if the pain stadily marches onwards and upwards in intensity, that's your chronic fissure reactivating.

So I shall return and post again having had a detailed look at my own anus, and if I become certain the posterior fissure has reopened. Will keep taking the psyllium though. Useful stuff.
- I would certainly ADD psyllium to my list of recommendations for how anyone should treat their fissure in my original post. Straight psyllium is as cheap as sawdust online. I tried it once years ago and gave it up because it seemed to do nothing, but it took 4 days to work its way through my digestive tract, and the result was far better formed, quite soft, easy bowel movements. Even the Odd "ghost poop" - full but barely noticable when passed. As an 80 kilo, six foot man, I'd recommend a heaped tablespoon in a pint of water. (stir rapidly, drink it down, re stir the gel now forming at the bottom, drink it down)
- I am becoming increasingly leary (brit slang: 'suspicious, especially as regards claimed competence) of all doctors but particularly those dealing with non fatal diseases. I've seen other posts where people have heard their doctors say they "hardly ever do LIS". I am starting to suspect this is because they don't want the risk of being sued for cutting too far and rendering you all but incontinent. Much better to keep prescribing you the same cream, and bill you every time you come for a visit. I also think many simply do not appreciate how debilitating this can be, and frankly give out poor info on how to handle it.
- I suppose it is possible my spincter is reforming to take the more formed, and less soft (because magnesium REALLY softens) stools I'm having on lepicol. I seem to recall another poster here (or on mumsnet?) saying that a proctologist told them that you cannot simply have VERY soft bowel movements because then the fissure heals to tightly, and will re-rip. It is necessary to have large, regular, formed, but not rock hard movements, to accustom the anus to these. I can see the sense in this.

I hope to post again with better news.
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Re: 5 years of chronic but may be healing

Postby Rich44 » 07 Apr 2021, 22:29

Stingeyringey wrote:
Rich44

- Good to know you agree with some of my theorizing.

You say you had LIS when you discovered you were off the charts tight. Why are you still concerned with sodium and water intake etc? Do you find the fissure returns some times despite this? I'm sorry to say I find that slightly depressing.
No, the fissure has not returned at all. I was trying to balance water and sodium because sometimes my stool may be too dry and harder to pass. Other than that - no complaints at all. Life on the toilet is normal.

Stingeyringey wrote:I wouldn't worry over much about "balancing" it. Salt your food a little at dinner and drink a glass of water with every meal would seem to do it about right. For soft stool I've recently found a big glass of water with a heaped tablespoon of psyllium in it once a day has done more than anything to give me consistent, rarely hard stool.
I drink plenty of water everyday (it's all I drink), and I have plenty of salt throughout the day. Most of the time I am having big, bulky stools that are fairly easy to pass. Once in a while I have dry harder stools which in the past would tear me up. But I have no pain at all when I go now which is a dream come true and I've learned to relax and let them come slowly. I can't tolerate psyllium - it gives me terrible gas pains and I'm done with it. I take Citrucel to help a little with bulking up the stool. It doesn't ferment in the gut and produce gas.

You seem pretty educated on all of this stuff but WHY are you not seeing a colorectal surgeon? Of course you had this waste of time consultant from the National Health and it's your own fault for seeing a quack like this. You need to see a specialist that sees these things all the time. My CRS is the head of colorectal surgery at the hospital and an expert at microsurgery. He said bluntly that Botox is temporary and you'll be right back in the office in 9 months with the same problems. Is this how it is in your country? You have to go to who they tell you? If so, I am glad to pay for my health insurance here in America so I can see the top specialists any time I want. I've said it over and over - the LIS was the greatest thing I ever did and I should have done it years ago. :D
Chronic Fissure June 2014 - October 2020
Botox, skin tag removed - February 2015
Levator Ani September 2014 - February 2016 (caused by stress - left my job, cured!)
Lateral Internal Sphincterectomy, skin tags removed - October 2020
Fissure 100% healed!
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Re: 5 years of chronic but may be healing

Postby Stingeyringey » 09 Apr 2021, 16:25

No, the fissure has not returned at all. I was trying to balance water and sodium because sometimes my stool may be too dry and harder to pass. Other than that - no complaints at all. Life on the toilet is normal.


I drink plenty of water everyday (it's all I drink), and I have plenty of salt throughout the day. Most of the time I am having big, bulky stools that are fairly easy to pass. Once in a while I have dry harder stools which in the past would tear me up. But I have no pain at all when I go now which is a dream come true and I've learned to relax and let them come slowly. I can't tolerate psyllium - it gives me terrible gas pains and I'm done with it. I take Citrucel to help a little with bulking up the stool. It doesn't ferment in the gut and produce gas.


I'm happy you seem cured. That seems another ringing endorsement for surgery - that's alright for men, but for women LIS is far more dubious, and some of them seem unaware of advancement flap surgery, possibly because so few surgeon are qualified to DO it.

You seem pretty educated on all of this stuff but WHY are you not seeing a colorectal surgeon? Of course you had this waste of time consultant from the National Health and it's your own fault for seeing a quack like this. You need to see a specialist that sees these things all the time. My CRS is the head of colorectal surgery at the hospital and an expert at microsurgery. He said bluntly that Botox is temporary and you'll be right back in the office in 9 months with the same problems. Is this how it is in your country? You have to go to who they tell you? If so, I am glad to pay for my health insurance here in America so I can see the top specialists any time I want. I've said it over and over - the LIS was the greatest thing I ever did and I should have done it years ago.


The consultant was also a rectal surgeon.
There seems to be some considerable dispute in the medical literature as to whether botox is effective given a) the presence of the sentinel pile, if not removed, can, sometimes, cause re-tears b) there is no agreed upon dosage, or location for injection (some claim far higher effectiveness injecting at several points around the anus as opposed to just two positions, as normal) c) some claim debridement of the wound combined with botox is AS effective as LIS, but this is listed in the literature as just "botox" and some others claim that the full effect of botox is achieved by re-using it 6 months later, even if there is no immediate relapse to give the anus a full year worth of healing. More research is needed, clearly, though there seems general agreement that some fissures are entirely refractory and require surgical methods. This somewhat implies certain numbers of people have much deeper fissures or much poorer wound healing etc.

Yes, indeed, on the NHS you are sent where you are sent. Private care is an option but you will buy that on top of paying your taxes for the NHS. Both systems display advantages and disadvantages i.e. in the USA, there are far more people undergoing needless heart surgery to earn the surgeon some additional scratch. Most surgeons in the U.K. are on a salary, and have no need to invent reasons to cut people up. GPs are also not under pressure to hand out opiods like sweets because they need not worry about "attraction and retention" of patients. The downsides include things like a long triage system, timewasting non tax payers clogging the system up by going to hospital because they're hung over etc.
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Re: 5 years of chronic but may be healing

Postby JaimeDeschain » Yesterday, 06:56

Why is it bad to take magnesium for long periods and what "habbits" would it form?
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Re: 5 years of chronic but may be healing

Postby Stingeyringey » Today, 16:29

As Regards the above question I suspect taking magnesium long term to soften stool is supposed to be "habit forming" in the sense that you stop being able to poop properly without it.

I see some sense in this: My reading seemed to indicate the defecation relfex is partially from disdension of the rectum and partiall from nerves detecting "fluidity" as it were. This is why the squits is so hard to resist.

It's certainly true for me that, being on magnesium, I would have a far MORE urgent need for the toilet than I do now, just taking lepicol (update on that shortly), because the stool was a lot SOFTER, it probably wedged more convincingly into the spaces in my rectum, producing a far more URGENT urge. I also never felt that I "hadn't quite finnished", because that URGENT feeling is what causes the autonomic and automatic "yawning" of the inner sphincter when you finally unclench your outer sphincter.

I imagine if your rectum got used to this for YEARS, ordinary, harder stool, might produce much less urgency, or even constipation, if you stopped. I think this is generally all that's meant. I have speculated on whether the magnesium might also give you a lazy colon in peristalsis terms, but most poop is supposedly to remain almost entirely liquid as late as the ascending colon, so this doesn't seems likely.

As far what constantly taking magnesium for years does to your blood chemistry I don't know. But apparently not enough for it to be dropping large numbers of people, because studies seem rare.

I think some doctors warn people off "osmotic" stool softeners (those which draw and keep water into stool) like magnesium as they feel they wont be able to not be constipated on them. I can find no other reason, but someone with more knowledge might like to chip in.


+_+_+_+BREAK_+_+_+_+

As regards my own fissure / mainly healed fissure.

I continue with my lepicol, as recommended by the consultant. Little bleeding I had stopped, and no notable pain associated with it, and what appears to be a tiny and very external cut on the anterior part of my outer sphincter seems closed (wonder if it was a tiny fissure? by definition? Oh well) no pain no bleeding.

Given that I GOT MYSELF here after 5 years with a fissure primarily using magnesium for 6+ months as outlined in my first post I'd certainly go back and use it again.
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Re: 5 years of chronic but may be healing

Postby Stingeyringey » Today, 16:31

"I think some doctors warn people off "osmotic" stool softeners (those which draw and keep water into stool) like magnesium as they feel they wont be able to not be constipated on them. I can find no other reason, but someone with more knowledge might like to chip in."

Idiotic sentence. I mean the doctors warn people off osmotic stool softeners because they will become DEPENDENT on them and will never acquire better toileting and dietry habits and their rectum will never be "agitated" into defecation unless the stool is always very soft and wet.
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