Over the last week I feel as if I have earned a MA, or at least a BA, in Anal Fissure treatment. A week ago my CRS confirmed I had an anal fissure. Five days ago another GI doctor confirmed the diagnosis, and described it as being 1 cm in length and fairly deep. 24 hours ago I was in excruciating pain - thank God there were no deadly weapons in the house or I might have been tempted to use them involuntarily just to end my suffering. Today for whatever reason I am feeling better - I thought it might be because I had fewer BM's as the Miralax worked itself out of my system, but perhaps it is more than that.

Early this morning as I was going through yet another anal spasm after a BM, I said to myself this cannot continue, what I have to do is take a few weeks off from work and go on a healing fast. By fasting my body, I will give my anus time to rest and recover. I prepared an email to my supervisor explaining my situation. I even got out a calendar, and perched on a chair with a throbbing backside checked how many sick and vacation days I had in my bank, and planned how I would use each to take off the entire month of January. I said to myself, "I am going to take advantage of this - this healing fast is something to look forward to." Shortly after, the anal spasms began to dissipate.

From what I have learned over the last week, what seems to happen is this - you have a BM, the BM aggregates the AF causing pain, the pain from the AF causes your anus to tighten, which in turn cuts off the blood supply and makes the AF hurt more, which causes the anus to tighten more, which causes the AF to hurt more, on and on in a vicious extremely painful cycle.

So the question is how to break the cycle? After all, if a very tight anus is what is causing the problem, it only stands to reason that a loose, relaxed anus will solve the problem. So how to achieve this? How to loosen the anus? There are many ways it seems - surgery and dilation to loosen the anus mechanically, prescription creams such as diltiazem, nifedipine, and nitro to loosen it chemically, sitz baths and other non-prescription creams with lidocaine, menthol, camphor, etc to loosen it thermally with heat, physical therapy to loosen it mechanically in a different way, fiber, water and laxatives to encourage or help loosen it when you use the anus to do what it is meant to do, etc. But what is the common theme here - they are all meant to loosen or relax the anus, so the blood will flow and the fissure will heal itself naturally.

But can you have a loose relaxed anus if the rest of your body is tense and riddled with anxiety, perhaps over the pain caused by the AF, perhaps over something else such as work, money, relationships, or the state of the world? Perhaps the first thing one should do when dealing an AF is to examine your own life, figure out what is causing you anxiety and stress, be it the pain caused by the AF or something else, and come to terms with these issues first. Then when your body is relaxed, your anus will naturally relax or at the very least it will be more receptive to the many different modalities of treatment we mentioned in the paragraph above.

And it a sense why shouldn't it - maybe your tight anus is telling you something. Change your perceptions, feelings or beliefs that are causing you stress, relax your body, and your anus will follow. After all, you deserve it, you deserve to be relaxed and happy don't you? In the end, your anus is just another part of your body, and it wants what is best for you...

Hi loved your post. Has this helped you?

You are right on the nose ring of fire and maybe my posts have worn off on you as I have been posting this for years on here. Stress and anxiety will prevent you from ever healing properly. You can fool yourself with treatments but it's not going to work if you are too tight! And sometimes there is a point of no return and you have to get surgery. That happened to me. My anus got so tight I was straining to have every single BM. The anal manometry test I had proved this. I was not only off the charts too high, I broke the balloon they use for the test! The LIS took care of the tension, my body healed that fissure on it's own in no time and that was back in October 2020. I have had no issues ever since. I have had a couple of minor fissures occur (because they will come back at some point) but I had ZERO panic. I did a couple of sitz baths and that was it. Gone by the next day. I knew they didn't have to be chronic.

ring_of_fire wrote:Perhaps the first thing one should do when dealing an AF is to examine your own life, figure out what is causing you anxiety and stress, be it the pain caused by the AF or something else, and come to terms with these issues first.

This is why psychotherapy can be an important part of healing - just as important as intervention by a CRS.

I recovered from this about 10 years ago. I was in pain just like you for one year. I was working full-time had family so I was always busy. I posted about my healing experience 10 years ago when I had completed it, I have not had any issues since recently I came to my mind to check up on it to see if anybody had questions on my post, in the past I checked it out every once in a while throughout the years. But it seems that it has been erased, and my profile as well.

This is very simplified version of what I did.
Make sure every BM is soft. I ate a very bland diet, I am hispanic so I ate this every lunch and dinner, 2 tamales, rice, and a handful of doritos. for breakfast oatmeal and a bannana. With every meal I used a 32oz cup and filled it 1/4 with apple juice, the rest water. Every bowel movement was soft doing this.

I used nitroglycerin cream. I dont remember the strength because it was 10years ago but I believe it was .0125%.
It was a very low dose, before this the doctor had given me 2% and it was very harsh and caused a lot of lightheadedness. I did internet research and found the .0125% was appropriate for fissure healing.

I tried everything I suffered just like you for 1 year. I did everything, but it was not until I did the cream that I finally healed. Of course since then I learned my lesson and always keep my BMs soft. It all started because I had a birthday weekend that included alcohol a lot of processed food and not enough water which led to a hard BM which I believe caused the fissure and the sufering.

Thank you for coming back and giving other sufferers hope and advice.

patience_and_healing wrote:Thank you for coming back and giving other sufferers hope and advice.

I recently moved and was unsure if I had still had the bottle of nitro. I always kept it just in case, thats how bad I was traumatized by the pain that I kept this just in case it came back.

But the official name on the prescription is

Niroglycerin in aquaphilic 0.4%
apply rectally every 12 hours.

2 weeks of this and soft bowel movements and I was shocked when I started having BMs with no excruciating pain the whole day afterwards.