Hey all,

25-year-old male here. Roughly nine months ago I had an inspection done at an urgent care center, and they confirmed that I had an anal fissure. The pain was unbearable... like pooping knives. I was basically in tears. I started to work on my diet, but nothing got better, so the day after my birthday I went to the ER because the pain was so intense and I hadn't established a primary care doctor yet. They, too, confirmed the fissure and recommended more sitz baths, colace, metamucil, etc.

So, I did that for awhile and eventually weaned myself off. The pain had gotten lesser, but I was still uncomfortable. Well, fast forward to present day and the pain is back. I've established primary care, and I had a check-up last month (though no anal inspection was done). This time the pain isn't so sharp and zappy, its more dull, sore, with occasional jabs. Has anyone experienced this change in pain? I'm slower to pass stools now, and I try to take my time and not force anything.



As of today, I'm back on metamucil, magnesium, and colace. I'm also going eat a soluble diet, with some greek yogurt, tons of water, and vegetables. I've got to cut out alcohol completely... but its so hard being a young man in a new city and not going out to grab drinks... :) But this pain is too much, and I need to get my life back.

This morning I emailed my doctor and told him I was ready to discuss the surgery (LIS), but I wanted to get advice here as well. I'm not ready to let this fissure control my life... I want to go hiking, biking, travel overseas, and not worry about this pain flaring up (because it is SO debilitating at times). Is the risk of incontinence worth it? I'm pretty healthy otherwise.

Thanks, everyone. So thankful for this forum.

-drummer711

Tell us how long you've been on the metamucil, magnesium, colace, and water. It took about 3 months of metamucil, Miralax, water, and nitro before the pain was tolerable, not gone, but tolerable for me.

Vasodialators like nitroglycerin aid healing for many of us.

Fiber supplements, other than Metamucil, may prove better for you. I found a tablespoon of ground flax seed each morning to be most helpful though I do also use Metamucil.

I don't hike or bike but have no problem with jogging and travel has proven to be a non-issue with proper preparation and care.

As for the alcohol, most could care less what you are drinking. A glass of soda water is usually sufficient to divert attention should that be a problem.

Oh yes - I was warned that LIS is not pain free nor an easy solution. Only the schedule nurse told me 5 or more days off from work for recovery. That's when I cancelled the surgery and found this forum.

Hi Drummer,
It sounds as though you are doing the right things with your diet and water intake, and it is helping with the pain, but you are not fully healing.

You don't say if you are using a prescription cream, like nifedipine, diltiazem or nitroglycerine. These drugs all work the same way, by relaxing the internal anal sphincter to prevent the horrible painful spasms, and by dilating the blood vessels to allow more blood to get to the area to promote healing.

I do heartily recommend trying one or more of these drugs before trying LIS. I had to try all three before finding that nitroglycerine works for me. It could still take a few weeks to find one that works, and give it a real chance to work. It took about 5 weeks for the nitro to heal me, but I felt the improvement immediately, and the relief of no more spasms was huge. From day one, I felt that healing had started, and the pain was less every day.

I also heartily recommend sitting on a warm heat pad or hot water bottle. It has a similar effect to the drugs, and you can sit on them all day long. The heat has been proved to relax the anal sphincter, and of course it also dilates the blood vessels. Heat does really ease the pain, and the extra blood supply helps healing.

Seriously I would try the drugs and the heat before LIS.

Read some accounts of LIS on this forum. Some people have had excellent results, others not so much. You will want to choose your surgeon with great care, and ask him/her a LOT of questions about their success rate and whether their patients get re-tears etc. The risk of incontinence is relative, isn't it? If the drugs and heat don't work for you, along with all your dietary changes etc, the risk will seem minor compared with the constant fear of pain.

But if you can reduce your pain levels, you may decide you'd rather heal naturally even if it takes longer. That's the choice I made.

All the very best of luck and keep us informed of your progress!

Such fantastic responses and advice, I am so thankful for all of you... and for this forum.

You're very right. I think a natural heal is the smart way to go for now. My doctor recommended it this morning, as well. As for the cream, I was just prescribed Nitroglycerine today and will be picking it up tomorrow afternoon. I'm excited to give it a shot. Well, as excited as anyone can be to apply a cream to their rear end!

I really appreciate the comments about the drinks, as well. It's true... soda water is enough to divert attention. I've got some good friends, so I think they will understand.

I took metamucil religiously from Feb-April or so, well maybe not religiously but I was certainly very pro-active about it. I laid off of it at the same time I cut the Colace from my routine. I felt like it was healing and the summer was here... it wasn't so hard to keep blood flowing and I figured I was in the clear. Once the colder weather hit, I started having problems again. So, I'm back on the stuff, as well as the stool softener, but this time I'm more rigorous about it. I should mention that my pain isn't constant. I have flares.... I could go three days without any pain, and then the right mixture of poor diet and stress brings it out again -- so I rinse and repeat. I go easy on myself for awhile, then I have a night of drinking and boom... back at it. The solution is pretty much right in front of my eyes, so this time I'm pulling out all the stops.

I'll have to give ground flax a shot. I'm going to see how my system holds up with the metamucil, colace, magnesium, lots of water, veggies, yogurt, and sitz baths. I'm hoping that this combination will prove to give me relief, and help the healing process begin.

Thanks for all of the help, everyone. Every bit of advice is beyond appreciated, as we all feel. :)

- drummer711

Hi Drummer
I'm an old man (alas) but I still like to have a beer with friends and love hiking and biking. I have had two fissures. One years ago which healed quickly with Diltiazem and the current one which has been more troublesome because I had to have unrelated surgery but I am now healing ok. Anyway I just wanted to share relevant experience with you. On both occasions I have very reluctantly given up my beloved cycling until I was sure I was healed. Hiking is no problem and I think the exercise helps. It was painful when things were at their worst but I applied vaseline and persevered. I never gave up drinking beer and wine. The problem with these is that they can be dehydrating so I always drink water before, after and during a session. I understand your wish to be sociable. If you want to be more cautious than me you could always have one beer to begin with and then switch to water. Probably noone will notice by then but, if they comment, you could say that you have to drive later or that you are taking antibiotics.
I find Movicol (Miralax) the best softener and now take nothing else. I'm down to half a sachet a day.Keeping things soft and regular seems to be the most important thing of all.
I hope some of this helps.
Best wishes for speedy healing.
Allan

About the nitroglycerine - you've probably been warned that it can give you headaches. I would try applying tiny amounts to begin with. They might have told you to use a blob about the size of a pea. Well, I started with a bit the size of a lentil! I gradually worked upwards to a pea size, and never have had a problem with headaches. I used to use bigger blobs at night, because then I could go straight to bed and not worry about the headache. The only effect it has on me is that I feel a bit of pressure in my head and sometimes my chest. It goes away quite quickly.
And once I applied the nitro before I went dancing, and felt a bit dizzy.

Hi Drummer,
I feel I could have written your post. I also have found this forum to be a godsend. It's amazing to me that so many people are suffering from the same ailment, yet you never hear about this in the outside world. I guess I can understand since I suffered in silence for months. I had a really bad flare up that happened on Sunday and I have stayed home all week because of it. Each day has gotten progressively better for me. My routine is that I wake up, drink a glass of cold water and take 3 Advil. My urge comes about 30 minutes later. I sit on the toilet with my feet up on a stool and just wait for my BM to gently fall out (although it does still feel like a razor blade). I then immediately hop into the tub and soak for about 15 minutes. Next, I apply my nitro and get back into bed with my heating pad and just close my eyes and try as hard as possible to relax. My diet for the day consists of oatmeal with flaxseed, melons, salad with an olive oil dressing, avocado, chic peas, tomatoes, red bell pepper and more flaxseed, greek yogurt, fruit, small amount of brown rice, sauteed (in olive oil) veggies and maybe a small amount of chicken, organic applesauce and a glass of metamucil before bed. I also take a 100mg Colace 3 a day as well as continuing with the Advil. This diet has been giving me a nice soft BM each morning. To add to my AF issue, I also have an internal hemorrhoid. What is truly aggravating about it, is that it seems to drop and harden when I walk, hike or exercise further aggravating the AF. I have pretty much been prone all week and while in the short term I feel like it's helping me, I'm so afraid that the moment I start moving again, everything is going to flare up and I'll be back to square one. I'm still trying to find the right balance and avoid surgery. My doctor has recommended Botox as a next step if the Nitro doesn't work. Is this an option for you before the LIS? As for alcohol, I don't think it bothers me if taken in moderation. And, I have found that a single glass of wine even seems to calm things down. Either that or it just dulls the pain for the moment. I'm not advocating that anyone use alcohol as a pain med, but for me, it hasn't hurt. Constipation is not my problem. The heating pad/hot water bottle and putting my feet on the stool when I poo have been the two most helpful things, well, and the high fiber diet.

One more thing I meant to comment on and that is all the different forms of pain one experiences with an AF. It's a cruel cruel affliction. I go from passing a razor blade, to throbbing and burning to a dull bruised like ache to more burning to sharp stabbing pains that feel like I'm being pricked with a needle to feeling like I have broken glass just sitting in my rectum to more burning then easing to a slight paper cut just before bed then sleeping okay and waking in the morning feeling like a new person only to have it all repeat about 30 minutes later.

You are all so awesome! Ah! So much support, it already makes me feel better! The pro-tips about the Nitro gel, the reminder to drink water with alcohol, and just in general sharing diets and experiences... man. You all rock.



I'm hopeful that the gel will work its magic, though I'm less excited about its price. I found a manufacturer's coupon online, though, so that combined with my insurance should make it more bearable. I don't plan on using it often, though.

Since it is friday, I am going to celebrate with a friend and have a small glass or two of whiskey, followed by copious amounts of water. I've been sticking to my yogurt/veggies/prunes/raisins/kind bar diet and so far so good. I actually feel very light, and totally focused. Very excited to continue this diet and see where it takes me. It's too bad I live around so many awesome restaurants... the temptation to blow my diet on a delicious meal is SO CLOSE! AH!

As always, thanks for the advice and the support. I'm going to keep updating this thread with my status and experiences, and I hope others can get help from it, or at least know they are not alone.

Together we will prevail! :)

-drummer711

pitaX1000 wrote:I go from passing a razor blade, to throbbing and burning to a dull bruised like ache to more burning to sharp stabbing pains that feel like I'm being pricked with a needle to feeling like I have broken glass just sitting in my rectum to more burning then easing to a slight paper cut just before bed then sleeping okay and waking in the morning feeling like a new person only to have it all repeat about 30 minutes later.

Ah, such is the life of an AF sufferer, right?

I'm glad to know that the pain takes many shapes and sizes... I was worried that my condition had changed, or that something else was at work. These darn things...