Fissure for 6 months, no pain though?

Digestive health
1

Hi everyone,

I have read many posts on here about everyone's struggle with the curse that is an anal fissure. This is my first time posting but I thought I should because I have never read another person with a situation quite like mine... which is peculiar to say the least.

A little background... I am a 27 yr old female, active and healthy, located in the U.S. Last winter I had quite a traumatic health scare that resulted in severe anxiety and stress which I attribute to the partial cause of my first, now chronic, fissure. My fissure resulted from over-exertion passing an abnormally large BM. Immediate blood and pain which stayed pretty constant for several weeks until I first sought the advice of a CRS. BTW this was all over Christmas holiday so I didn't see the CRS until about 5 weeks after the fissure happened. I would absolutely DREAD going to the bathroom, however I did not experience excruiating spasms like most seem to do. I also went straight to the CRS bypassing my GP. I was obviously diagnosed with a fissure and put on Nifedipine Ointment. This was in January of this year (2017). After 5 months of using this therapy I still have the fissure but I am in practically no pain either when having a BM and have not bled in 6+ weeks. I actually really didn't bleed that much after the 1st month of this ordeal, besides slight pinkish streak on toilet paper ocassionally. To be honest, I don't really think about the fissure desite the occasional PTSD (as I call it) when I got to the bathroom sometimes. I basically do everything I did pre-fissure but, to be completely honest, sometimes I look at that area and can still see the fissure inside the canal.

Well, I had an appointment with my CRS this morning and she said the fissure is still quite deep and the granualtion (healing tissue) is not good healing tissue. Right now my CRS has suggested Botox and Debridement of the fissure, which means they will slightly "clean" out the fissure and inject the Botox to relax the scphincter muscle. She actually prefers NOT to do the Botox because she feels LIS is a much better procedure in terms of low reoccurence, but she refuses to do the LIS on me because I am asymptomatic (I have no pain and no bleeding).

Has anyone in the world experienced a chronic fissure that does not hurt??? I obviosuly don't want to have a wound in my butt anymore but at the same time I am deathly afraid to have surgery due to the idea of the pain returning.

Also, just for relevance in order to get to the pain-free state I am in today I religiously take Citrucel (regularity/fiber powder) morning and night and by nature I eat really healthy.... no meat, only fish and tons of veggies and fruits.

I guess I am just at a loss on what to do because my lifestyle is clearly not the problem: I am healthy, active and have very regular/soft BMS. It makes me think there is some underlying health issue with me causing the lack of healing? Again, I do not get bad spasms either.

Any and all advice helps!

2

I guess it's an advantage that you are not in pain ! My fissure also is stil a deep open wound and I'm actually in a lot less pain although the symptoms are the same ! I think the nerves regenerate and adopt and even though the wound is still open the pain receptors aren't sensitive anymore because of the new nerves

But in sayinf that I had Botox and I believed it haloed alot of the healing

Even tho every time I S**t my butt hole burns or has a weird discomfort

Fml right

I've had this for four months now

3

Hi Caitlin,

I had the fissure cleaned up and Botox injection almost 4 weeks ago. It's a "Mini" surgery. I think the fear is worse than the actual thing. I still experience pain but it's less that what it was before the op. I'm not sure if that helps seeing that u don't feel pain at all. I suggest doing what ur doc recommend as u don't want it to get worse

4

Considering you dont expeerience any pain and the fissure is in healing process...why don't you just give it few more weeks and continue with ur fiber diet and no meat etc. 

And if you feel fissure came back again after few weeks with pain, then you can explore the options given by your doctor. 

5

Thank you for your post! I am an otherwise healthy 40 yr old female and I do not have pain or spasms other either. My fissure has lasted about 6 months as well. For me the only pain I have is the split second passing a BM when I have reopened the fissure-- otherwise nothing and the bleeding is my primary symptom. I was just recommended for Botox and decided to request a second opinion-- my next appt is in July. I have read extensively on the subject of fissures and the Botox is supposed to relieve the spasms associated with fissures. But without the spasms I do not understand how this will be beneficial. I have read numerous patient accounts stating their pain level increased after Botox and they experienced surges of pain throughout the day as a result! This really worries me but I cannot imagine living with the fissure the rest of my life and do not know what else to do. Besides the bleeding scares me and makes me hope that it is indeed related to the fissure and not something else.

6

Here are some suggestions I have for you to help you through:

1. Try somee zinc oxide in the form of calmoseptine which has menthol to soothe the area down there as well. Calmoseptine can be bought at almost any local drugstore and can be bought online too.

2. Try squatting when going on the toilet instead of sitting. This is a much  helathier position and the poop sometimes will just slide out,  no pushing or straining involved.

3. I would definately take a fiber supplement, specifically metamucil  is what I take evveryday,  in ordr to allow your stools to be soft and to allow them to pass thorugh easily. THis being said, with any fiber supplemetn, you must drink lots of water when using them, or they will not work veffectively. Also, do not take too much as too much fiber can irritate your bowels on the way  out and diarreah actually does worse down there.

Most of these are for pain though. Dont really know what you need to stop the bleeding. 

Hope this helps!!!

Best,

Myles

 

7

Hi Caitlin, 

I am also a young female with a healthy diet and am having the same issue as you - I still have bleeding after every BM, but with very little pain.  I initially had spasms and a ton of pain, but after 6 weeks with the fissure, it is now only uncomfortable.  I’m wondering what you ended up doing and how you are doing now?  I’m set to go to an appointment with my doctor next week so I’ll see what he recommends, but was hoping for an update from you! Thanks! 

8

Hi m52341,

I'm sorry to hear you are suffering from the curse that is a fissure, but glad to hear you (like I was) are not in excruciating pain. I have not written on here since my original post but I would be happy to give you and (anyone else who may find this thread helpful) an update as to my current status and "recovery". I will preface this by saying my journey has had MANY ups and downs.... more like a rollercoaster in HELL but I want to repeat something my doctor told me, which I think is really important to realize as you navigate this ordeal.... healing is not always a straight forward path/trajectory. You will have progress and healing, and then you might have set back. The important thing is to not let a fissure ruin your life. You have to take one day at a time and deal with your symptoms for that day and only look forward. It took me a long time to start thinking this way and I know it's hard when you have pain and/or are bleeding every BM, but its really important to keep your sanity. I will also say that I consider myself still on the road to full recovery (physically and mentally) even though I just recently was cleared by my surgeon as "healed".

Hmm where to begin?! Okay so first - I decided to go with the LIS surgery and I had this done in October of 2017 (almost 10 months after I actually got the fissure). I had been going back and forth whether I should proceed with the Botox or get LIS for weeks and had been putting off a decision (because again I wasn't really in pain but had blood and a chronic fissure nonetheless). I probably ready every thread about fissures and related topics that exist on the internet but I was still really torn. My surgeon said the decision was up to me, but she did not like Botox because in her opinion, the rate of success is low. So I chose to do the LIS because quite frankly, I wanted to put this whole thing behind me. The recovery from LIS surgery was not that bad. If you have ever felt the pain of a fissure, LIS is much more bearable. For me it was a different kind of discomfort to... surgical discomfort. Not like pooping a shard of glass (although the first BM after surgery wasn't pain free by any means, but nothing like a fissure BM). I was off work for a full week and in retrospect I wish I took a little more time off.

Unfortunately, for me I developed an infection. During my post-op examination my surgeon saw that I had more "drainage" than I should, so they put silver nitrate on the incision site (HOLY HELL THIS BURNS) and I went on my first course of antibiotics of Flagyl and Levaquin. Also, if anyone is unsure what drainage is... its basically like clear-yellow opaque color mucus fluid that seeps out (totally gross but I wish someone could have explained this on other threads). Furthemore, she said my fissure was completely GONE. (amazing how when one problem disappears another pops up like a pest). Anyways, I finished the course of Flagyl and finished 7/10 days of Levaquin because the side effects were horrible for me, as I am sensitive to medicine in general. At this point I actually began to feel something on the side of my anal opening that just didn't feel right. It did not hurt really but it felt like a hard "knot" about 1-1/5" away from my actual anus (on the surgery side). So on my followup visit after the antibiotics course, I brought this up to my surgeon and she said it might be scar tissue and said it looked much better and little to no drainage was occurring, but she wanted to see me again in 2 weeks to see if it was still on the right course to healing. Fast forward to next appointment, still infected - manually tried to drain it a bit in the office and back on another 10 day antibiotic course, knot still there which she now suspected was probably a small abscess. So after the next course of antibiotics I actually started to feel really good, knot felt much smaller to non-exsistent, no light bleeding with BM's (which occurred occasionally since LIS but not often), and no drainage. It was my birthday ironically the day I went in for my appointment after the second course of antibiotics, and my surgeon said it looked like the incision site was close and there was no drainage. Best birthday present ever.... or so I thought...

Literally the day after this appointment, I got a stomach bug. I had frequenet loose BMs for about 48 hours (sorry TMI). I knew I reopened the incision. Also for reference, my birthday was Dec 21 and so I couldn't get back in to see my surgeon until after the holidays. So when I went back to her, it had been over a week and at this time the infection had started again and the knot was back. So I went on one last course of antibiotics but my surgeon advised that if it still wasn't 100% then I would probably need a secondary procedure to surgically drain the abscess. So, after the third course of antibiotics it still did not look like it should, so I was scheduled immediately for an I&D of Anal Abscess (incision and drainage). This was another outpatient procedure and I took another week off work to recover. The recovery for this was alot better that LIS, although they told me it would hurt more. I had slight "pinching" discomfort with BM's for the first few days but that eventually diminished and I felt great. There is still a little but of drainage for the first week to two weeks after I&D but that is totally normal, as the abscess is surgically uncovered so the infection has nowhere to go but OUT.  It took me almost 3 months to fully heal from the I&D. I had no pain but apparently I am a slow healer and I also produce too much granulation tissue which disrupts the correct healing process. So I probably visited my doctor 5-7 times after my I&D and she would manually scrape out the granulation tissue (also got the Silver Nitrate another time ugh) to allow the incision to heal. I went to my last (hopefully) appointment with my surgeon on April 3rd and she finally said it was closed and healed. This time I do think I am finally out of the dark, dark woods... I have no pain, no blood, no drainage, no knot, and no fissure. I am still only a few weeks since then so I am very careful what I eat. I still take Citrucel daily and drink a lot of water. Another super crucial thing is to NEVER STRAIN. Take your time on the toilet and RELAX. I also will note that I am far from being healed mentally. This experience has changed me in a way like no other, but I am slowly getting back to myself. I won't lie... I have potty PTSD as I call it, every time I go to the bathroom still but I am hoping with time this will too fade away. Again it is so important to not let your stool get hard and not strain but equally important to change your mindset. Ironically I did not start to actually heal, until I felt better and more positive about my situation mentally. I started taking one day as it was and moving forward with whatever the next day brought.

For anyone reading, I hope you don't give up hope that you eventually will get past this. You will... even if it takes more than a year. Please don't loose yourself because of it.

9

Wow, I can’t believe how much you’ve been through!  It is amazing that you were able to be positive after all of that.  I was hoping your update was going to be that you healed without intervention, but I really appreciate that you took the time to share your journey. 

10

Hi,m52341 ! May I know abt ur fissure now? Is it still bleeding?

11

Yup, still bleeding after every bowel movement, and I feel uncomfortable for about 12 hours or so after each BM.  I’m not in severe pain like I initially was, so I just deal with it.  I agree with what Caitlin wrote - each day seems different, so I try to just deal with the symptoms I feel each day.  Going to the CRS for a follow up appointment tomorrow so I’ll see what he recommends.  

12

I see!! How much bleeding do u experience after every BM? How many fissures do u have? Yesterday,i even passing gas with blood. I'm so worried if it is a serious disease. 

13

One more question,is it ur first time experience anal bleeding?

14

I don’t think I’ve had bleeding from gas, but I’ve had bleeding after peeing, and once bled for no apparent reason at all.  I don’t worry that I have any disease, or anything worse than a fissure - my symptoms all indicate fissure - bright red blood, pain during and after BM, etc.  I think I only have one fissure, unless i got another since going to a doctors appointment 6 weeks ago.  Yes, it’s my first time with anal bleeding.  

15

Thanks for replying my question,i hope u keep update me ur condition since we both share similar symptoms.

16

U're still bleeding even when ur stool is soft ?

17

Yes.  I don’t understand it — My stool is usually pretty perfect now and I still bleed.   This week I’ve had pretty minimal blood - in the middle of each BM I see my poop is streaked with blood on the sides.   I usually have to push a little to get the BM moving, so it may be that pushing that causes the blood.  I don’t know.  I’ll definitely let you know what my doctor says today.  

18

Look forward to hearing from you. By the way,may i ask how old are u?

19

How is ur condition now? 

20

My doctor didn’t do an exam, so I’m not sure how The fissure actually is relative to how it was six weeks ago.  I told him that I still feel discomfort after every BM.  He didn’t recommend Botox since in his opinion Botox isn’t effective.  He recommended a procedure where a steroid is injected into the fissure.  I’ve read a lot of horror stories from people who’ve had this procedure so I’m not ready to get it at this point.  He proscribed me a stronger dose of the Diltiazem cream that I’m currently using.  I will start it once I finish my current bottle and will update if my condition changes.  For now I feel discomfort for most of the day, but I can live a normal life with this level of discomfort so I don’t want to risk making it worse with any surgical procedure at this time.   I am currently breastfeeding and have read accounts of other women who’ve stopped breastfeeding and healed, so I’m going to give myself a chance to heal once I stop breastfeeding in the next month or so.  For now, I’ll keep using the diltiazem, eating tons of fruits and vegetables, and drinking 6L of water each day, and will hope for the best!  Good luck with your healing!