My experience with a chronic anal fissure

Digestive health
1

Hi all

I thought that I would post this as a lot of people appear to be going through the same agony that I was going through for over a year.

Anyway, I was at uni and going through a bad time in my life, whenever I get stressed my guts go into turmoil. As a result I was off uni for a week with severe rectal pain and feeling lower than a snake's belly. I booked an appointment with my GP as I had experienced similar symptoms before.

My GP recognised the symptoms immediately, I thought I had piles, she said I was too young so had a look. The digital examination wasn't fun, in fact she said she had never seen anyway change colour so quickly but it was worth it because I was refered to a colo-rectal surgeon.

I took my sick note back into my tutor and as I was doing a clinical degree, he said straight away that fissures were worsened and sometimes caused by stress. The penny dropped.

As I said I was going through a very very bad time in my life which necessitated me going on antidepressants (Cipralex) for my emotional state. When this was added to wall climbing agony due to fissures I was near breaking point. I remember after one bowel movement almost fainting with the pain, I was lying at the top of the stairs at my mum's house and clawing at the wallpaper with my fingernails - I have had a broken leg and in terms of pain that fissure was far worse, trust me.

I went to see the colo-rectal surgeon a few weeks later, I was terrified, but he was a lovely man, very very considerate. He told me that I had a large fissure that could be helped with an ointment. I told him my background so he talked a bit more openly and said that fissures are an incredibly debilitating condition. He once had a 16 stone rugby player openly weeping on his consulting couch with the pain - I can understand why.

I was prescribed GTN ointment and started using it as directed. I had a slight headache which I could live with, but this was far better than the agony of the fissure and this headache was pretty much gone after the first week. After a week of use the pain from the fissure had also subsided to nothing. After six weeks I went back to the surgeon and I was healed.

I wish that was the end of the story but it isn't, I have probably had four or five bad flare ups since and dozens of other twinges, spasms, bleeds and itches since but I am nowhere near as bad as the first time - I can live with this now. I have seen the surgeon twice since and he has offered surgery but my frame of mind precluded me from that, I was simply terrified.

My GP is very understanding and I can get GTN on prescription whenever I need it. I was prescribed Anoheal by the surgeon as well but this didn't work as well as GTN for me, but I have seen cases in work where this has been incredibly effective.

As I said earlier, I was doing a clinical degree, which I have now passed, so I feel that I am pretty well qualified to offer a bit of advice, so here it is.

1. Go and see your GP. Don't be embarrassed, your doctor has seen dozens of these - they are very very common. If you get fobbed off or feel that you haven't got anywhere, go back and tell him/her that you are not happy and you will go elsewhere i.e. change your GP. Changing your GP hits their bank balance, and as GPs are notoriously greedy, they will do something. Nobody should have to suffer with this.

2. Take something for the pain but NOT codeine. Ibuprofen worked best for me.

3. Drink plenty of fluids and lay off the alcohol while you are healing.

4. Eat lots of fibre and fresh fruit and veg, switch to brown bread and have something like Weetabix for breakfast. This softens stools and makes them easier to pass - less pain and less damage to existing fissures.

5. Use a stool softener, one Movicol sachet daily really really helped me. You can buy these over the counter from your local Pharmacist but tell them what it is for. Alternatively get them on prescription from your GP.

6. Lay off the red meat, there is some science to this as meat increases the residence time in the gut and predisposes to harder stools. This really helped me and I have seen a few accounts here where sufferers also say that.

7. Try to relax, easier said than done, but try simple things like having a hot bath instead of a shower. If anything helps you, no matter how crazy or off the wall it may sound, carry on doing it. Going out for a drive helped me. Staying active also helps constipation and makes you feel better. Don't stay in and stew - stay positive.

8. Stick to the doctor's directions of any drugs you are given. If you are told to apply a cream for 6 weeks into the anus, then make sure it goes into the anus for 6 weeks. And into the anus means into the hole - not nice, but a lot nicer than the agony from an untreated fissure.

Remember you are not alone, these things can be cured. You will feel terrible and you will feel like nobody else understands what you are going through but believe me, these things are very very common.

And if all the above doesn't help there is a simple operation that can be done on a day case basis that has a 95% chance of curing it for good.

If you are reading this you are no doubt feeling horrible but believe me, there is light at the end of the tunnel.

Good luck with your pain in the ass.

2

Hi

Can you tell me when using GTN were you advised not to apply it internally under any circumstances, as i was?

Been reading conflicting information regarding this, so not sure what i should be doing for the best result

3

I am so gld i have found a group of people who understand the pain of an anal fissure - I have been suffering for over 6 months and thought I must have a really low pain threshold and should be able to get on with coping with a small tear!

I have read some of the treatments advised and will try them out - perhaps there is light at the end of the tunnel - Thanks to all of you.

4

Hi all just thought i would let you all know my past and present with anal fissure.

I have suffered with anal fissures on and off for nine years since the birth of my son, I have had an anal stretch 8 years ago very succesfull but soon came back when i got constipated. I have now been suffering this time round for 3 months, I went to see my doctor and he said because it hadnt healed they were classed as chronic so probably wouldnt heal on there own. I went for surgery under general anastetic 6 days ago. When I was under they had a look I had 2 anal fissures and hemorrhoids. They proceeded to do hemorrhoidectomy to remove these then also applied botox to my anus.

After surgery is was in severe pain for the first day. Second day the pain was only bad when i opened my bowels so took pain killer ensured i kept my bowels soft and had 3 sitz baths. Third day a little better only needed 2 sitz baths and pain killers. Fourth day no sitz baths but took pain killers just in case. Fifth day no pain whats so ever, didn't take a bath or any pain killers. Sixth day still no pain. thank god.

All i can stress to anyone suffering is that you have this done if offered, it is the best thing I have ever had done. There is a risk that they can come back but i have stepped up to solve this once and for all. I have changed my diet by eating load of veg or salad and fruit. I have a glass of prune juice every day along with fresh orange juice plus 3 pints of water spread through the day. I am still taking the laxative prescribed to me until i have been for my check up. So in my case keep stools soft after and it only takes 5 days for pain free days.

I am so happy now and Ive even lost some weight.

Hope this story helps anyone who reads it and that's suffering.

Thanks Bev

5

Hi there, I realise this post is around 4 years old, but it came up when I googled anal fissure and I'd very much like to give some advice that I found really helpful, by doing my own research.

I have had an anal fissure for around a year now, on and off - more on than off! I am a 38 year old woman, vegan, very active and consider myself a really healthy eater. A year ago I got on a plane - something I hadnt done for 15 years, due to intense fear of flying. Around this time I had a number of stressors apparent in my life. I feel that the fissure developed around this time. When on holiday, I was very tense and I found it difficult to find food suitable for vegans - I ate a lot of bread basically and became constipated - something I wasn't familiar with at all. Kapow!! very very painful!

I'd not read about fissures - i went to the docs after 6 months of pain and some bleeding. I was petrified. I had a lot going on and the last thing I wanted was some hidieous diagnosis in a very delicate area. The doctor didnt examine me , he just asked for symptoms - he gave me lactose fluid and some cream to apply. I admit to not using the lactose as i didnt feel I my stools were that hard. I did use the cream however, which worked temporarily. The pain came back around a month after i thought it'd healed.

I was pretty terrifed to go back to the docs, so i didnt. I did lots of online research about pain in that area and decided to treat for fissure.

After using coconut oil internally and externally, aloe vera juice, psyllium husk, acidophillus tablets, a gallon of water a day(!), lavender oil etc etc...nothing was working and i was becoming tearful and agitated. I told NO ONE about the pain i was in.

Ok, so here is what helped me.

I bought 20+ strength Manuka Honey - I applied it inside my anus using the 'germaloid' cream insert that came with the cream. I covered the insert in honey - admittedly it was a little messy!! Honey in my knickers wasnt entirely comfortable and it stung like hell at first. But i used a pad and it helped a lot. I did this whenever I possibly could - up to 5 times a day.

I drunk 2 litres of water alone (not including the cups of tea) per day, I used a teaspoon of psyllium husk as a stool regulator, every time i ate. I ate lots of water fruit such as melons and I increased my fibre intake. I did this for 2 weeks before seeing any real results...and after a little while, no pain.

It has come back and i am suffering again, but im straight on the manuka honey - again for me, its defintely stress induced. I hope this helps people? I do understand the indescribable pain associated with this....but this has worked for me and its a natural remedy.

I just have to make sure that i keep it up, so that the painless times increase and the painful times decrease!

6

Just had my first experience with an Anal Fissure this past week. It is by far the worst pain I have ever had in my life. I have had 3 vaginal births and the pain from the fissure was 10x's the pain of any of the experiences of childbirth. I felt like I was sitting on broken shards of glass.

After 4 days of feeling very constipated and using a laxative with no relief I went to my family doctor. She could tell I was in severe pain. She attempted an exam and quickly decided against it when I was screaming at the top of my lungs. She called a colleague in the medical center who is a surgeon. I went over to see him 1.5 hours later. My family doc called in some pain medication because she wanted the surgeon to be able to be able to do an exam.

Took the mess and tried to relax for an hour. Went to the surgeon, tried to examine me, same problem the family doc had. Far too painful. His diagnosis was a possible anal fissure or an abscess . Did a CT scan, no abscess but a major blockage. In surgery 45 minutes later to remove blockage and found an anal fissure. Treated with medication and sent home.

Have been home5 days now and have actually experienced a bowel movement with very little pain. The first couple days home on pain meds and high fiber diet. Slept , took many hot baths and sat on alternating heating pad and ice packs. Now , am on Miralax, high fiber diet, and at least 64 oz. of water along with tea each day. I am also practicing relaxation techniques.

My doctor believes the constipation was stress induced, however just having gone off of some medication for acid reflux this all occurred after the end of the meds. Wondering if anyone else has ever been on a medication called dexilant? Any complications? Just curious.

My surgeon has talked about a Botox injection also. Not sure where we will end up wih that.

On the up side, I have lost 12 pounds since this began and am committed to not ever having this reoccur again. Truly was the most pain I have ever had in my life. Wishing all well and a continued recovery.

Take care,

7

I have been having chronic fissures now for som years.Like some others I mistook them for haemorrhoids

and did nothing for while but use the kind of creams one get from the chemist without a prescription.

As the pain intensified I finally was seen by a colo rectal surgeon, given the botox treatment , rectogesic and Diltiazem.

There has been temporary but not complete healing. So I was botoxed again only to relapse in a more

horrific wayimmediately after the treatment than before. As my symptoms also became hellish after the first botox injection, I conclude that I may have an intolerance to the medication, However, the medical profession will not even consider this and they are offering me now sphinterectomy, which I am reluctant to accept.

Unlike other fissure sufferers my pain is not at its worst when I passing stool but when I am in an upright position and when I am walking. I have virtually become disabled - and have reached the end of my tether.

I am no stranger to pain: I had both my hips replaced, I had chronic cystitis for 9 months, I had dismenorrhoean, but I find the fissures most debelitating of them all.

8

I fully sympathise with your report. In my case the fissures have not responded to botox injection, followed by GTN and (new not yet licensed in this country but allowed for colorectal surgeons to use in their clinics) Diltiazem. I am doing regular camomile sitz baths. I meditate and do, when possible gentle Yoga exercises. I ised to be very active: cycling, swimming, running but had to give this up now. I am not in stressful situation in my life - apart from the persistent anal pain. Bowel movements are only mildly uncomfortable for me but I suffer agonising pain when walking or bending down.

The only pain killer that gives me temporary relief is Codeine. Paracetemol or Ibuprufren are useless, so is Tramadol.

I know of the addictive potential of codeine, but are there any other considerations why this should not be taken?

9

Codeine or any other opioids will cause constipation, which is exactly the most important thing you want to avoid with a fissure, so avoid if at all possible. Softening the stool is the whole aim of treatment - may assist with healing and avoid worsening the fissure. Fibre, fluid & stool softeners all the way!

10

Hi, I’ve recently been diagnosed with CAF following admittance to local hospital via A&E. The pain has worsened over the past 8 years. Through embarrassment and fear of something worse (I used to work in the furniture manufacturing industry and can name about 20 former colleagues who have passed away with bowel cancer) I couldn’t or wouldn’t visit the GP. Following surgery, biopsies and Botox 3 weeks ago, the pain has eased but not gone. I experience pain following a bowel movement, extreme pain if I go more than once the same day. I have tried to pin point within my diet trigger foods/drinks and trying to avoid. No pain killer will ease it, paracetamol, ibuprofen, codeine or tramadol. When I was admitted, the only thing what would ease the pain was morphine and that was only after 40ml. That’s a lot from the medical web sites I have trawled through. Anyway, my question to go out there is, food and drink triggers. Who experiences triggers through this and what to avoid. I know were all different but I need to start somewhere. This has seriously affected my day to day life with both work and home life. I am currently off sick due to the pain and this is my 3rd week off, the longest period of sickness since 1993. Thank you for any advice.

11

I am currently suffering with my second bout of CAF. The last was 12 years ago and I think was related to stress and exertion. It lasted for around a year and cleared up after using GTN. This time it came on after a severe episode of constipation. This was back in August last year and have been suffering ever since. My trigger for the constipation was popcorn.

This time around its much more painful (and I mean really painful, so much so that when I had a septoplasty operation last week it helped take my mind off the pain!). I am active, healthy with a good diet and drink plenty of water. I have been eating paracetamol and ibuprofen for fun but not with any success. I have tried paramol sparingly but cautious not to cause constipation. This time around I have tried GTN for months but the condition has been getting steadily worse. I had a very painful examination by the colonic specialist who said there was nothing sinister as an underlying problem but shrugged his shoulders as to the anal fissure itself! I have been back to the GP several times and am now on Diltiazem. I am hoping this works better than the GTN as I have read up that Diltiazem is much better than GTN as clearing up CAF. The Diltiazem is supposed to reduce the internal sphincter pressure and increase blood flow to the area much better than GTN. So far no headaches as I got with GTN but I have mild fecal incontinence and lightheadedness as a result of the Diltiazem. When I mean mild, if I have to go, I haev to go there and then and the muscle tone in that area is "slack" meaning its difficult to "end" a poo if that makes sense.

Currently off work for 2 weeks following the nose op but I was hoping for some respite from the CAF as well as its become unbearable for me at work. The latest GP I have seen is the most sympathetic of the lot and will sign me off for the CAF if I need it. What I am afraid of is that if I extend my sick leave I might stay off for month the pain and discomfort is that bad.

Trying to be positive.....

12

Hi there, sufferer for over 13 years, my triggers are sweet corn, seeds or seeded bread and also pizza base. Hope this helps. I had a sphincterotomy about 5 years ago and up until recently it had helped, I had a severe infection in my arm( nothing to do with the fissure) but I was on IV antibiotics daily for a week followed by 10 days oral antibiotics which caused diarrhea which has flared everything up again. I have now been suffering for 2 weeks but am hopeful of a recovery from this as was fine up until diarrhea. Hope this gets better:-(

13

I'm so glad I found a group having the same experience like me. I had experience AF 3 years ago when I had a sever fight of constipation due to overdose of drinking of medicine to fight diarrhea. The effect is constipation. By then I had my 1st flair up and believe me i thought I'll gonna die coz it was my very 1st experience seeing blood in my poo. My parents comforted me saying its normal to happen coz I forced it and said I had piles.

Went to doctor, told me i had piles, gave me medicine, but nothing helps. Its that feeling when you poo something like is tearing your skin underneath. A friend of mine told me why not try Papaya and eat vegies first for a few weeks. Papaya is a natural bulking agent and helps digest foods. Believe me, it really helped to easy up my bowel episodes until the Piles and AF healed after few weeks of being religious in my new food diet.

Well now recently, it flaired up again. Last week I don't know why but suddenly a huge poo of mine came out and i think it caused a small cut in my anal. I can feel it coz the same old feeling I felt before. By the way, I dont have worries of drinking water coz I'm really a water addict. I consumed an avg of 3Litres a day. But then recently, I went to europe for vacation and stayed seating in the plain for 13 hrs I think it triggers back my Piles and AF. When I went to toilet, got constipation i guess because of very cold weather and yes, my AF got back.

Now I'm suffering for a week which I'm fighting to get back my bowel mood to soft it up again by drinking Prune Juice. Well luckily its very soft now but before it happened I had 5 days of fight of painful, bleeding AF when doing my daily business. I hope now that is very soft again it would start to heal and calm down.

14

I have CAF and another month sick note (total 7 weeks off work if I return then, what a mess!!) and a referral to Colorectal out patients for additional support.

However, after 10 weeks I have made a small breakthrough, seeing some improvements. I have had a CAF for 10 weeks, had and still occasionally have debilitating spasms and would quite like an epidural at those times (I had two natural births with no pain relief!)

Here is my step by step guide to get things improving:

1) GTN ointment 4% used morning, mid day and evening as well as after any BM's (I'm lucky enough to not get side effects) the GP was okay with my useage at this level as it mildly helps relax the spasm.

2) Really hot baths. not warm - Gawd Damn Hot ones - they REALLY kick out that spasm.

3) Ensure that you are getting 25-30g of fibre per day eg- (I discovered that my 'healthy diet' only contained 18g after entering my meals into Weightloss Resources online, it breaks down nutritional values for you.) Eg of how to get 30g fibre:

Breakfast: fibre cereal (Weetabix or Oats are both suitable with soluable and insoluable fibre) with probiotic yogurt and a piece of fruit.

Lunch: 2 decent slices of wholegrain bread with vegetable or lentil type soup or

veggie chilli / curry (mild for the CAF)

Dinner: brown rice, 2 portions of veg and a small piece of fish or white meat (slowly introduce red meat back in after healed CAF)

Snacks: Wholemeal scones, fruit, nuts.

4) Introduce Movicol into your life. Lactulose did nothing for me and I have relied on stimulant laxatives for way too long) Movicol along with the good level of fibre will help things move as painlesslessly as you could hope for with a CAF. I have had my first BM without stimulant laxatives in 15years (honestly, I was worried about the fibre bunging me up but at least with Movicol it really didn't I PROMISE on this one). I took at night to avoid the chance of unpleasant bloated tummy and bubbling during the day. here's what I did with Movicol:

Day 1 = 1 full strength adult sachets at 8.30pm mixed with water as directed.

Day 2= no BM so increased to 2 sachets both at night (lots of wind, deal with that as you wish).

Day 3= still no BM so increased to 3 all at night (LOTS of wind, hoping for BM tomorrow or hitting the Dulcolax again)

Day 4= perfectly NORMAL poo at 10am with no forcing or urgency. To give you an idea, it can be rated as a number 4 on this link: http://www.movicol.com.au/file/Movicol_Stool_Chart.pdf PERFECT and the first normal poo I have done without Dulcolax in about 15 years!! It's also the first time in 10 weeks that I have not had a painful BM. I'm very pleased that my patience has paid off, even if it is very early days smile

I plan to take 3 sachets again tonight and if too loose tomorrow I will reduce to 2 and half sachets then maybe 2 etc to get things settled at the right level for me.

I will keep on top of the diet and bowel habits and see how this helps in the long term. In the meantime I will continue the GTN / Sitz baths and see the specialist in a couple of weeks.

Good luck you poor people - we are an unlucky bunch!!

15

Ianee the majority of pain relief medications all cause constipation. I have been going to the toilet more easily since giving up on pain relief via meds and just focussing on eating 30g fibre each day, 2 litres of any fluid except alcohol and using GTN as regularly as possible. Also, to protect the CAF inbetween doses of GTN I coat it in vaseline which is surprisingly more comfortable (must prevent drying out and protect against irritati ok n / rubbing)

Good luck!

16

*irritation. Oh and very importantly HOT baths to kick the muscle out of spasm.

Regards

17

Very useful

18

3 days post Botox after A&E admission to hospital due to being unable to tolerate pain which was off the scale. So far so good, I'm finally feeling human again!

19

I have been suffering from chronic anal fissures for a couple months now. I just found out today that I have multiple tears and now have an infection. Anybody have any ideas for pain management??

20

Hot baths, and ibruprofen and paracetamol, I'm a 13 year on off sufferer