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Old 12-29-2010, 04:13 PM   #1
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Anal Fissure - I think but no significant pain

Many years back (15 years or so) I was diagnosed with an internal hemmorhoid. I had some blood after a BM and pain. Went on a high fiber and water diet for a week and all symptoms went away.
Over the past few years, I would have a very hard stool and get the same feeling I had back with the internal hemmorhoids. Again I went on a high fiber and water diet and the issue went away.
Now about 8 months ago, again I had a hard stool. The feeling was like passing shards of glass and there was blood. I assumed internal hemmorhoids. I conducted my home remedies with limited success.

I have some extremely small discomfort during a BM (maybe 2/10 on pain scale at start of BM) and during the BM, I feel great!! About 1 hr after the BM I have pain, but still only about 4/10 on the pain scale maximum. This lasts many hours. Almost like a bruise pain. Not throbbing or searing - just sore.
I went to my GP (I am in Canada - so I need to be referred to a CR surgeon). He conducted a digital exam and applied pressure in the 4 quandrants of my internal sphincter. Now the pain increased during this exam (maybe 8/10) and it was honestly difficult to tell which position hurt the most, but I think the 12 o'clock position was the worst (towards the spine). He figures its a chronic anal fissure.
I was prescribed proctosedil (pain suppository) and go on Metamucil with Colace for 3 weeks.

It has now been 8 weeks with no real benefit. I am very consistent as I have a BM at around 10 am every day. For most of the day I have some slight pain (slightly more when sitting). By night and the next morning I have no pain at all.

However, I am confused because most people who post for anal fissures have extreme pain and are afraid of a BM. It just feels like my inner sphincter is 'raw'. When I squeeze my sphincter muscle, I can feel discomfort. I get sharp pains in the inner sphincter when I cough hard or sneeze (only within the first 6 hrs after a BM - no pain after this time). I also find relief from the low level pain by 'pushing' with my stomach muscles (like pushing out a BM).
Anyone else have such symptoms? Probably going to set up an appointment with my GP to follow up in the next week.

Last edited by tygriff; 12-29-2010 at 04:14 PM.

 
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Old 12-29-2010, 05:13 PM   #2
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Re: Anal Fissure - I think but no significant pain

Hi in my opinion if there are 3 meals a day there should also be 3 bms. Being vegetarian helps that a lot in my opinion. Also one may wish to avoid dry crackers dairy, eggs and other refined foods. Has olive oil been used as a lube after bms and after a water wash and dry? In my opinion if there is adequate hydration especially in the morning and throughout the day with one glass before bed, it is less likely there will be hard ones.

 
Old 12-29-2010, 09:01 PM   #3
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Re: Anal Fissure - I think but no significant pain

I had the fissure problem for years...and NO, there is little to no pain during the BM. But and hour or so afterwards, the pain begins. I could be wrong, but I've kinda noticed on a "new" fissure, my *** feels like I've kicked in it and is sore, sore, sore to the touch. This lasts for about 2-3 days and then that pain subsides and the normal fissure pain begins...which is spasms that last for hours.

 
Old 12-30-2010, 03:28 PM   #4
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Re: Anal Fissure - I think but no significant pain

when i went to my colon and rectal surgeon i was told that i had several superficial cuts in my sphincter. my CRS told me to take colace and metamucil for a few weeks to see if things got better.

they didn't, and i knew they wouldn't because i had already tried that route and it had been over 2 years at this point that i was dealing with this.

so he scheduled me for LIS surgery. it's a quick, simple, out patient surgery. i am 100% back to normal. it's been exactly a year now since my surgery. took maybe 3-5 months total healing to feel almost completely normal again.

only regret is that i didnt get the surgery done sooner

since it has been 8 weeks, i would opt for the LIS surgery

Last edited by wantrelief; 12-30-2010 at 03:29 PM.

 
Old 01-11-2011, 08:39 AM   #5
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Re: Anal Fissure - I think but no significant pain

Glad to hear of someone else with an anal fissure who doesn't have pain during a BM, since most people complain that their pain begins with that. I don't have pain during a BM but do at other times, sitting standing, walking. I've been dealing with this for about 4 months. I had to switch MDs to get the more modern treatments, Nifidepine and coming up, Botox. The Nifidepine worked for a while but then it seemed I became allergic to it because upon application I would get tremendous pain, and so I stopped it. I've also noticed and been told that most people with an anal fissure can exercise, etc and that does't cause them pain, but I'm the opposite. As long as I'm laying pretty flat, I'm OK, but I just can't sit for too long (not true if I've had a glass of wine or two) not can I walk for very long.

While waiting for myy insurance company to OK the botox, I started taking Valium this AM. Not sure if it's helped or not, but not very noticeable if it has. I know Botox is a 50/50 shot, but since surgery could cause incontinence, even if the odds are minimal, I prefer trying everything else.

Good luck and thanks for sharing your story because I was starting to think I was the only one with a fissure who didn't howl due to a BM.

Update: It's been a week since my Botox injections and no pain relief. I braved the snow and went back to the doctor's office but to see his partner. He too is not in favor of surgery yet and said if things don't improve, he advises another shot of Botox. Really liked this colorectal surgeon, has good reputation at NYU, so am going along with his advice. I mean when a surgeon isn't jumping to do surgery, it makes sense to listen.

Last edited by BayRidge; 01-27-2011 at 03:13 PM. Reason: adding update

 
Old 01-11-2011, 10:38 AM   #6
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Re: Anal Fissure - I think but no significant pain

BayRidge,

Can you elaborate on your symptoms? Here are mine:

1. Slight discomfort (stretch feeling) at the start of a BM then no issues during the rest of the BM
2. For about 30-60 mins after the BM I am fine as well
3. Then I begin to feel a creeping, sharp pain that does NOT get excrutiating, it is just there and this occurs every couple of minutes over many hours at the sphincter area. These peaks of pain only last a couple of seconds. Between these it seems OK
4. Flexing of the sphincter muscle causes discomfort
5. Relief during the peaks of the discomfort can be achieved by pushing (like pushing out a BM).

Sound similar?

 
Old 01-11-2011, 03:08 PM   #7
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Re: Anal Fissure - I think but no significant pain

Quote:
Originally Posted by tygriff View Post
BayRidge,

Can you elaborate on your symptoms? Here are mine:

1. Slight discomfort (stretch feeling) at the start of a BM then no issues during the rest of the BM
2. For about 30-60 mins after the BM I am fine as well
3. Then I begin to feel a creeping, sharp pain that does NOT get excrutiating, it is just there and this occurs every couple of minutes over many hours at the sphincter area. These peaks of pain only last a couple of seconds. Between these it seems OK
4. Flexing of the sphincter muscle causes discomfort
5. Relief during the peaks of the discomfort can be achieved by pushing (like pushing out a BM).

Sound similar?
I sometimes will feel pain after a BM, and it does take a while if I do, and sometimes not at all. I think a lot of my pain comes from the "tag" rather than the fissure so since that is outside of the rectum, it doesn't get affected by the BM, but it does from other activity.

As an update, I'm getting Botox but since there's a lag before it comes in thanks to insurance red tape, I asked for and got a prescription for Valium. I'm sensitive to drugs so I started taking it today, only half a 5mg pill with breakfast and one with lunch, and while it makes me a bit drowsy, my pain is much reduced from yesterday or the past week. I guess I'll go ahead with the Botox but I wonder whether people with fissures would be helped by any drug that acts as a relaxant. (Wine works for me too.)

 
Old 01-11-2011, 03:26 PM   #8
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Re: Anal Fissure - I think but no significant pain

Hi I suspect sitting too much may decrease circulation to the area.

 
Old 01-13-2011, 10:36 AM   #9
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Re: Anal Fissure - I think but no significant pain

Quote:
Originally Posted by sjb View Post
Hi I suspect sitting too much may decrease circulation to the area.
Since the pain can start after only a few minutes of sitting, I don't think it's a question of cutting off circulation. As I said, the pain seems to come from the tag, which is outside the rectum, so I think it's the pressure on the tag. I put a diaper rash ointment on the tag and provides some relief some times.

My goal is to get the fissure to heal so I try spending as little time doing things that cause pain as possible. I have a lounge chair in my office that keeps pressure off my anus area and that seems to work, though sometimes I have to go lie down.

I am also very sensitive to stress. It doesn't take much for my anus to tighten up, and that causes pain. Exactly how I'm going to cure myself of that I don't know, at least during business hours. Luckily for me I moved to a home office before this started so I don't have to commute and if I need to lie flat, my bedroom is down the hall. But if every time I feel a bit stressed my anus is going to tighten up, then I don't know what happens. Botox or surgery may help for a while but somehow I have to change the way I deal with stress, which is not that easy to do. Hard to meditate when you have an impatient client making all sorts of demands.

Also I take 3 stool softeners before I go to bed and have been drinking a ton of water (and peeing a ton too) but I can't say I'm impressed with the quality of my stools. For a while I was taking these pills that are for a colon cleansing, and they really softened my stools, but don't know whether that's a solution as you're not supposed to take them forever.

I hate the cold so being stuck indoors during this season isn't all that bad for me but I just hope I'm done with this when the weather turns nicer. I see people running on commercials and feel so jealous that if I so much as walk around the house too much I get stabbing pain.

Last edited by moderator2; 01-22-2011 at 08:57 AM. Reason: please do not post commercial websites

 
Old 01-13-2011, 12:24 PM   #10
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Re: Anal Fissure - I think but no significant pain

Hi I suspect that if a person sits more not only the tag is affected but the circulation in the tiny blood vessels in the skin all over the seat. And thank you for telling me about tension there when there is stress it is good to be reminded about things like that. :grin:

 
Old 01-14-2011, 09:00 AM   #11
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Re: Anal Fissure - I think but no significant pain

Another quick question:

Where is your pain / discomfort?

For the longest while my pain was almost internal (deep in the inner spincter - maybe like internal hemms). Now that this discomfort has subsided, I feel tightness and almost paper cut like discomfort externally right at the top of my butt crack (sorry for the slang there).
Now I am confused as the pain / discomfort felt now (external to the sphincter opening) seems to coincide better with the fissure analogy.

Was the pain internal also a fissure pain?

 
Old 01-15-2011, 09:52 AM   #12
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Re: Anal Fissure - I think but no significant pain

At first my pain was clearly from the spasing of the sphincter muscle. I would fine relief by laying on my bed and putting my feet up against the wall. Once I started taking Nifidepine, that pain disappeared but I would get pain outside the anus, I think where the tag is. Putting a diaper ointment would help. But I was also getting severe pain from the Nifidepine, like an allergic reaction (though MD says that's not possible) a strong burning that had me climbing the walls for half an hour or more. I stopped taking the Nifedipine and will be getting botox on Monday. For the moment I am taking valium, which seems to prevent the spasing pain, but I still get pain near or on or around the tag from sitting, standing or walking. If I walk around like a little old man, taking very small steps I can keep that pain down, but life sucks like that. I'm really hoping the Botox works. If not, on to surgery. If I keep my legs extended, lounging but not sitting, I can keep the pain down to what I would call discomfort, not real pain. But once I try to do anything, then I get pain.

 
Old 01-16-2011, 06:40 AM   #13
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Re: Anal Fissure - I think but no significant pain

That seems similar but also different from me. The pain I feel after a BM is a faint 'stab' pain internally (almost behind the sphincter). I think it is related to the muscle in spasm. As it spasms, I get the faint stab pain. It is more annoying than painfull. In the past 4 days, things have been getting a lot better. The spasm pain only last about 30 minutes and then I am good until the next BM. The time seems to be getting smaller every day.

I am going to my GP on Jan 21st for a follow up. Up until now, I am just on diet alone (no drugs).

I feel I am just at the cusp on fully resolving this. Maybe GTN cream or similar could resolve this for good. At this point, the discomfort definitely does not warrant any surgery.

This is what confuses me, maybe it is not a fissure since the pain is so little.

 
Old 01-17-2011, 10:19 PM   #14
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Re: Anal Fissure - I think but no significant pain

After fighting the fissures for the last several months, I decided to do the Botox since the pain was getting unbearable. About 2 days prior to the procedure, a sharp pain was really bothering me...after he looked, he said it was a skin tag at about the 12:00 position that he would "clip off" during the Botox injection....man that hurts. The Botox DOES help, but remember it only lasts for 3 months. If your fissures don't heal completely during the 3 months, it's back to square one. Mine has been bothering me again, but not as bad. DO EVERYTHING he tells you to do during that period...Fiber, fiber, fiber...keep things soft. I have found a combination of Metamucil and Miralax works pretty good. you still have bulk but you have soft bulk. Forget about taking a magazine to si and read...I'm up and down in 30 seconds with no straining. For now I'm feeling fine, not perfect, but fine. If the pain does get like it was before, I'll have to do the permanent solution.

 
Old 01-18-2011, 06:29 AM   #15
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Re: Anal Fissure - I think but no significant pain

Hi I would suggest a GI specialist instead since it seems that the GP did an exam which seemed to cause more pain. Some doctors are much more gentle and or more knowledgeable than others. An internet rating might be helpful for this purpose to see how others like them in my opinion.

Has a hand or regular mirror been used both behind and under the body to see if there is anything in the area where it hurts externally?

Have washes and olive oil after BM's been tried?

 
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