Anal fissure

[Fuddymunster]

Six weeks ago I started with symptoms of which I thought were piles - discomfort and slight bleeding when passing stools. My symptoms started to get worse ie as I started to feel a sharp stabbing pain when passing stools and at other times of the day. After 5 weeks i

... Spoke with my GP (couldn't get an appt on that day) and she said based on my symptoms it sounded like a fissure and not piles. She's prescribed glycerol trinitrate which I have to apply twice a day to the area. The side effects put me off using it (ie 1 in 10 users will get a severe headache! Etc) but I've been in so much discomfort with it that I started using it a couple of days ago. My GP said to go back in 2 weeks if there's no improvement. I dread going to the toilet each day as it's painful. I don't get constipated and am eating healthily so not sure what else I can do.

The reason for my post is just hoping to hear some positive stories about anyone with the same experience. I've had a couple of cries and am feeling a bit sorry for myself.

Also can you use anusol alongside the glycerol trinitrate?

I'm taking the same meds for the same reason and I agree that it's miserable. I've suffered from fissures since I was a child so it's nothing new, but combined with postnatal constipation (DD is 7 weeks), I think it's the worst ever.

I've found the medication works well, combined in my case with Movicol, although is very painful to apply at first. But now it's almost healed, after a week. It's the first time I've used the cream rather than just waiting it out, and it really does make a difference to recovery time.

Something else that helps is hot baths.

Good luck. It WILL go away!

Thank you so much Stiffy. I've never suffered before, just had a few piles for a few weeks after giving birth to my children who are now 11 and 5, so I know I've been very very lucky.

Yes it has been a miserable past few weeks and I think I just needed a bit of reassurance, that it will go away, so thanks for that.

Do you use anything else alongside the g. trinitrate? Fingers crossed I haven't suffered yet with any of the side effects.

Will definitely be having that hot bath tonight!

Glad for you that the cream has helped to heal your fissure after only a week. 7 weeks is still early days after having a baby and I'm sure that's one issue you can do without! X

Fissures are miserable. I had one a few weeks after DD was born.

I used a pile cream with anaesthetic (Germoloids) to numb it ten minutes before a bowel movement. and went from the worse pain I've ever experienced to complete relief. Would recommend applying with a finger instead of the applicator to avoid damaging the skin. And I'd avoid the ointment and get the cream- just incase the ointment prevents your medication from working.

I also used a low dose of Lactulose to keep my stools soft for a few weeks to let it heal. Avoid 'scratchy' bran cereals and anything else that could cause damage (coconut flakes, nuts).

Thanks UnfortunateL. So reassuring to hear that it will go!

What is the difference between the ointment and the cream? I thought with pile cream that there was just cream or suppositories.

I'm not sure if I can use anusol or germoloid cream when using glyceryl trinitrate. The side effects listed would put anybody off the g. trinitrate so must be strong. It says to only use every twelve hours so I wondered if I could use pile cream still after a bowel movement. Does anybody know?

I've only been using the cream, Fuddy. Apart from some dizziness the first couple of times, I've not suffered from the side effects either. My husband used it a while back and his GO told him to take a paracetamol first, to ease any headache.

Thanks Stiffy. I did actually get a headache today (not severe though) but don't know whether that was the meds as the first couple of days I took it I didn't have any symptoms. I'm just praying for a pain free bowel movement in the next day or so.

God it's awful isn't it. I remember the pain and toilet anxiety so well. Nurofen half an hour before the toilet, salty bath afterwards, stool softeners, the headachey nitrate cream... In the end what I think made the difference was a birthing technique I read in an Ida May book. This sounds stupid and you will think I'm taking the piss, but trust me... When you're on the loo, you do not strain or push EVER, you wait until the BM decides for itself that it's 'time', then you do this breathing: breath in normally, then as you breath out, you relax your lips and vibrate them together as if you were doing an impression of a horse (I know...I know). So you blow the breath out of your mouth with floppy relaxed lips that are vibrating together. The reasoning is that when your mouth muscles are totally relaxed, it is impossible to tense your rectum. (and it's unconsciously tensing the rectum that is aggravating the fissure). Lots and lots of water to drink too. It honestly works. I had mine for years and even had investigation under general anaesthetic & allsorts, but relaxing on the toilet via this technique was key to letting the tissues heal. Best of luck.

I've had the exact same thing. Never let yourself get constipated... I take lactulose at the first sign of constipation, and drink as much as I can bear. Usually this and some germaloids for the pain sorts it out. But the latest episode went on for weeks. The GP gave me the GTN ointment. I used it 2x and got the most cracking awful headache and some dizziness. But the problem just went. that was over a week ago and nothing since! I would take a couple of nurafen and a couple of paracetamol, then use the ointment just before bed, then do the same in the morning. Sooo worth it. I'm still being careful to avoid getting constipated. Part of the problem is that in anticipation of the pain your anus spasms, which makes the pain worse, and makes the injury worse. its a true psychosomatic illness, in that it's a genuine physical problem exacerbated by one's anxiety (about pooing). A couple of comfy poos and you break the vicious cycle.

Not sure if you can use the pile cream after the ointment, pop into your local pharmacy, they'll know.

Thank you so much madmomma and sprinkles, I really appreciate the advice.

Madmomma, I can so see how the breathing technique could work and will give it a go tomorrow.

Sprinkles, strange thing is I'm never constipated, if anything am slightly the other way, so maybe that's how I've caused the fissure. I go once (sometimes twice) a day and never have to strain. However for the first time in years I didn't go at all today and I know that's because mentally I've become frightened of 'going'.

So reassuring to hear your stories of getting better. Must get some sleep and fingers crossed tomorrow's a better day.

Feeling very sorry for myself today. Had a bowel movement this morning which was painful. Tried madmomma's breathing technique which I think really did help. However have been in pain since and just feel like curling up in a ball and hiding. Have had paracetamol and applied the g. trinitrate but still in a lot of discomfort. I made the mistake of googling chronic anal fissure and am so worried that if it doesn't go I'll have to have surgery. Also worrying that maybe it's not a fissure and is something more worrying. I'm not pregnant, nor just had a baby or constipated so don't know why I have developed this so badly. Sorry for the moan. My husband says to stop worrying and relax and it will go but I'm in such discomfort. Thanks for listening.

By the way, it's day 4 of using the meds.

the tube of GTN gel says i think not to use longer than 6 weeks. or was it 8? Either way, I think you probably should try to give it a go for as long as recommended in the leaflet. If not, go back to the doctor and get a second opinion. I really feel for you, and your DH's advice is not really that helpful, its hard to relax when it hurts so much. You said before that you don't get constipated, if anything its the opposite. It might be worth trying to bulk your poos out a bit as the liquid part of poo is quite acidic (it's partly the cause of nappy rash) so it going to irritate your fissure. Something like psyllium husk you can get at all health food stores. You must take it with lots of water though. It won't make it any harder to go. Most people take it for constipation, but really it just helps regulate things.

Thanks sprinkles. The past few years I often have more than one bowel movement a day and I do wonder if I've developed a bit of IBS. Interesting what you say and perhaps that's what's caused it, will definitely look into thee psyllium husk.

It will go FM, you won't need surgery. Nurofen liquicaps are much better at getting to the pain than paracetamol - I was on them constantly for a year. It's a good point sprinkles made about bulking up the stool so it's less acidic. Give the nitrate ointment a really good go for a few weeks and keep going with the breathing, the painkillers and hot baths with loads of salt in them. You will get there. Your husband just can't understand how painful it is. It really sounds like a fissure - nothing nasty - it's just a cut, but in a bloody arkward painful place. Take those nurofen and keep your chin up.x

Thanks so much madmomma, I really appreciate all the advice. I think DH was trying to be positive, but I did feel annoyed at him, because it's so painful. I would never have anticipated suddenly getting a fissure and how painful such a thing could be. I suppose it's early days yet in the healing process. I'm really hoping that I come back on this thread soon to post that it's getting better. Xx

I really empathise with you Fuddy. Yes, I speak from experience. I believe mine was brought on by eating too much sugar and drinking too much wine which lead to being overweight and the obvious constipation. It lasted 8 months I had to go to hospital for an colorectal examination.
I couldn't use ointments because I had cut my anus and it stang - I used the same as you but ultimately, I gave up nearly all sugar, drank loads for water daily, avoided constipation at all costs by changing eating habits.

One thing I did do, after all the various pills and ointments didn't work was take regular baths with 8 drops of lavendar and geranium essential oil added after the bath has run. It is soooooo soothing! Whilst I was in the bath I was able to, at least, push the piles back in. The anal fissures took care of themselves with a focussed changed diet. Squeeze your bottom as hard as you can regularly - this acts as a kind of exercise for you rectum. Good luck, it will all be gone soon.

Something that has really helped me is eating a few spoonfuls of linseed every morning. You can buy it in the supermarket ground up. Also known as flaxseed.

Just a thing to think about - are they sure it is a fissure? After same symptoms for 8 months and seeing 4 GPs I was treated with steroid cream and am (fingers crossed) cured after 3 days. Just worth a mention as they told me it would be a longterm problem and prescribed the glycerol tn stuff that I didn't use.
Hydrocortisone cream seems to have cured it! Guess what I am saying is not all fissures are the same thing so go back if no better.

I had this once a few years ago and it used to terrify to go to the toilet. And I'd be digging my nails into/biting down onto whatever I could get hold of when I went! It was horrendous, the anxiety if it all seem to give me diarrhoea aswell which meant I was going all the time.

Went to the docs and he prescribed some ointment that had to be specially mixed at the pharmacist, which seemed to relax the muscles around the anus slightly and I presume treat the fissure as well. There were no side effects at all and it worked wonders in a few days. It was awful though, hope it gets sorted.

Hi,

I saw this whilst looking for something else, can I just add that I had surgery for this, not that I think you would get that far possibly but just to alleviate any concerns you have. I had a fissure, creams, diet and things did not help, I was told it was not healing because the muscle behind it (sphinter muscle?) was naturally contracted and against the grain of the fissure healing.

I had an op called a sphinteroctomy (god lots of spelling challenges) to relax the sphinter muscle and let the fissure heal. I had to go under for the op, but a couple of days after of no bowel control was worth it, comical in a way! it sorted out a problem I had for a few years in a few days and all for inconvenience of a few days of surgery and convalescence so your concerns in this area should not be great if they are, it's the easiest op and recovery time I have had for all my ops, 4 at the last count!!!

John

Thanks so much everyone for all the tips and advice, I could never have got all that advice from the Doctors.

Littlemum, although I have a healthy diet, to be honest I was snacking on chocolate, crisps and diet coke inbetween, not drinking nearly enough water and not enough exercise. Have started having hot baths, will try the essential oils too. I do remember having lavender baths after give birth which were very soothing.

Bellabear, thanks, someone else has suggested the linseed too.

Samvet, I don't know for sure it's a fissure as I couldn't get an appointment with my Dr on the day I rang so had a phone call instead. She said the symptoms sounded like a fissure, to try the GNT for 2 weeks and if no better to see her. Will ask her about the hydrocortisone cream if I need to, thanks for that.

Lynzilove, yes I'm at the stage of being terrified to go to the toilet. Reassuring though to hear positive stories.

Am off to Holland and Barratt tomorrow for my supplies ...

I've had a reoccuring fissure for the past 3 years. The first time I went to the dr but it healed itself. Then it came back 2 years ago, about 2 weeks after I gave birth. I have to say I'd rather go through the pain of labour than have a fissure, the pain is absolutely excruciating. It made me so unhappy at a time when I should've been enjoying my new baby! It didnt help that my baby was a slow feeder so I was sitting for 2 hours at a time breastfeeding and it felt so painful to sit on my sore area for so long. Anyway I went to the dr and was given Rectogesic ointment and my goodness it worked a treat. I stopped using it after a week and a half but the fissure came back again a couple of weeks later so I used the ointment again and used it for the full 8 weeks.

I worry everyday about it coming back with a vengeance again. I try everyday to eat more than 5-a-day, drink lots of water and for 2 years I've only ever eaten bran or wheat type breakfast cereals. I hate having this continuous worry. I'm lucky that it doesn't reoccur too often, about once every couple of months and when it does it's not been a full blown fissure - more like a part-time one! If I sting when I go to the toilet I know I'll see a bit of blood but then the next day I'll usually be ok again. I don't understand??? The last one I had was 2 weeks ago and I bled twice. I hope so much that each time will be my last but it's so sad to find it happens again. Perhaps this is my way of life now, watching what I eat to make me go to the toilet regularly..... :(

I have had a recurring fissure for several years. The worst persistent episdoe I have ever had was after DS1 was born when it was open and incredibly painful for 10 weeks. I was thoroughly miserable and went to the GP in despair. Was prescribed Rectogesic/GTN and have now found that once it take hold and becomes persistent, this is the only thing that will heal it up. Works brilliantly and noticeably within days, but does make me feel crappy - horrid headache and lightheadedness. I tend to use it immediately before bedtime, so that I can go and lie down and that way it doesn't affect daily life too much. Hope it gets sorted very soon. MPD

Something I was wondering was can an anal fissure get worse after a 2nd pregancy, with the force of pushing the baby out? We're thinking about trying soon for a 2nd baby and this has been in the back of my mind for a while.

(I've actually started another thread about an umbilical hernia getting worse in a 2nd pregnancy - yes I've got one of those too. A fine bill of health me :()