Digestive Disorders / Gastroenterology Expert Forum
Anal Fissure
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Anal Fissure

I have been constipated the last couple of weeks.  I took some Senokot last Tuesday to help with this.  Then on Wednesday I had a bowel movement.  It was really hard to pass the stools.  I noticed there was blood on my stools and on the toilet paper.  I went to a doctor the same day and was told it was an anal fissure.  The doctor gave me hydrocortisone suppositories.  I took these for a couple of days, but had to stop using them because it was too painful to use them.  Also, that same day I drank some prune juice.  This caused me to have diarrhea, which worsened the pain.  Ever since Wednesday I have been in so much pain I have not been able to sit up, therefore have not been able to work.  I have to lay on my side, I cannot even ride in a car. The pain is constant, not just when having a bowel movement.  I have increased my fiber intake and fluid intake and now I'm having 1-2 soft bowel movements per day. I have been taking 3-4 tub baths in plain warm water a day.  I have tried using hydrocortisone cream and anesthetic cream.  None of this seems to be helping.  I also noticed something strange when I was applying the cream.  It looks like there is something hanging from my anus. I can't tell if it is skin or a hemorrhoid, but the doctor did not mention it.  I also feel constant pressure there, like something is pushing down on me.  I haven't noticed anymore blood in my stool.  And yesterday I started to have itching and burning (like I'm on fire) there also.  I'm not sure what to do.  How long do fissures take to heal?  How long do they take to stop causing so much pain?  I can't miss anymore work from this, but I can't even sit up.  I'm typing this standing.  Could I have something else going on with me besides a fissure? Thanks.
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Hello - thanks for asking your question.

Hydrocortisone is not normally effective for anal fissures.  

Topical nitroglycerin increases local blood flow and reduces pressure in the internal anal sphincter, which may further facilitate healing.  In studies, the median time of healing was 6 weeks.

Another form of therapy is botulinum toxin.  Injection of botulinum toxin into the anal sphincter can improve healing in patients with chronic anal fissure.  Time to healing in these studies were approximately 2 months.  

The ability of oral nifedipine to reduce resting internal anal sphincter pressure prompted its use for the treatment of patients with chronic anal fissures.  Treatment was associated with an initial reduction in maximum anal resting pressure and pain scores.  Time to healing in these studies were approximately 2 months.  

If these medical therapies do not help, then the next option would be surgical.  In trials, surgery has proven to be more effective than medical therapy.  

As for the question of possibilities other than a fissure, other considerations may include a colorectal mass, inflammatory bowel disease, or hemorrhoids.  Endoscopy would normally diagnose these conditions.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
17 Comments
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Avatar_n_tn
Hello. I have suffered with anal fissures for over 7 years.
If the problem gets too bad then GTN ointment 0.2% is a good help.
Lots of baths also.
I have had surgery but it did not help.
If this is the first time you have had a problem then I wouldnt worry to much, they do generally take time to heal.
I would check the other problem out again though..hope this helps.
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Avatar_n_tn
I have a family member who suffered tremendously with bleeding anal fissures.  It went on for about 8 months.  The only thing that worked(and she tried everything from perscription cream to suppositories) was 1.5 tbs of cold pressed extra virgin olive oil (drank) and metamucil.  I have since found out that olive oil also helps keep the gallbladder clear of stones.  Some doctors suggest mineral oil for constipation, but I would think that this treatment would be much better.
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Avatar_n_tn
the "hanging" thing could be what's called a sentinel pile, and is often seen with a fissure. Cortisone ointment doesn't usually do much. Nitroglycerine ointment is much better. If your doctor isn't familiar with using it, perhaps a referral to a surgeon would be useful. When the ointment doesn't do the trick, a simple operation usually does.
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Avatar_n_tn
am havin that same pain too. only thing i noticed is theres a small lump in the outer portion of my butt. checked with my doctor and told me that it was a muscle expanding evrytime i do my bowel. it gets painful when am havin a hard stool or too much bowel movement. sometimes it gets kinda itchy and irritating and i cant sit down too long when it happens cause i feel pain. am concerned with the lump....does anyone out there have had or has this lump just outside the anus. it worries me but the doc says theres nothing to worry bout.
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Avatar_n_tn
About a year ago i went on the Atkins diet and became severely constipated.  Bowel movements were few and far between and extremely large ( pardon the subject ).  As a result, i noticed blood on the tissue and experienced excruciating pain in my rectum.  I thought it was hemmoroids (hemorrhoids) and made an appt. with a surgeon.  He diagnosed me with an anal fissure and gave me a script that seemed to help some, along with 3-4 tub soaks per day which is kind of hard when u work full-time.  Finally, after dealing with not being able to sit more than a few minutes and all of the pain, i went back to him and he said "You need surgery",,,,it's called a spyphincterotomy.  Basically they sew up the tear in your rectum.  Ahhhhhhh,,,the relief,,,2-3 days post op on heavy meds (oxycotin) then darvocet for another 10 days and back to work within 2 weeks.  I could have really returned earlier but had like 300 hours of vacation..my advice,,,,don't go thru the agony,,,they rarely heal themself and just have it taken care of.  Good Luck,,,I know exactly where u are right now.
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Avatar_n_tn
Oh, also,,,,have had absolutely no problem ever since,,,,my surgeon told me,,,"do u know how many people have sat in that chair(across from him) and told me about the Atkins diet?  He said, after the exam  as soon as i explained my symptoms and told him about the atkins diet he knew exactly what he was going to find,,,and did.  Anybody out there going on the atkins diet, drink TONS of water,,,the dehydration causes the large stools.
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Avatar_n_tn
i notice a lump everytime i stress out my bowel movement but otherwise its not there...is this a muscle???
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Avatar_n_tn
well actually i just feel this lump sometimes when my stool is hard.......but at times i dont feel it there...weird but it gets me scared you know.......help anyone??? told my doc bout it and said it was piles or somethin to do with my diet......whheeeew!!!!
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Avatar_n_tn
Thanks for the reply.  I am so scared to have this surgery. I am only 26, but I don't see how I can go on this way.  Did you try anything else before you had the surgery, such as the nitro ointment?  How long did it take for the pain to go away after having the surgery?  Was the pain from the surgery worse than the fissure pain?  I'm not sure what I should do.  I am supposed to make an appointment to see a surgeon tomorrow. Thanks.
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Avatar_n_tn
I had an anal stretch 7 years ago this did not help.
A couple of years ago I went in to have a sphinkerotomy and decided at the last moment not to go ahead due to the risk of incontinence.
I am currently looking into having Botox as I have 5 fissures at the moment and the sphinker is totally in spasm and not responding to GTN.
Anyone had Botox????????????
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Avatar_n_tn
The pain after the sphincterotomy ( which is done under general anesthesia and u don't feel a thing )was GONE in 72 hrs.  What is causing your pain right now is tiny bits of feces getting into the tear in your rectum and burning like crazy.  Before my surgery it would sometimes feel like somebody had a red-hot poker ,,,weird subject i know, but damn,,,i know RIGHTsmm
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Avatar_n_tn
sorry,, ihit the wrong button,,,i was saying,,,i know RIGHT where you are,,,,i tried the nitro and prescription steroid cream
for 3 weeks, along with the sitz baths,,,very little relief.  It's such a treat to now be PAIN FREE AGAIN. I have to tell you, I was damn scared too,,,i am a 42 y/o guy and the thought of them taking a knife to you back there is damn scary,,,,but my wife is a nurse and she said,,,,it's a piece of cake,,,really was,,,,,i went to Denny's that afternoon and had grits and scrambled eggs,,was starving to death...then stayed on meds for a couple of days ,,,the third day post-op, i went to a poker party andd sat for hours with no pain.  Take care, there IS relief to be had.  Brad.
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Avatar_n_tn
Wish I could be sure you guys are talking about my symptoms.  I know this is somewhat of a gross topic - but I am desperate.   My symptoms are very inconsistent.   Feel good.  Next day for no reason start itching, then burning after movement with or without bleeding.  Severe pain after movement for several days.  The could be any or all of these symptoms.  Have been to 2 doctors [ one surgeon] with no relief.   Topical prescription ointments don't have much effect.   Hot tub baths are very temporary.   suppositories are out of the question.  Have just had colonoscopy with negative results.   surgeon says next step is anal stretching. [ unsure about this one ] One doctor blames something called portal hypertension which is effect of liver [ drinking alcohol] and or gallbladder dysfunction. Uncomfortable when can't go - scared of pain when I can.
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Avatar_n_tn
hello, as I have posted before the anal stretch did not work for me.
I have also had anal motility testing which did show I had a problem, have you had this done????????????
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Avatar_n_tn
I have had no other tests except as noted.   From the comments noted on this web site and others, I do not intend to submit to the dilation procedure - it seems barbaric and somewhat primitive for the new millenium.
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Avatar_n_tn
I can sympathise with everyone suffering from ths awful condition.  I was diagnosed 8 years ago with an Anal Fissure after childbirth.  After many visits to the doctor, and many prescriptions later, I was finally referred to a surgeon.  I opted for surgery and it did work for approx 7 years until my bowel habit drastically changed (a poor diet did not help) and it came back with a bang!  Back to painful, bloody bowel movements.  I now eat a healthy high fibre diet, drink plenty clear fluids and exercise and things are lookin up.  However I have to moniter things and avoid holding on when I need to "go" get my drift?
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Avatar_n_tn
Last year I had some stress in my life and my digestion got messed up.  I forced BM occasionally and created anal fissures.  I could fill the toilet with blood every time I had a BM.  I had a colonoscopy which was good because he found and removed a polup.  This was not my problem, just the fissures.  He suggested I drink Metamucal EVERY day and use a presciption ointment.  It cleared up within two weeks and I have not had a problem since.  Of course I still drink my Metamucal every day at dinner time.  I use the Wal-Mart brand.  I've tried others, including tablets, but they do not work as well.  I don't need the ointment either.  Just the Metamucal.
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Avatar_n_tn
A related discussion, suffering with anal fissures was started.
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Avatar_f_tn
I do have same problem also currently doinf sitz bath diltiazem ointment. The first day i put the ointment it helps a lot but aafter a while pain and spasm still on and off im still in pain just taking motrin for a relief nitro ointment didnt help and it only gave me headache its been 3 weeks now since i saw my surgeon. Dont know what ro do now pain is terrible please help.. Dlnt know if am going ro botux or surgery or just wait a little bit longer thanks
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