Anal Fissure

Hello,
I was diagnosed with an anal fissure about 10 years ago.  I have had it off and on since then.  I am now 31 years old.  I will have a month or so go by with no symptoms except maybe a very very very slight amount of blood from excessive wiping after bowel movement.  And then there are times where I will have a lot of bleeding for a week or so.  However, isnt it true that the actual amount of blood in the toilet and on paper will seem like more since it is mixed with water and fluids?  Two days ago I had a large dry stool which opened up the fissure and it bleed a lot.  Since then I have been drinking a lot of fluids and trying to add some fiber to my diet.  It is not horribly painful. I can only feel a slight tearing at times.  I notice the blood in the toilet and on paper.   Sometimes a lot and sometimes none at all.  I have a couple questions.  First, what can I do to help eliminate this problem Ive had for a decade.  Ive never taken any measures in the past to fix it.  It always fixed itself.  I recently orderd some wheatgrass cream that I heard was good.  What do you think?  Second,  if I decide to let it go is there any real health risk?  Im not going to have any surgury to correct it unless there is a serious health risk.  I feel there are many other ways to correct it without surgury.  Thanks for you help.

Take Care

[Kevin Pho, MD]

You would want to ensure there isn't anything else causing the bleeding other than the fissure.  This can be evaluated with a flexible sigmoidoscopy and/or colonoscopy as well as a rectal exam.

If the fissure is still present, topical nitroglycerin ointment can be considered.  If that doesn't work, one can consider more specialized therapy like botox injections or oral calcium channel blockers.  Surgical therapy would be the last resort.

These options can be discussed with your personal physician or surgeon.

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.

Kevin, M.D.
kevinmd_

[maryheather]

I have also had problems with a fissure.  
My doc told me to take warm baths as much as possible.  She also told me to use an OTC product called Anusol-HC.  If this doesn't help, there is a prescription you can get.  Additionally, I try to put as much fiber in my diet as possible, because my problem was loose stools that caused me diarrhea...and the increased wiping was making the fissure worse.
My doc has never mentioned needing surgery, however I know that it does exist.  
And yes..from experience, the blood in toilet looks like much more than it actually is.  
As a matter of fact, I had my first colonoscopy yesterday due to bleeding that resulted from a fissure.  I am a healthy 33 year old.  Everything was fine, just the fissure that had healed on its own.  
Good luck, and hopefully the doc here can give you more advice.

[dog123]

thanks for the help maryheather.  I think i got my recent fissure from dehydration.  I usually drink 10-12 8 ounce glasses of water a day and i was only getting 5-6.  I think it will be something i will have to deal with but at least i think i can manage it.