Gay man with inexplicable recurrent anal fissure

[2_to_the_n]

I have a recurrent problem with anal fissures between about 1 o'clock and 3 o'clock to the medial line. The problem typically presents itself several hours after anal intercourse, but almost never during. That is to say that sex is painless. We go slowly, very lubricated, and with great communication- except none of these factors seem to matter. If the problem does present itself during sex (albeit rarely) it goes from completely comfortable to a very slight stinging sensation immediately. There is no gradation from "comfortable" to "problem" and even "problem" isn't that bad if we just stop.

At this point the problem will generally seem to clear itself up within 3-4 days, sometimes longer.

Visually the fissure appears as an extremely superficial ~.5cm linear tear radiating outward, generally in the 1 o'clock - 3 o'clock range.  It appears that it extends slightly into the perianal tissue. The problem is clearly visible without probing.

What I don't understand with all this is the inconsistency of the problem. My partner and I have been together for years and we know each other. We generally have problem-free sex, so I don't believe this is a side effect. Especially since it usually happens with a bowel movement hours later. Visual inspection after sex shows no tearing. My diet is high in fiber and I am very regular. After the first 24 hours the pain is completely gone but I can still see the fissure. I have had anoscopy done and I've been told my anus/colon are perfectly fine. A referral to a gastroenterologist turned up nothing new. I have gone through the elimination diet under medical supervision across many, many weeks, so I am confident my diet does not have allergens in it that would aggravate my anus nor do I suspect IBS. I am tested regularly for STDs and they come back negative.

My only remaining theories is I have naturally dry mucosal membranes. This I know to be true to a degree, and somehow sex weakens/damages/dries the anal mucosa badly enough that bowel movements trigger fissures.

Any and all advice/suggestions are appreciated. This problem has also stumped at least one acupuncturist and a naturopath in addition to my GP.

[fororo]

HCD,

I had an anal fissure in November '15. I noticed a stinging sensation as I was bottoming for a guy. It lingered for two months, so I went to the doctor and got tested. I ended up testing positive for syphilis. At this point, the anal fissure was pretty painful. Getting penicillin shots immediately made the fissure begin to heal, but it still opens up from time to time (and I don't bottom at all anymore). I'm thinking about getting surgery.

Definitely go get tested, and make getting tested a regular occurrence.

[Mattyr99]

Yeah, Mr. Lucky is an idiot.

[icherub]

that's just your opinion. Anal sex causes no problem as long as it is practiced within reason

[Bonzal888]

I have the same exact problem and I'm a gay man as well. I've sexual partners in the past and I've never this problem, this problem arose with an ex of mine about a year ago and I've had difficulty with it ever since. It usually heals up within a few days and the actual fissure pain doesn't really come until about 24 hours after like he said. I would just like to know if there is something I'm doing wrong during intercourse and if there is a way to prevent this from happening cause it is quite annoying.

[hcd30320]

Hello thanks for posting. Have you had any relief? I am having the same issue. Had anything worked for you? I'm currently using Diltiazem ointment., I used it consistently for 4 weeks, recieved anal sex from a fairy large guy, taking it very easy and slow til I adjusted and had the fissure reoccur. Wishing I would have waited another 4 weeks. Any advice?

[CalGal]

You may also want to consider checking any lubricant you may be using. Product ingredients can change over time, or people can become intolerant to certain ingredients. It's not unusual for women to have problems with certain personal products even ones they've used for long periods of time. So it certainly wouldn't be difficult to assume the same might not be true in this case.

[reddawg]

Why would you think that your medical problem is "inexplicable?"

[mr.lucky66]

Greg seems  like have some sound advise. I just can't stop thinking about how anal sex isn't really a natural response, that is to say it's a big price to pay. all the best

[ggreg]

The way anal fissures work is, anal sex rarely causes them, rather some difficult bowel movement in the past does it.  Lots of people get them, usually heal by themselves.  But they can also take a long time to heal, which is what is happening to you.  It can take up to 8 weeks, so that's how long you have to be abstinent and also not strain when you pass waste.  Following a movement, use baby wipes to keep the area clean, soak in the tub a couple times a week.  Increase your water intake by a glass of water a day, eat cheerios with Acidophilus milk daily or eat 100 percent wheat toast daily, and add several easy walks weekly, for the next 8 weeks.  It will feel better within 3 weeks, but give it 8 weeks for it to totally heal, or else you will have to start all over again.

If this still doesn't produce good results, of course you should see your doctor, topical 0.5% nifedipine ointment prescribed by him should help it heal better.  The only reason it wouldn't heal is on account of your physical makeup, somehow the anal muscles are a little too active, and that medication will relax them, and it has other healing properties, too.  Over-the-counter medical products won't help very much, but if it hurts when you pass stool, a little KY jelly put on there after you shower should ease the discomfort, it's good because it's water-soluble.  Oily stuff just makes it harder to keep the area clean.

The reason you should abstain is not because it causes the fissure, rather it will irritate it.  Nothing wrong with your relationship or your sex life at all.  And just think how much fun you'll have in 8 weeks....that's real close to Valentine's Day...if you start today.  :)

[Jaybay]

Anal fissures can be notoriously difficult to heal.  Like mr.lucky said, you're going to have lay off the sex until it's healed.

[mr.lucky66]

You should not have anal sex and the problem should get better. How important is it? you have to choose.