Your pages made interesting reading - even though I'm a retired doctor I always believe in self-help first. Here in Europe we don't see our patients as a downpayment on that yacht - in fact quite the reverse - we've long waiting lists and anything which gets a patient off our books quickly we like. That said I'm talking about my personal experiences, and not offering 'medical advice' and certainly don't want any follow up, not the least from litigious Americans. If you think I'd have problems then either don't post or change the details...
I’m a retired medic – this advice is from my personal experience only and is not intended to replace proper medical attention and is given ‘caveat emptor’ however, it’s what ‘cured’ me. I've also added in advice from friends and colleagues who either had a fissure or had treated them successfully. Anal fissures can be the result of Crohn's disease and other serious bowel diseases, so ALWAYS get a proper diagnosis first. Don't even think of self-diagnosis. I have a friend with Crohn's who has regular fissures that are directly caused by her disease - treating the upsurge in her Crohns is the main remedy... providing temporary relief to her fissure is secondary. If there's nothing else going on then...
Unless you’re a woman who’s recently given birth, or have inserted a foreign object into your anus, the most likely cause of your anal tear/fissure is constipation. There are two things you need to do
By the time you’re into muscle spasms and pain in between bowel movements you’re bordering on the need for surgery. Even as a medic I wouldn’t recommend surgery unless you’ve given every other option a good try. It's designed for extreme cases. It's also quite profitable if you're in a private healthcare system rather than a public one, so you may not get 'straiht' advice from a surgeon.
Nitroglycerin creams are very good if you are getting spasms but must be used sparingly and at the minimum dose possible. Alternatively the recreational drug ‘poppers’ has a similar effect, but is likely to have its main effect elsewhere in the body as it’s inhaled, only reaching the rectum and anus as one of its last ports of call – cue: headaches and palpitations. It can cause heart attacks. Avoid. Locally applied nitroglycerin creams can cause headaches and palpitations too, so use the absolute minimum dose – not the formulation used for heart patients. Check with your doctor/pharmacist as they may not be aware of the use of nitroglycerin for anal fissures.
Botulinin toxin (Botox) is an extreme remedy for extreme circumstances. It can lead to temporary minor incontinence. Make sure your doctor is experienced in using Botox for anal fissure, and not just for facial wrinkles.
Pain relief: lignocaine/lidocaine can cause hypersensitivity reactions but is good in the short term – never use for a protracted period, or if you develop itching – it can lead to you becoming allergic to something as common as washing detergent residues in your underwear! Some haemorrhoid creams can be applied using an applicator – if you are happy about inserting the applicator these are great. However the easiest way is to use suppositories. Suppositories are designed to sit higher up in the rectum than your tear or fissure probably is, so to actually coat the damaged area you’ll need to hold the suppository in the anus, without letting the muscles take hold of it and ‘pull it inside’, for about a minute. The wax will melt and coat your fissure. Use a suppository after EVERY bowel movement. Systemic pain relief such as Ibruprofen tablets work well. To promote healing you need to damp down the inflammation process – simple zinc oxide contained in most suppositories is actually good at promoting healing, but adding in a steroid such as hydrocortisone can work well – some suppositories contain them, but a good source is mouth ulcer ointment. This had the added effect of being suspended in a susbstance called ‘orobase’ which is like a liquid sticking plaster which coats and protects the fissure. It’s not intended for anal application so you’ll have to work out a way of getting it up there. Smearing it onto a suppository is a good way. Don’t use it for more than two weeks as it can eventually result in a thinning of the skin, which makes you more prone to tearing again. Hot baths are another good way of stopping spasms – your body is only trying to protect itself by spasming so don’t get obsessed. If you spasm after you’re ‘cured’ THAT is a problem, but it’s only like wincing to avoid a punch – protective if you’re getting punched – but it can become a nervous tic and continue long afterwards.
If the damage/repair cycle is going on and on – if you’re chronic I’d reccommend giving the system a ‘kick start’ - this is what one might call ‘homeopathy’ but a good strong INDIAN curry can temporarily inflame the area around the fissure, and this can get the healing process back on route (it worked for me). Inflammation is actually part of the body’s healing process, and draws healing chemicals, cells and fluids to the affected part. I say Indian curry as the spices used (eg turmeric) have healing and antibiotic properties – and are a better bet than thai curries which are often just hot. You’ll get ‘ring sting’ but it might just get you out of the cycle of heal/damage which is what makes a fissure chronic.
You MUST stop being constipated. My Gastro tutor at medical school said that if it took you longer to crap than to pee you were constipated (my urology tutor found this funny – he dealt with men with swollen prostates, he said that if it took you longer to pee than to crap you had prostate trouble!). Basically if it takes you longer than 15 seconds to crap than you’re constipated and need to do something about it. Or if your crap is more solid than runny oatmeal.
Take more fibre in your diet: soluble fibre is best as insoluble fibre (bran) is rough and can rasp the sides of your anus, and is more likely to irritate your fissure/tear. Try porridge/oatmeal and fruit - the less acid the fruit the better initially to avoid local irritation, but don’t skimp. Drink more: a litre on getting up in the morning (when you’re dehydrated), and probably 3 – 4 extra litres of water per day. The large bowel is very good at extracting water from the faeces within – and can turn them into a brick-like lump quite rapidly, this is guaranteed to injure your fissure. Being full of water means your body won’t want to suck any more out of your bowel contents. You’ll pee a lot, but it’s better than ripping yourself apart every day. Try Lactulose – this cheap, osmotic laxative, holds water in the bowel, making the stools softer. Initially it can cause flatulence, so adjust the dose to small, regular ones rather than fewer big ones. 15 ml two or three times a day is what it says on my bottle – and always a dose with every meal. You must compensate by drinking extra water as moving water from your bloodstream to your bowel can cause dehydration – this can lead to headaches (similar to ones you get if you exercise or have a sauna without drinking fluid to replace that lost). Remember coffee and alcohol are diuretic and make the body lose water so either cut them out or drink more water. Actually I found that coffee speeded up my bowel motions and just factored in an extra litre of water a day... Lactulose and fibre can both increase the amount of faeces you’re passing – if you find yourself crapping three times a day eatless, or adjust your fibre intake. One girl I know went on a fast – water + vitamin tablets for a week, then gradually added in oatmeal and fruit. She spent that week at home relaxing and meditating, in a warm environment, with a caring spouse. She really made fast progress. Don’t do this unless you’re sure you know what you’re doing or have medical advice!
You must NEVER get constipated again, even when you are ‘cured’ so keep on drinking water/eating oatmeal/taking lactulose even if things are going well. If you get constipated again you will rip again. Avoid straining when you crap: in fact avoid straining at all – stop going to the gym (I’m a sportsman and had to give up all but the most gentle of exercise for 3 months) anything that increases intra-abdominal pressure is a no-no. Even playing a wind instrument can put pressure on your fissure (give the trumpet a rest). If you can’t go to the toilet without straining (if you’ve followed the above rules this shouldn’t be a problem) try a glycerin suppository – (this is not the same as nitroglycerin) gain control of your bowel. This is an easy, gentle laxative, which has the added benefit of ‘lubricating the passage’ and letting stools out more easily. Try to train yourself to crap at the same time each day, when you’re at home preferably – glycerin suppositories can help this. Any greasy/oily suppository or cream will halp - which is why you often read about strange cures - it's more likely the lubricating function of the cream/dietry supplement that works. I met someone who swore by that margarine that contains a non-digestible fat - it makes the stools very fatty and provides its own lubricant. In fact if you take a lot of this it can lead to oil trickling out of your anus, lubricating your pasage, but with an unpleasant side-effect. Aim for one big, soft bowel motion a day, that takes less than 15” from sitting down on the job to completing the paperwork! Use moist toilet tissue if your tear extends to the outside.
Progress: expect setbacks – healing is a gradual process – the anus is a part of your body that gets daily use, and is in contact with a lot of germs and noxious substances. Hopefully after each setback you’ll start off again on the route to healing from a better position – a sawttooth curve. If you’re not ‘cured’ within 6 months you will need to see a surgeon. If you are really anal about water, soft stools and not straining you’ll probably be healed by then. But remember you have a weakness ‘down there’ so never get constipated again or you stand the chance of going back to first base...
Hope it helps. The main thing is to keep your pecker up and not to get sloppy with taking care of yourself even after you're cured. If you go skiing or hiking, carrying that extra water is essential.