Please withhold my name and e-mail address if you use this on your web-page
First, let me thank you (who ever you are). Your web-site and its contributors has allowed me to return to a healthy and pain-free state *without* surgery. For this I cannot thank you enough. I'm writing to offer my own story, and hopefully some helpful advice and information that might help others who suffer from this wretched condition.
I am a 36 year old male. I was recently diagnosed with anal fisures after I switched doctors. I had come to this same conclusion two years ago after reading your excellent web site. My diagnosis came after years of trying to treat the "hemoroids" that doctors thought I had. After going through this for several years, I can only echo the excruciating pain, bleeding, angst, issolation, suffering, and pre-occupation that others on your page have described. My condition had gotten to the point where I was uncomfortable most of the time, especially while sitting, walking, moving, coughing, sneezing, laughing, etc.
I had all but given up on the medical profession after being painfully examined and run through needless proceedures (including sigmoidoscopy) while doctors failed to understand my problem.
(Note: these are my theories only... consult physician, YMMV, etc.)
- I have come to believe that you don't so much heal the body as bring the body to a point where it can heal itself. I don't particularly believe in miracle cures. I've tried to look at anal fisures in this light. - After what I've read, I think that it is common for most people to suffer small anal injuries at some point in their lives. For most, there is some temporary discomfort followed by healing. In some of us, these injuries don't heal and become painful fisures which are constantly re-injured (torn) with each bowl movement. Stopping this constant re-injury is the key!! - I also seem to suffer from a wierd thing which I think is Proctalgia Fugax - a spasming of the autonomic sphincter... This strange and uncomfortable condition sometimes wakes me in the middle of the night and keeps me up for a while. This condition may contribute to lack of healing of fisures.. or may be caused by it. Note: I have not had this since I started using the Nitroglyceryn (see below). - I'm actually confused as to how surgery can help with anal fisure. If an injury is not healing now, how will you heal from the surgery? Perhaps it is helpful in extreme conditions but it sure sounds risky/painful to me. I have found that most Doctors like to move to surgery quickly... they "solve" problems and make money. My new doctor wanted to re-evaluate for surgery after only *a week* (again, I've had this for years... what's the hurry?). - On the workings of Nitro...There has been much noise about the effects of Nitrogen on blood flow (see Nobel prizes from last year and the Viagra debacle). Nitro does seem to relax the Autonomic Sphincter (the one you don't control). This may be why it has helped with the Proctalgia Fugax. Also, if the Nitrogen absorbed by the tissues increases blood flow, perhaps it aids in healing.
(Again, I'm not a doctor... I don't even play one on TV.... consult your physician, etc.)
So, the basic approach is to keep from re-injuring yourself and allow your body to heal naturally. This is best done by softening the stool (diet and stool softeners). In addition, application of .2% Nitroglyceryn ointment seems to aid in healing. This approach may take some time... some of the Nitroglyceryn trials I have seen quote six to eight weeks. Today I am pain free after three weeks of doing this approach!!! Each of these things would be good by itself but I think the power in this approach is in the combination.
1) Change your diet, eat *lots* of fruits and vegetables Eliminate or cut down on read meats. Eat regularly (don't fast, skip meals, etc.) 2) Take a fiber supplement (Two tablespoons of Metamucil per day for me, one in the morning, one at night). Note: I did this by itself for a couple years with no long-term success. Only when combined with the other things did it seem to help. 3) Take a stool softener. I take a generic from Walgreens Each liquid cap is 100mg of Docusate Sodium. I take two in the morning and two at night with my fiber. This is twice the recommended daily dosage but I was desperate! Note: Drink *lots* of water if taking a stool softener. Stool softeners work by pulling water into the bowel so you need to replace it in your body. 4) Apply .2% Nitroglycerin ointment digitally *inside* the anal canal. I did this at least three times/day and/or after each bowel movement. You learn to wash your hands *alot*! This may be painful at first but becomes easier as you heal. I don't think its essential that you put it *on* the fisure... just get it inside. Note 1: Most doctors will not have heard of Nitro. You will have to persuade them to perscribe it. My doctor had read some literature but I had to talk him into prescribing the stuff. His comment was "well OK, I guess it won't hurt you" (doctors don't generally like to be told what to do). Note 2: The pharmacy filled my first prescription for .2% Nitroglycerin with 2% Nitroglycerin (two percent vs. two tenths of one percent). This is because .2% is not yet commercially available. They didn't notice!! I did, and refused the perscription. 2% is a *VERY* high dose intended for heart patients and will almost certainly give you severe instantaneous headaches. Have your doctor instruct the pharmacy to cut the Nitro down to .2% Note 3: Even with the proper .2% Nitroglycerin, you will have to experiment to find an amount that doesn't cause headache. The first time I tried it I ended up in bed for hours. After using smaller amounts more frequently I have been able to avoid headache. You may also feel some "heartburn"... remember that Nitro is used for heart/angina patients (yet another reason for talking to your doctor). Keep trying! 5) Get some exersize!! This can be walking, running, cycling, swimming, etc. Exercise helps keep you regular.
Don't give up! I initially had a couple pain-free days and then had a very painful setback. I tore again and had more bleeding and pain. This was very discouraging but I kept at the above regimin. I now feel almost completely normal. After so much time it is a wonderful feeling indeed!
Thanks again for your help and I hope this helps others.