I am a fifty-two year old male Caucasian and tend to get at least one minor anal fissure per year. I realize now that I've always had them off and on, even as a child. My parents and others used to tell me I had a pile so I probably wasted much effort with tubes of useless ointment over the years, although those ones containing anesthetic at least relieved the pain.
In addition to water intake, fibrous diet and the rest I find it helps to give the area a good coating of petroleum jelly immediately prior to a bowel motion. If I feel an impending motion is likely to be large I put a substantial blob of vaseline on my finger and spread it around as far inside as I can manage. It goes without saying that I wash my hands in strong antiseptic before and after. My fingernails also happen to be very short and blunt; I don't think doing this would be advisable otherwise.
I usually give it a week; if it hasn't improved in that time I get some Ultraproct suppositories from the doctor. I have found suppositories much more effective than ointment for me. The doctor has indicated that I can have minor surgery which would probably stop fissures altogether but it seems a bit out of proportion in my case. The fissures have been in different positions and even the biggest of them has responded well to Ultraproct.
After talking about it to many people, I think that somebody who has never had a fissure is a rarity. Many mistake them for piles, which for some reason people find easier to talk, even boast about. In my case it is practically certain that a large intake of chocolate will stand a good chance of producing a fissure within a day or two. I don't know why and neither does the doctor; I just know that it is true for me. It's probably a similar situation to mouth ulcers. The pain is much greater than the seriousness of the condition and so little research is done. Twenty years ago I used to get large, excruciatingly painful mouth ulcers. Every time I accidentally bit my mouth I'd be in for two weeks of pain. Now I hardly have any and those that do occur don't grow large and aren't particularly painful. Chocolate again perhaps? What's true for one end might be true for the other. I don't know, but your page is an excellent idea; doctors and researchers seem too busy to spend time thinking about conditions which aren't likely to be fatal.
The chocolate association came about because I used to have fissures in the Christmas holidays and in August (after my birthday). For some years people had given me large bars of chocolate on these occasions. Even then I didn't make the connection until 1997-1998 (a particularly bad time for fissures) when I suddenly realized my newly acquired habit of buying bars of chocolate on the way home from work and eating them might not be such a good idea. With much reluctance I eliminated chocolate from my diet altogether last year. It is not the whole story because I have had one small fissure since, clearly due to a titanic bowel motion following decidedly immoderate consumption of pizza, but for me it is a definite causal factor, of that I am certain.
I have the tube right here in my briefcase - Nyal Coldsore Cream - active ingredients menthol and camphor in a special unspecified base. The pharmacist told me this preparation is now unavailable in New Zealand so when I've finished this tube I guess I'll have to get something else.
Two weeks ago I unthinkingly consumed what was in total a substantial amount of chocolate from various food sources over a couple of days. A small fissure appeared about five days ago. It's nowhere near as bad as others I've had so I'm optimistic about treating it with Ultraproct suppositories and a good diet. I'm really quite certain about the chocolate factor now, at least as it pertains to me. I don't have a clue about the process involved and neither, it seems, does my doctor.
The last sixteen months have been good - no fissure, no doctor, no ointment. While I am sure about the chocolate theory for me, there appear to be other aspects at least as important. In retrospect, I was too ready to accept my doctor's assertion that size and frequency of bowel motion don't matter as long as the stools are soft. I now think it does matter, at least for me. If I take Metamucil in any quantity I produce two or three massive motions a day - how can these possibly help prevent or heal a fissure, even if they are soft ? Now if I were the sort who became regularly constipated, then yes, there might be some sense in it. However, I'm as regular as clockwork - always have been - constipation isn't an issue.
In my naivety I began to wonder if my body was trying to tell me I should simply eat less. At 55, it becomes imperative to exercise well and eat wisely. I have always done the former but perhaps I was eating a bit too well - big daily meals - big daily bowel motions - fissures. Well, since my last post here I have simply begun to eat less. Not stupidly so - I have a decent dinner and lunch but I don't finish all the casserole, roast, spuds or whatever delicious treat may be on the table just because it's there. I'm still regular but the motions are smaller - precisely the opposite of what my doctor said - he insisted that a motion builds up to a standard size and only the frequency of expulsion changes. I have found this to be incorrect (for me) - I stay regular with smaller motions.
Okay, so it's been nearly seventeen months - the last month I've begun to enjoy a bit of chocolate again - now we'll see ! This will be interesting.
Patient 24 here. In the several years since my first correspondence I have proved several times the relation with chocolate, at least for me. Each time I have consumed a bar of chocolate after having had none for months and found myself with a fissure a day or two later. I haven't the faintest idea why this peculiar association should be the case but the correlation is now beyond doubt. The fissures themselves have always been in the mildly painful nuisance category and invariably clear up after a week or two of ointment and careful eating. Fortunately these ointments are now available over the counter here (Proctoseydl and such) and I haven't bothered the doctor about fissures for years.
There is, however, an apparent contradiction about the use of these ointments. They all stipulate on the packet that one ought to use them sparingly and for no longer than a week. My doctor, on the other hand, said it is important to use a generous enough amount to make sure the ointment gets on the fissure. With experience I can now feel exactly where a fissure is and use my clean finger rather than those applicators, which get the ointment all over the place - usually too far in. He also told me to always keep on using the ointment (Proctosedyl or Ultraproct) for several days after symptoms disappear. Exactly what is supposed to happen if you use too much I have not been able to ascertain as yet.