How relieved I was a couple of weeks ago to discover your wonderful A.F. Self Help page! I'd had anal fissures before, and got through them slowly and painfully, but hadn't had any such problem for some 12 years.
Prior to that, the problem had arisen usually not because of hard stools but apparently as an aftereffect of courses of antibiotic (starting a week or two after the end of the course) which had presumably knocked out gut organisms that normally destroyed my proteolytic enzymes in the colon, so I was having a lot of gut pains & diarrhoea and passing soft stuff that presumably tended to dissolve the lining of the anal canal. A bit like shitting nitric acid, and it could feel like it too...
Various people advised me at the time to eat lots of live yogurt - something I was sceptical about because I reckoned that the stomach acid would knock out any of the useful bacteria in the stuff before they could get where they were needed. But in desperation I tried it when I eventually had to take another course of antibiotic, and in fact I didn't get the problem. That didn't *prove* anything of course, but at least it did give a ray of hope, which was reinforced when a year or so later I had to take another course of antibiotic and again I used live yogurt and had no trouble. Since then live yogurt (with oodles of chopped fresh fruit) has always been my breakfast starter (which I greatly enjoy anyway), and I was having no sign of a return of sores or fissures in the anus, even with the occasional hard stools.
But then I got caught during my stay in the Scottish Highlands this May. I had great difficulty 'going' in the shared bathroom / WC at the B&B where I was staying, so then had to find discreet places to 'go' out on the mountains during my walks, and sometimes I missed a day. Such a 'miss' resulted in one stool that was not only hard but unusually wide, and it stretched me a bit too much and 'did' it, causing me subsequently to have the exquisite pleasure of an array of razor blades torturing me in the back passage during certain of my walks.
Because my sphincter had tightened up since my previous fissure experiences, this confounded fissure kept opening up, and much of the time I couldn't even get a (clingfilm-wrapped) finger up to apply Preparation H or some old Germoloids ointment. I eventually went to my doctor, who, in the tone of his 'Congratulations!' exclamation, made it clear that he well knew the nature of the torture visited upon me. He looked up a report on the NTG treatment, which was completely new to him, and offered to try prescribing the ointment, though as yet having no experience or feedback about it. It took nearly a week to get the ointment because the chemist store had to make a special order for the normal 2% NTG to be made into the 0.2% version and put in a tube.
Meanwhile I'd started using a lactulose syrup (initially 15 ml twice a day, according to the instructions) as a stool softener, and this worked amazingly well. It's known side-effect, however, manifested in considerable abundance - flatulence. Now I suffer from inefficient digestion & flatulence at the best of times... Oh well... :-)
At first the NTG ointment seemed not to be doing anything, and indeed initially I couldn't even get it in at all, for the sphincter was so spasm-locked. When I did get it in, it was a difficult, slow and very painful business, which seemed to further promote spasm rather than release it, and seemed in view of the the acute pain I experienced then to reopen the fissure too, though with no blood showing. But now, after some 2 weeks of using the ointment, although there is still a little soreness that I can feel at times, healing at last seems to be consistent and is no longer being put back by my putting that finger up the back passage to apply the ointment.
To be honest, I have no idea to what extent the ointment is doing the trick or just the stool softener. I've reduced the lactulose to 10 ml doses, and expect to cut it out altogether before long (perhaps passing though a 5 ml stage). It'll be great to be down to my normal (though still excessive) flatulence!
It was once I was already on the NTG ointment and wasn't getting immediate relief of the spasms and was thus getting very concerned about the possible need for surgery, that I did a Web search on anal fissure, and so found your site. I wanted to see what sort of timescale was expected for recovery with NTG, which was something my doctor had no idea about, and of course I got all the answers I wanted from your site, and more. I think just having a much clearer understanding of the condition, and knowing something about the surgery options, helped clear out a lot of the fear surrounding the condition, which in turn helped reduce the spasms. I would say that just reading pages on your site has thus played a direct part in my healing process. Isn't that nice! :-)
I'm neither ashamed nor embarrassed (at this stage in my life) about having an A.F. problem, so have put a plug (with link) for your site on mine, in my Friendly & / or Useful Links section (there's a slight delay in getting the updated pages uploaded to my site, though, owing to a problem with my ISP). I would encourage others to do likewise. If we continue to hide within our embarrassments, we just help perpetuate the silly and inhumane taboo that our cultures put upon such subjects.
In the presumably unlikely event of your having cause to post anything from my report on your site, you are welcome to use my name and e-mail address, provided that you garble the latter to stop spammers taking advantage of it through their scanning your pages for e-mail addresses. For public airing, use the following address complete with decoding instruction:
deadphilipcowneptunethemystic.co.uk (please remove the dead cow) It took me a while to figure out that to use this email address you need to deletet the "dead" before "philip" and the "cow" at the end of "philgoddcow". It helps to notice his name and web site below. Jack
(Symphonic & Choral music by Yours Truly - you can hear it now! -- Crazy novels, short stories & poetry for downloading - and more...)
I've been very cautious and waited a while before concluding that this year's AF is fully healed. I give below a summary of the chronology of my AF and its healing. I'm sure that on any future occasion, unless the sphincter has become even more tight in the meantime, I should be able to considerably reduce the period of pain and of healing by applying the appropriate measures from the start. Also, because the 0.2% GTN ointment didn't seem to prevent sphincter tightness and spasms (though of course it may have made them a little less than they would have been otherwise), next time I'll ask for 0.4% GTN. I got no headaches at all with the 0.2% and would be prepared to try double-strength, reducing again to 0.2% if necessary. Another measure I'd take to avoid a recurrence would be to take a supply of stool softener such as Lactulose next time I go on holiday, so that if the bathroom / WC arrangements where I stay cause my backside to clam up and cause constipation, as was the cause of the problem this year, then I can get taking the stuff at once (and probably fart all the other guests to Kingdom Come!).
Also, next time round, the AF experience will be far less troublesome because, thanks to your AF page and all its contributors, I'm now properly informed and feel fully in charge of my situation, and would be able to choose among various treatment options as appropriate, without depending on a G.P.'s more limited knowledge.
My chronology is as follows:
19.5.00: The original injury, from an over-stretching hard B.M. while on a walking holiday.
24.5.00: A day of torture during one of my mountain walks. Blood on tissue and in bowl in evening. Started using Preparation H, which may or may not have helped.
17.6.00: Another day of torture on a long walk, after very gradual lessening of pain; 2 loose B.M.'s on the walk (unusual for me to have even one on a walk), the second with blood on tissue. About then, started taking lactulose (15 ml twice daily) to soften stools.
20.6.00: Got the 0.2% GTN ointment, but as the pain was getting less I decided not to use it unless I had a relapse, as I'd realized that the mere fact of sticking a finger up helped reopen the injury.
1.7.00: Another day of torture, so I started using the ointment (application before going to bed, and after B.M.s). Sphincter so spasm locked that I couldn't get it in at first.
Week from 3.7.00: Sphincter still in spasm much of the time. Getting the ointment up with a clingfilm-wrapped finger was usually a lengthy and very painful procedure, probably doing almost as much harm as good. The pain had changed from sharp razor blades to a sore burning pain. Was this good or bad? That's when I sought out the AF Page and got more at ease about the whole business. At the end of the week I decreased the lactulose to 10ml twice a day.
Week from 10.7.00: Pain & spasms steadily decreasing. It was also getting less troublesome (though usually still quite difficult and painful) to get the ointment up the anal canal. Stools still consistently soft with the reduced lactulose.
Week from 17.7.00: Oh no!! On Monday afternoon I was tortured by a prolonged intense spasm of the sphincter, the old injury becoming intensely sore once more. It came to hurt quite a bit even to fart. But over the following days the soreness steadily decreased; no blood observed at any point. The long hike on Saturday was completely devoid of arse pain - allelujah! :-)
Week from 24.7.00: Only a little residual soreness felt when applying the ointment and for a while after, except that twice in the week I had sphincter spasms which returned the soreness, but not enough to be a major pain event, and overall during the week it was only a slight soreness at times.
1.8.00: Stopped the GTN ointment. Although there was still a little residual soreness, I suspected I was perpetuating it by my sticking the finger up to apply the ointment.
6.8.00: My intuition was no doubt correct; remaining soreness dissipated over a couple of days after stopping the ointment, and on this day I stopped the lactulose.
It's now 8th August, and I'm confident that this injury is fully healed. May all who visit this site find speedy healing!
Three final words.
1. a heartfelt plea to anyone who may read this. We greatly increase our suffering from things like AFs by allowing ourselves to be hemmed in by social taboos concerning the anus. The truth is that if, in appropriate circumstances, you let it be known to friends and aquaintances that you have an anal affliction, the world doesn't fall apart, and, amazingly, nobody rejects or thinks ill of you any more than they would if you had toothache or bad migraine attacks. I understand that some (mostly young) people may have 'friends' who would make fun of them for their affliction, but what sort of friends are these anyway? Over the decades I've let go of certain 'friends' who sought to attack or belittle me for simply being my full self. They were a loss well worth making. I challenge those AF sufferers who have websites actually to include on their sites a plug (with link) for this site, just as I've done. The sky is still out there, the sun still shines, I haven't been struck by lightning (yet), and various people are being encouraged to stand up more for themselves because I'm doing so. Spread the message by 'coming out' yourself!
2. As a spiritual healer, I have a broader perspective on the issue of AFs. Although this would be regarded as mumbo-jumbo in the materialistic-reductionist viewpoint in much of orthodox Western medicine, many of our afflictions have a symbolic significance and purpose; they are means by which the higher consciousness is seeking to tell us of ways in which we need to change our outlooks and lifestyles.=20 Certainly my own AF came at a time when a 'Get off your Arse!' message was extremely appropriate concerning certain changes that needed making in my life, and the wonderful symbolism of sticking nitroglycerine up there quadruple-underlined the message! So, my suggestion, however outlandish this may seem to orthodox medics, is that when you have a chronic AF, quite apart from addressing the physical problem directly, you also need to look carefully at the way you're living and ask yourself, "In what way(s) do I need to get off my arse and make positive changes in my life?". For me, it was one of several motivating factors that converged recently to lead me into some very powerful emotional self-healing of an issue that has greatly constrained and limited my life so far (I'm nearly 58 now). If you apply this sort of view of your affliction, you can end up being actually grateful for having been given that painful experience to motivate you to improve your life. Isn't that nice! :-)
3. The Great Itch. Like so many other people with AFs, I used to get horrendous itching around the outside of the anus and in the perineal area. This got resolved in 1987, when I started getting what I could call the 'nitric acid effect', when apparently a course of antibiotic knocked out essential gut flora, resulting in my proteolytic enzymes coming out intact and attacking the anal canal lining. One response I had to that devilish situation was to give my bottie only two gentle wipes after a B.M., just to avoid anything getting dropped around, and then go to my washbasin and give the area a soap-and-water wash and very thorough rinsing. Fortunately I have long enough legs to make this practical. Very soon I was free of the itching, and it has never seriously returned. Of course occasionally I'd get a little bit of internal itching from a healing AF, but that's different and never lasted enough to be a problem.
So that's it, this time round. Thanks again, Jack and all who've contributed to the AF Page.
(Symphonic & Choral music by Yours Truly - you can hear it now! -- Crazy novels, short stories & poetry for downloading - and more...)