Patient 53

Date: Wed, 17 Nov 2004 08:54:29 -0800 (PST)
Subject: AF Pages: cure it physically
To: jack1faf6.arc.nasa.gov

Dear Jack,

What a great deed you are providing by maintaining all this information on your site. Thank you! Here's my story and I think you should publish it:

I have suffered from an anal fissure since May 2003. Of course, it got misdiagnosed by me and my internist as hemorrhoids. The treatment with cortisone ointments did not help. In fact, I believe that hemorrhoidal treatments are counterproductive on fissures: Cortisone causes thinning of the skin and other active ingredients reduce blood circulation in the treated area when you need increased circulation to foster healing!

When the fissure got worse after about a year, I went to a different physician who again diagnosed just the normal hemorrhoids (that everybody has without complaints) but transferred me to a physician to do surgery on them. Finally, this guy diagnosed me correctly with a fissure and I used the Nifedipine as prescribed by him. It helped somewhat, but it did not heal the fissure. However, knowing what bothered me, I finally did some research on my own and found your excellent site and other information.

I have to say that some of the patient stories are very grave and that I probably suffered much less than some of the reporting patients. However, my fissure did not heal properly either, so I considered my options and did some thinking. I came to the following conclusions:

1. I don't want to change my lifestyle and organize my diet and everything else around my fissure. I want to heal the fissure for good, keep eating meat, dairy, and spicy food, and I want to keep working out.
2. I don't want to keep taking stool softeners for the rest of my life.
3. It seemed that the only option left would be surgery, but I did not feel comfortable with that either.
4. Fissures are very much a physical problem of the size of the anus (being the smaller of the diameter of the skin and the muscles) being less than the size of the stool that has to move through there. Hard stool tears the skin (the muscle will not tear) when it is too big because it won't shrink before passing through. No wonder people get a fissure when they have their first bowel movement after longer constipation. However, people also get fissures when they change their diet or when they recover from diarrhea. Why is that?

My theory is that both the anal muscles as well as the anal skin grow and shrink to accommodate the size of the passing stool. The patient accounts would suggest, based on this theory, that you heal your fissure by making your stool very soft initially so that the healing fissure will not tear again and then slowly get back to normalize the hardness of your stool, this way slowly expanding the maximum size of your anus without tearing the skin. If you succeed, you should be fine.

Unfortunately, irregular hardness of the stool is hardly avoidable for many people, given the ups and downs in stress level at work and the variety of food choices which no foody will want to pass on! Now we get to the part of my account that is new to this site:

Taking control over the anal expansion with dilating it the slow way!

I got the idea from reading some German sources on anal fissures, where anal dilation, performed on a regular basis by the patient him/herself at home, seems to be presented as a standard treatment, yet it is not being mentioned even once on this site. Is it because Americans are prudish and think that could impossibly be an appropriate way of treating yourself?

Anyway, I went ahead and used standard issue sex shop, smooth-surface, hard-plastic dildos of increasing sizes and personal lubricant from the drugstore to slowly expand the maximum size of my anus without causing too much pain. I did this every day before going to sleep and after working out plus any time that I felt that the muscles were cramping up. The treatment always had a relaxing effect on your anal muscles, just as a healthy bowel movement should have. (Remember the good mornings before the fissure?)

In the beginning, the dilation caused a little bit of bleeding, but much less than from the bowel movement the same day. The explanation is simple - the hard plastic with lubricant hardly exerts any friction on the skin, and there are no hard particles that could tear tissue, either. Most of the discomfort was not caused by the fissure being irritad but rather by the muscle being expanced to a size unknow to it in recent times. However, it is important not to be brutal to your anus because you don't want to increase your fissure. Some accounts on this site about dilation by physicians are truly scary and are not what I am suggesting!

Dilating the muscles and the skin the gentle way, I was able to gradually increase the size of my anus to some normal size that will let my stool pass, no matter how hard it is and how many pieces of nuts and pomegranate and cactus fig kernels are in there. Skin and muscle have simply accepted the size of the dildo as what they have to accommodate and they expanded by building the extra tissue. It is important to understand that you are going to risk getting problems later on when you allow your anus to shrink again (through having diarrhea, constipation, fasting, change in diet, or else) - it will reduce skin and muscle tissue and will tear if you suddenly have to pass fairly hard stool through it again.

Anyway, these are my 2 cents worth, and I would hope that some people give it a try to see whether it could work for them. My account alone hardly makes a sample to test my theory!