Anal Fissure

While an anal fissure is not specifically a WLS-related issue, it can be exacerbated by WLS-related issues (constipation, diarrhea) and can devastate your quality of life. I have worked out (tailoring a treatment regimen from recommendations on the internet, in consultation with my colorectal surgeon) a medical (as opposed to surgical) treatment for anal fissures. I strongly urge anyone who has a fissure to try it BEFORE surgery, and to do so as soon as you know you have a fissure. Don’t suffer needlessly!

This is a MEDICAL (rather than surgical) course of treatment for anal fissure that worked for me!

I should preface this with the fact that when my anal fissure was FINALLY properly diagnosed in 1995 (after THREE YEARS of incorrect and humiliating and painful treatments), the treatment was surgery, a sphincterotomy — which is slicing the anal sphincter to stop the spasms and allow the fissure to heal (I think they also cut the scar and granulomatous tissue of the anal fissure to provide clean surfaces to heal together as well). That was the WORST surgery I have ever had, and the most painful — and it was OUTPATIENT. I will freely admit that it DID cure the fissure, and I was pain-free for 10 years after the excruciating recovery period — I needed demerol pills for several days after that surgery, it was that bad.

When I got my second fissure in 2006, I obviously was more educated and aware about them. Before I even went to see the colorectal surgeon, I did some intensive internet research, and went to the surgeon with a MEDICAL course of treatment I had found (well, modified from my research). This was particularly important to me because I had learned that doing a second sphincterotomy is a BAD idea — you greatly increase the chances of fecal incontinence, and as a DSer, I occasionally need to exercise good sphincter control if I eat something that gives me gas or loose stools! I got him to agree to try my plan, and when it worked as well as it did, he said he was going to modify how he treated other patients!

This is what I did, which healed the fissure in 10 days:

Nitroglycerine paste: I believe this was a 5% formulation that had to be made up by a compounding pharmacist. Use a pea-sized dollop, applied directly to the fissure. Nitroglycerine is a muscle relaxant that calms down the spasms of the sphincter, which helps the fissure heal (rather than doing it surgically by sphincterotomy). It also is absorbed through the mucous membranes, so the first couple of times you use it, you should be at home in case it gives you a headache or makes you feel light-headed (as you probably realize, nitroglycerine is a heart medication). Use twice a day, AFTER you go poop.

Nifedipine pills: This is a heart medication that is also a muscle relaxant. I believe the dosage was 10 mg, taken twice a day orally — as I recall, we opted against the time-release version due to the malabsorption. This supplements what the nitroglycerine does topically. Again, if you don’t have high blood pressure, this treatment can make you feel a little lightheaded, but it should go away after a day or so as your body adjusts, and compared to the pain of the fissure, it is an acceptable side effect (to me). It can also be used as a topical treatment, which is what I first suggested to the surgeon, but he thought there was already too much medication being applied topically, which might prevent all of them from working well, so we opted for parenteral administration of this one, and it worked.

Lidocaine gel: I recall this was a STRONG prescription, 5%? Or, you can buy it over the counter at a sex toys store or online as Anal-Eaze (yes, used for what you are thinking). You want to apply this gel BEFORE a poop to numb the pain, and then afterwards as well (after you apply the nitroglycerine paste). Again, this medication is absorbed through the mucous membranes, and should be used sparingly, because it can affect your heart rate.

Sitz baths: Or some equivalent, at least twice a day. I used a hand-held shower massage to get warm water directly to the area in the AM, and hot tub at night. You want to increase the blood flow to the fissure and thereby promote healing. Plus it makes it feel better.

In addition, you want to be particularly careful to not get constipated, to not strain while pooping (follow the mantra to just “let shit happen”), and to not pull your butt cheeks apart too far on the toilet — a habit some of us get into to avoid the loose skin on the butt getting in the way, and also because it “feels” like that helps get the poop out, but which puts tension on the skin of the sphincter and can tear the healing tissue.

When I returned for a checkup after 10 days of this treatment regimen, my surgeon was amazed at the fact that the anal fissure was almost completely healed. And, I should note, it hasn’t returned (knocking on several wooden objects).