Guide for DEEP chronic fissures (2 weeks)

I'm a male 24 yo and I've been dealing with chronic anal fissures for about 3 1/2 years now. Unfortunately mine tend to be very deep when they happen, they bleed a lot, and some have been down to the muscle fibers. Obviously this is extremely painful and debilitating, but throughout this time I've been able to find ways to heal even the deepest fissures that bleed heavily in around 2-3 weeks. I wanted to share because the Internet has helped me a lot throughout this time (we all sit and read as much as we can possibly find about this condition when it happens). Here are my steps for you.

1) MIRALAX or generic propylene glycol. This is an osmosis laxative and draws water into the colon to soften Stool. It is safe even long term (I've been on for over 3 years) and doctors use it for children. It's non habit forming, almost none is absorbed into the blood or processed by the liver (don't believe the scare sites that are out there about propylene glycol, it is not metabolized by your body and passes through pretty much unmodified). Take 1 full cap of this daily to start, or move up to twice daily after a few days if necessary. Aim for a soft serve ice cream consistency of stool. *this allows you to eat whatever you would like while you have a fissure (no nuts or seeds though).

2) Magnesium Citrate. This is another stool softener that is very safe and helpful (most people are deficient in magnesium anyways). I recommend taking 400mg daily in the evening, you'll find many brands online.

3) SQUAT. No more sitting on the toilet conventionally, this puts a kink in your Rectum and makes full elimination more difficult. Squatty potty makes a small stool that helps elevate your feet into a squatting position on the toilet, or if you're nimble enough, just place your feet on the toilet rim and squat over the toilet. Bonus tip: Place your hands on the toilet and lean slightly back when in this position almost like your reclining in a chair, this will take the stools pressure off the posterior part of the Anus (where most people have a fissure) and put pressure on the anterior when going.

4) 2% Diltiazem. This is a calcium channel blocker that comes as a cream and works topically by pulling blood into muscle and relaxing it. This relaxes the Anus and stops the spasms that occur after going to the bathroom. It is great for pain control and helps with the pain from walking by relaxing everything, and will heal even deep fissures within a few weeks time. Use as long as possible, it takes over a year of healed time before the Anus recovers 50-60% of its strength back so use this daily 2-3 times for 6 months or more if you can.

5) NO supplemental fiber. This is a big one for initially healing a fissure. This goes against what every doctor will tell you, and for good reason. You will need lots of fiber later on, but not initially when healing the fissure. The reason is this... Fiber supplements like psyllium bulk the stool, even though they soften things too. This bulking is counter productive because you're trying to heal a cut. Your stool is constantly stretching this area and tearing it, even soft stool will do this when it's bulky. Try to get as much fiber as you can through your diet, this can be anything from cereals, whole grains, fruits, beans, vegetables, etc. Fiber from food don't seem to bulk the stool like psyllium supplements will (at least in my experience).

6) Vaseline. This is gross but will help immensely, especially if your stool is on the hard or bulky side. Right before you go, put a little Vaseline on your little finger and get it up in there. Squat over a small mirror. This will help the stool slide right out with much less pain or irration. This step is a life saver if you're constipated.

7) Baby wipes. Much less irration, however many are not safe for sceptic systems, so it's preferable to just wet the softest toilet paper your can find before wiping.

----LONG TERM----

Try to lower your dose of Miralax gradually after a month or so of fissure healing (no blood, little pain) to 1 cap a day for 5 days, then 3/4 cap for 5 days, the 1/2 cap. You may find you need a 1/2 cap or more for many months and that's perfectly fine, it's non habit forming for the colon. You're going to want to start introducing supplemental fiber at this point also, because it's very difficult to hit the daily intake of fiber with food alone, every day. I like organic psyllium husk (NOW organic whole psyllium husks is great and cheap online). Id recommend 1 tbsp morning and night long term, but introduce fiber slowly, start with 1 tbsp a day for a week or so and then slowly move to 2 a day. You don't want to bulk the stool too quickly or you will tear the fissure open again. I would highly recommend taking the 400mg magnesium daily long term as well, there's no down side to this and it will always help to soften your stool. Stock with the diltiazem for as long as possible, I would use it even 3-4 months after the fissure healed because it's helping to blood into that tissue at an increased rate and help heal internally.

Some other suggestions of things that can help:

Enemas may or may not help you, organic Virgin coconut oil is a great Topical with antiseptic properties, Topical zinc creams can be helpful and promote faster wound healing, an oral zinc supplement (orotate/picolinate are most bioavailable).

THAT IS IT! I will go as far as to promise each and every one of you this will drastically help you with your fissure. With this routine I've healed at least 15 fissures, many extremely deep, in less than 2 weeks. The key with any fissure is persistence, and patience. Unfortunately mine come back when I have a night of drinking or forget to take magnesium, etc. But right now I'm making a conscious long term effort to stick with my steps because they really do work. It can feel like a curse dealing with this problem, and I want you to know that there is hope for you (without surgery) no matter how bad your fissure is. It just takes time and commitment to these types of life changes. Keep on keeping on!

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