My experience with a chronic anal fissure

I fully sympathise with your report. In my case the fissures have not responded to botox injection, followed by GTN and (new not yet licensed in this country but allowed for colorectal surgeons to use in their clinics) Diltiazem. I am doing regular camomile sitz baths. I meditate and do, when possible gentle Yoga exercises. I ised to be very active: cycling, swimming, running but had to give this up now. I am not in stressful situation in my life - apart from the persistent anal pain. Bowel movements are only mildly uncomfortable for me but I suffer agonising pain when walking or bending down.

The only pain killer that gives me temporary relief is Codeine. Paracetemol or Ibuprufren are useless, so is Tramadol.

I know of the addictive potential of codeine, but are there any other considerations why this should not be taken?

Codeine or any other opioids will cause constipation, which is exactly the most important thing you want to avoid with a fissure, so avoid if at all possible. Softening the stool is the whole aim of treatment - may assist with healing and avoid worsening the fissure. Fibre, fluid & stool softeners all the way!

Hi, I’ve recently been diagnosed with CAF following admittance to local hospital via A&E. The pain has worsened over the past 8 years. Through embarrassment and fear of something worse (I used to work in the furniture manufacturing industry and can name about 20 former colleagues who have passed away with bowel cancer) I couldn’t or wouldn’t visit the GP. Following surgery, biopsies and Botox 3 weeks ago, the pain has eased but not gone. I experience pain following a bowel movement, extreme pain if I go more than once the same day. I have tried to pin point within my diet trigger foods/drinks and trying to avoid. No pain killer will ease it, paracetamol, ibuprofen, codeine or tramadol. When I was admitted, the only thing what would ease the pain was morphine and that was only after 40ml. That’s a lot from the medical web sites I have trawled through. Anyway, my question to go out there is, food and drink triggers. Who experiences triggers through this and what to avoid. I know were all different but I need to start somewhere. This has seriously affected my day to day life with both work and home life. I am currently off sick due to the pain and this is my 3rd week off, the longest period of sickness since 1993. Thank you for any advice.

I am currently suffering with my second bout of CAF. The last was 12 years ago and I think was related to stress and exertion. It lasted for around a year and cleared up after using GTN. This time it came on after a severe episode of constipation. This was back in August last year and have been suffering ever since. My trigger for the constipation was popcorn.

This time around its much more painful (and I mean really painful, so much so that when I had a septoplasty operation last week it helped take my mind off the pain!). I am active, healthy with a good diet and drink plenty of water. I have been eating paracetamol and ibuprofen for fun but not with any success. I have tried paramol sparingly but cautious not to cause constipation. This time around I have tried GTN for months but the condition has been getting steadily worse. I had a very painful examination by the colonic specialist who said there was nothing sinister as an underlying problem but shrugged his shoulders as to the anal fissure itself! I have been back to the GP several times and am now on Diltiazem. I am hoping this works better than the GTN as I have read up that Diltiazem is much better than GTN as clearing up CAF. The Diltiazem is supposed to reduce the internal sphincter pressure and increase blood flow to the area much better than GTN. So far no headaches as I got with GTN but I have mild fecal incontinence and lightheadedness as a result of the Diltiazem. When I mean mild, if I have to go, I haev to go there and then and the muscle tone in that area is "slack" meaning its difficult to "end" a poo if that makes sense.

Currently off work for 2 weeks following the nose op but I was hoping for some respite from the CAF as well as its become unbearable for me at work. The latest GP I have seen is the most sympathetic of the lot and will sign me off for the CAF if I need it. What I am afraid of is that if I extend my sick leave I might stay off for month the pain and discomfort is that bad.

Trying to be positive.....

Hi there, sufferer for over 13 years, my triggers are sweet corn, seeds or seeded bread and also pizza base. Hope this helps. I had a sphincterotomy about 5 years ago and up until recently it had helped, I had a severe infection in my arm( nothing to do with the fissure) but I was on IV antibiotics daily for a week followed by 10 days oral antibiotics which caused diarrhea which has flared everything up again. I have now been suffering for 2 weeks but am hopeful of a recovery from this as was fine up until diarrhea. Hope this gets better:-(

I'm so glad I found a group having the same experience like me. I had experience AF 3 years ago when I had a sever fight of constipation due to overdose of drinking of medicine to fight diarrhea. The effect is constipation. By then I had my 1st flair up and believe me i thought I'll gonna die coz it was my very 1st experience seeing blood in my poo. My parents comforted me saying its normal to happen coz I forced it and said I had piles.

Went to doctor, told me i had piles, gave me medicine, but nothing helps. Its that feeling when you poo something like is tearing your skin underneath. A friend of mine told me why not try Papaya and eat vegies first for a few weeks. Papaya is a natural bulking agent and helps digest foods. Believe me, it really helped to easy up my bowel episodes until the Piles and AF healed after few weeks of being religious in my new food diet.

Well now recently, it flaired up again. Last week I don't know why but suddenly a huge poo of mine came out and i think it caused a small cut in my anal. I can feel it coz the same old feeling I felt before. By the way, I dont have worries of drinking water coz I'm really a water addict. I consumed an avg of 3Litres a day. But then recently, I went to europe for vacation and stayed seating in the plain for 13 hrs I think it triggers back my Piles and AF. When I went to toilet, got constipation i guess because of very cold weather and yes, my AF got back.

Now I'm suffering for a week which I'm fighting to get back my bowel mood to soft it up again by drinking Prune Juice. Well luckily its very soft now but before it happened I had 5 days of fight of painful, bleeding AF when doing my daily business. I hope now that is very soft again it would start to heal and calm down.

I have CAF and another month sick note (total 7 weeks off work if I return then, what a mess!!) and a referral to Colorectal out patients for additional support.

However, after 10 weeks I have made a small breakthrough, seeing some improvements. I have had a CAF for 10 weeks, had and still occasionally have debilitating spasms and would quite like an epidural at those times (I had two natural births with no pain relief!)

Here is my step by step guide to get things improving:

1) GTN ointment 4% used morning, mid day and evening as well as after any BM's (I'm lucky enough to not get side effects) the GP was okay with my useage at this level as it mildly helps relax the spasm.

2) Really hot baths. not warm - Gawd Damn Hot ones - they REALLY kick out that spasm.

3) Ensure that you are getting 25-30g of fibre per day eg- (I discovered that my 'healthy diet' only contained 18g after entering my meals into Weightloss Resources online, it breaks down nutritional values for you.) Eg of how to get 30g fibre:

Breakfast: fibre cereal (Weetabix or Oats are both suitable with soluable and insoluable fibre) with probiotic yogurt and a piece of fruit.

Lunch: 2 decent slices of wholegrain bread with vegetable or lentil type soup or

veggie chilli / curry (mild for the CAF)

Dinner: brown rice, 2 portions of veg and a small piece of fish or white meat (slowly introduce red meat back in after healed CAF)

Snacks: Wholemeal scones, fruit, nuts.

4) Introduce Movicol into your life. Lactulose did nothing for me and I have relied on stimulant laxatives for way too long) Movicol along with the good level of fibre will help things move as painlesslessly as you could hope for with a CAF. I have had my first BM without stimulant laxatives in 15years (honestly, I was worried about the fibre bunging me up but at least with Movicol it really didn't I PROMISE on this one). I took at night to avoid the chance of unpleasant bloated tummy and bubbling during the day. here's what I did with Movicol:

Day 1 = 1 full strength adult sachets at 8.30pm mixed with water as directed.

Day 2= no BM so increased to 2 sachets both at night (lots of wind, deal with that as you wish).

Day 3= still no BM so increased to 3 all at night (LOTS of wind, hoping for BM tomorrow or hitting the Dulcolax again)

Day 4= perfectly NORMAL poo at 10am with no forcing or urgency. To give you an idea, it can be rated as a number 4 on this link: http://www.movicol.com.au/file/Movicol_Stool_Chart.pdf PERFECT and the first normal poo I have done without Dulcolax in about 15 years!! It's also the first time in 10 weeks that I have not had a painful BM. I'm very pleased that my patience has paid off, even if it is very early days

I plan to take 3 sachets again tonight and if too loose tomorrow I will reduce to 2 and half sachets then maybe 2 etc to get things settled at the right level for me.

I will keep on top of the diet and bowel habits and see how this helps in the long term. In the meantime I will continue the GTN / Sitz baths and see the specialist in a couple of weeks.

Good luck you poor people - we are an unlucky bunch!!

Ianee the majority of pain relief medications all cause constipation. I have been going to the toilet more easily since giving up on pain relief via meds and just focussing on eating 30g fibre each day, 2 litres of any fluid except alcohol and using GTN as regularly as possible. Also, to protect the CAF inbetween doses of GTN I coat it in vaseline which is surprisingly more comfortable (must prevent drying out and protect against irritati ok n / rubbing)

Good luck!

*irritation. Oh and very importantly HOT baths to kick the muscle out of spasm.

Regards

Very useful

3 days post Botox after A&E admission to hospital due to being unable to tolerate pain which was off the scale. So far so good, I'm finally feeling human again!