Pain management for anal fissure

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Hi - I would love some advice about pain management for an anal fissure. I had mine diagnosed about three weeks ago, but have had it longer than that. I am currently using Rectogesic (externally - far to painful to try internally) and have started having linseens, a sachet of Fybogel a day, increasing my water intake, eating more fruit and veg, and generally eating less (have lost a stone since this started!) to try and soften my stools, but so far no joy. My main problem is that my stools are still large, and each bowel movement is agony. I really would like suggestions on pain management and how to cope with work. Taking time off is not really an option as I have just had a period of sick leave with an unrelated problem, and if I don't work, I don't get paid. But the pain is horrendous and so far taking Ibuprofen and paracetamol do not even touch the pain. As anyone with this condition will know, once the pain starts it is impossible to think of anything else and trying to work through it is nearly impossible. Even travelling to and from work (by bus) is awful as sitting down is agony and standing on a moving bus for an hour is not really an option. I am just about at breaking point as trying to cope at home is bad enough but I have to go to work in an hour and I don't know how I am going to get through the day. I have already had a hot bath this morning and applied my medication, but think the pain is going to kick in soon. These forums have so far really helped me, just by knowing there are other people out there suffering from this awful condition and any advice you can offer me will be welcome. Thanks.

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  • Posted

    HI jo,

    I want to start by saying you are in my thoughts,i had my first bad attack about 2 years ago. I was given a prescription by my doctor for Laxido which is a white powder taken with water which i took before i went to bed this loosens your stools to make going to the toilet a lot easier and Rectogesic ointment.

    Because my anus was so painful to insert this i put it around the outside of my anus and this seemed to ease the pain,and in time i was cured.

    But then a few moths ago it came back i dont know why because after suffering with the horrendous pain it makes you more aware what you eat etc.

    I went back to my Doctor who repeated my prescription but for some reason the pain did not go away,he reffered me to a Consulant at a nearby Hospital.

    I was admitted as a day patient my Consultant explained to me what was going to happen because they cannot stitch a fissure they use Botox its like a pollyfilla,which last about 3 months. I was given a General Anesetic, i was given pain killers when i left the hospital but have not had to take any at all.

    My operation was 2 weeks ago im still taking Laxido which still helps my stools to be much softer,but i will at some time stop taking it.If for some reason i have not gone to the toilet for a day will take Laxido again.But im now pain free fingers crossed .

    Just a thought Jo maybe go and have a chat with your Doctor about this treatment like you i felt i had no choice,as i could not put up with the horrendous pain anymore.

    Wishing you all the best Jo thinking of you and many others.

    Take Care






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  • Posted

    Hi Jo

    I hear you and understand... I bet you have a high stress job or you are a high achiever, or you are just scared full stop- this is part of the problem.

    Getting stressed and anxious won't help. I have been meditating and getting accupuncture for the spasms (which is the reason mine is taking ages to heal). Believe me- I am a stress head w a stressful job and was very worried about work too.

    In short term this is what you need to cope:

    A) a day pack full of rectinol, sudo cream, rectogesic, cotton wipes,a bottle of salt water and a hot water bottle. Sit on it constantly. The heat to the area opens blood vessels, relaxes muscles and promotes healing. It's the only thing that relieved my pain. Drugs don't help. I haven't wiped w toilet paper in 6 months. Always use wipes and warm salt water. I made it work.

    B) a glass of wine- it helps you relax

    C) Start more laxatives and eat less meat and carbs. Smaller meals more frequently

    D), 3 litres of water a day and ducolax. Can't have solid bm. If your bm are too big you are still eating too much

    E) exercise a lot more- increased blood flow gets things moving

    F) coconut oil- it's amazing health benefits will help in a million different ways. Eat it and apply direct to fissure

    I was ready to have botox and thought no way- my body can beat this and it can! Remember- this is short term, non life threatening and your body can heal. It's a cut, what do u normally do w a cut? Bandaid and try not to touch or move. Ie loose bm

    You need to be strict and above all try to be calm. Download meditation apps on your phone and do it as soon as you wake up. Look at it this way.. You worry you have a fissure, you don't worry, you have a fissure... One is more beneficial than the other. Accept it will be like this for a small period of time.

    I was in a very bad way and I'm much better now. Every ones journey is different but no one speaks about the mental change you need. Remember a fissure is a result of something. It's a symptom- think about what made it happen in the first place.

    Also- this is your body reacting to something... It won't change over night. You must persist.

    Good luck .

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  • Posted

    Boy do I know that feeling. I managed to stay at work but not sure how I did. Fybogel twice morning and night although I find drinking more water didn't really have much impact on me. I bought a portable bidet - a sitz bowl for the loo from Amazon. Only £6. Best thing I ever bought. It is essential to be scrupulous in cleaning so immediately after going to the loo it's a 10 to 15 minute soak. I did this more than three times a day. Sitting in warm water really helps and negates the need more any further cleansing with paper etc. It really eased the pain. I took solpadeine for pain relief as I found lesser painkillers ineffective. The rectogestic gave me an instant headache and didn't really work. What's worked for me is also Boots own haemorrhoid pessaries containing lidocaine and a non steroidal healing content. Laxatives like dulcolax stimulate the colon and rectum and if you are too loose it makes things worse . I'm sorry youre suffering so much. I really understand the pain. Get well soon
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  • Posted

    Heal from the inside out. Get a juicer and drink it all day long. To heal fast, no food just the juice. 2 apples 2 beets(good size)and a bunch of carrots. Lots of carrots. It takes about 3 days You will feel better. Depending on the severity of your fissure you will have to do this for a while. But it works. Use a stool softener and an enema. Get a big jar of Vaseline and make sure you don't damage yourself with the enema. In the morning, use either warm water or urine(urine works best because it heals you somehow. I know it's gross) and gently squeeze it into your rectum. Go lay down sideways for at least 20 min. Then let the fecal matter fall out without pushing. Do this every time you have a bowel movement.

    If you must eat solid food then have spinach, apples,carrots,Brussels sprout....things like that. Cook the veggies first. Raw may be a little too rough for your system right now.

    Also, in the morning before I even drink my water and take an enema, I take ibuprofen. That helps me not faint from the pain.

    Next, you must start exercising! It's important. Gently. No weight training or squaring because it might hurt you. Go walking jogging or swimming. Do not stay home. Go to work!

    It's extremely important to make sure ALL of your fecal matter is out your system before you start your day. The real pain comes because your anus is spasming and trying to hold in what you didn't defecate out. With this procedure that should work. But don't be in a hurry to jump into the bath if your body is not finished pushing it out.

    Last but not least. You must permanently change your diet. No more white flour, red mead ,alcohol, or anything that will make your stool hard. You will be so happy in 3 days but don't be fooled, it takes a long time to heal. Give this process a few months. Never go back to the way you ate before. You are damaged and the fissure can come back. After a few months slowly add food to your diet. If you happen to have a hard stool in the future, use an enema to loosen. No hard pushes ever again.... Good luck

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    • Posted

      Thanks errica311 ,

      As per your suggestion I followed the diet, for almost 5 days I took only carrot beet and apple juice and some boil rice with green vegetables, lots of water. I reduces the quantity of my diet as well. As luxative I used to take miralex daily and I applied ( inserted with dropper) aloe Vera juice for 1 week and regular walk for 2 miles on trade mill and miracle happened. It totally get cured without operation. I still won't believe myself. Earlier I was thinking surgery is the only way to cure this problem. It was really horrible pain for me almost last 5-6 months. Now onward I have to take precautions about my diet that no spice and heavy food with lots of water.

      Thank you so much

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  • Posted

    Hi jo. I had my anal figure about a month before I sought help. One of the most important things for pain management is to get those stools soft. Large stools will keep tearing the fissure and it will never heal. If fybogel isn't working you need a different laxative ASAP. I take movicol, three sachets a day do the trick for me, my bms are like cotton wool! I would recommend getting a prescription for movicol and you'll need to take it for a while even after you've healed.i keep in regular contact with my Gp regarding this. Sits baths with coconut oil gave me the best pain relief after a bm. If I couldn't have one after a bm I made sure to have a sits bath twice a day at least. Also rubbing the coconut oil on my anus helped. For my diet after discussing with my Gp i decided to give my system a break and stay off solid food for a few weeks so soups and smoothies have been on my menu. I use myfitnesspal to make sure I am getting enough. Keep away from foods that can constipate and up the fibre and water intake. I am about a month into this and am completely pain free. I hope this helps, good luck!
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  • Posted

    Hi Jo,


    I am so sorry that you have to deal with an anal fissure. They truly are one of the worst pains imaginable and it is almost unbelievable that something so small could cause so much pain. When I had my fissure, I was bed ridden and did do some things to help it that you can try. Apply coconut oil to the area may sooth it. Also, calmoseptine cream which has menthol in it adds a cooling effect. When going to the bathroom, try to squat instead of sitting on the toilet as this reduces the strain that you have to put in when you poop. After you poop, make sure to pat the area with a wet piece of toilet paper rather than rubbing with a dry one. Take a shower after pooping to make sure the area is very clean.  Moreover, make sure you take fiber supplements such as Metamucil, and that you are drinking lots of water. Do not eat spicy food and avoid eating anything that is sharp, such as watermelon seeds. The doctor I had prescribed me diltazem cream which apparently helps the sphincter muscle to relax, although it did not really do much in my case.


     In the end, I had a chronic anal fissure and had to undergo sphincteronomy surgery on my sphincter muscle in order to allow the fissure to heal. Hopefully, you will not need the surgery but I have to tell you from personal experience that the surgery literally saved my quality of life.


    I wish you all the best Jo and hope that you have a quick and non-stressful recovery. I am so sorry again that you have to go through this as no one should have to go through something as painful as this. You are in my thoughts Jo and I hope you get better soon.



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    • Posted

      Hello Myles,

        Taking a big chance that you will get this after a year, but I am dealing with the same issues with a fissure. Been going on for 2 and a half months. Been doing every thing that people say and still, being a pain....

      I am set for the sphincteronomy surgery in 10 days! this will feel like a YEAR! question is, how have you been after the surgury? Im hoping all is good, because thats where Im heading! 

      Thanks, Rick

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    • Posted

      Hi Rick,

      Thanks for reaching out. I am sorry to hear about how much you have been suffering and hope the surgery helps you as much as it has helped me. I am now 2 and a half years since my surgery and could not have felt better. I have had 0 issues with fissures since then, and only occasionally have hemmroid problems if I lift heavy weights. I also take metamucil daily and squat when I go to the bathroom. 

      As far as your surgery, I wish you the best of luck. I DEFINITELY recommend the surgery and only have these few words of advice for you. If you are doing the surgery, that is great, but make sure the person doing your surgery is reputable and has done this surgery multiple times in the past. I feel like a lot of people who have problems with the surgery do it with surgeons who are not experienced enough. So that is my first point. Second, healing will take time. I think it took me a full 2 weeks post surgery to recover. If in pain, I would reccomend biting on a wash cloth. It sounds weird, but it really helps to divert the tension in your body away from your butt where it would hurt. For the first time you go to the bathroom after the surgery, I would blast music in your ears and distract yourself as much as possible. The first time post surgery is no picnic, but after it comes out, the pain is no where near the pain of the actual fissure. It truly made a differenc in my situation.

      I will leave off with some tips for  you to do after the surgery or until it: 

      1. Try some zinc oxide in the form of calmoseptine which has menthol to soothe the area down there as well. Calmoseptine can be bought at almost any local drugstore and can be bought online too.

      2. Try squatting when going on the toilet instead of sitting. This is a much  helathier position and the poop sometimes will just slide out,  no pushing or straining involved.

      3. I would definately take a fiber supplement, specifically metamucil  is what I take evveryday,  in ordr to allow your stools to be soft and to allow them to pass thorugh easily. THis being said, with any fiber supplemetn, you must drink lots of water when using them, or they will not work veffectively. Also, do not take too much as too much fiber can irritate your bowels on the way  out and diarreah actually does worse down there.

      That's about it. I hope this reply helps. Post back if you have any questions or need advice. I am more than happy to help.

      Best of luck with your surgery,



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  • Posted

    Thanks to everyone who has replied to my original post - I am very grateful for all your advice and words of support - there are quite a few things there that I will try, and just hope that sooner rather than later the fissure will heal. I suppose I should look on the positive side - I have been trying to lose a bit of weight for a while and now it has happened without me really trying!! Best wishes to all of you suffering from this really horrible condition.
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    • Posted

      Hi Jo - pleased to hear you're looking on the bright side! I think most posts include everything you need BUT in my experience I would...

      1. Stop taking Fybogel right now. It makes your stools too 'normal' and you need totally loose stools so you don't have to strain in any way. I used 30ml Milk of Magnesia taken before bed. I just found it worked for me and you can take it every other day.

      2. Get some Instillagel from ebay - it's numbs you and it's an antiseptic. Amazing stuff when you are in total agony.

      3. Use coconut oil and do not wash with soap. You need to keep your bum moist and coconut oil is a natural healer.

      4. Use wet wipes only and have a bath after your morning bowel movement.

      5. Buy an electric heat pad and use it all day - it relaxes your bum muscles and that is the ultimate goal. You need to relax your bum so it can heal.

      6. Always squat and breath out when you go to the loo. Do not strain... ever!

      7. Take garlic and vitamen C and just generally start taking care of yourself. This is the key. Almost everyone with an anal fissure has been through a period of stress or they are not looking after themselves. You need to relax and breath.

      8. Eat lots of fruit & veg, drink lots of water and avoid white bread, pasta, white rice or anything that could bung you up!

      9. Do gentle exercise like walking or yoga.

      It's take me 4.5 months to heal - I had two anal fissures and I knew I could heal them myself and I've done it. You can do it too if you just follow the steps above. I know I will have to be very careful for the rest of my life, but it's made me reassess my life. I've lots some weight and I eat really healthily now and I have massively reduced my alcohol intake. Basically, it's your body telling you that you have to change some things, so listen to your body.

      Hope that all helps and good luck x


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    • Posted

      Hi bob101

                Your post really helped me with my thought process. I am a very lively and social person but at the beginning if this year had severe food poisoning and was admitted due to which i got the fissures. Suffered for a month and more then was totally healed so went out and socialised a bit and got terribly constipated and was back in pain. I love drinking and socialiasing but guess i need to stop doing it now. My body is telling me to go healthy now i love my chicken fish and mutton but guess have to let go of it as well. Hoping i can balance my life out and enjoy everything. 

          Tips that i would like to share that will help.

      1. Sitz bath really helps try doing it 3 times a day for 20 min. Warm water not hot. Add some betadine solution and some coconut oil to it. 

      2. Swallow a crushed garlic every morning with water. 

      3. 3 to 4 ltrs of water complusory every day.

      4. No meat no chicken no white bread no takeaway foods only home made soft diet. No spices non oilyfoods no cheese butter and dairy except yoghurt and buttermilk . 

      5. Have only soft fruits and fibre rich fruits , juices and soft veggies for 3-4 days till you feel it has healed then slowly day by day introduce solid foods but keep taking the water intake of 3-4 ltrs a day. (This is where i went wrong and had to suffer again)

      6. Avoid surgery as much as possible you can heal it naturally by sacrificing some bad habits. 

        Dont socialise for sometime untill you completely heal once you do then balance your life out eat vegetarian for 5 days a week and your meats and fish the 2 days but with sauteed vegetables. Do not eat dry chicken or meat they are the worst triggers.

         Hope I can be of help. Let me know if anyone has any questions smile Do not worry it will be alright its in your power to get it alright. 

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  • Posted

    Hi Jo. I tried it all. I had suffered 9 years and it was complete agony, I would have to pant during a bowl movement, it ripped me each time. It didn't matter what I done that blasted tear would never heal. I think from my understanding after having them so long they become chronic like mean and then the muscle goes into spasm each bowel movement. I did have the op in the end. Prior I had 3/lots of botox which helped but didn't heal. It was ruining my life completely. I begged my consultant and they done the internal spincterectomy in may this year. I am 3/months on now and healed totally. I've had no incontentence problems and am so glad I went for it now. Try all the things suggested as they may help u. Prior to my surgery I found anusol pesserys helped ease the pain temporary. Since surgery I have found calmoseptine cream very brilliant. Very calming to the use sensitive area. Good luck xxxxxx
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  • Posted

    i have the same problem and maybe not as painful as yours, it still is very painful and I dread the first bowel movement in the morning, after the first  poo comes out I know that the pain will lessen but its the starting thats the worst, on some days I nearly hit the ceiling and cannot sit down or if i do, I must sit on my side, what I have found is and I am not saying that this is correct but it helps me I get a hot water bottle and this seems to ease the pain but the hot water bottle sooths also the spasam as well ok this does not cure the problem, but its just getting the right food right as well but I have looked on this forum and finding others with the same problem or who have the problem much worse than me at least we can all help each other by trying different ways of coping , it getting through the days hwne it is bad but I find that husks and cereals help also fruit and veg and water 
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  • Posted

    Hi Jo, 

    where do I start...

    In late Dec 2012 while on a weekend to see my favorite jazz singer in Hollywood California, I had my first anal fissure tear. I had been a pretty healthy eater, juicing a lot, lots of veggies. But had a couple of personal stresses the October before, and had been kind of eating junk and not really been exercising much, and in Nov-Dec I ate what ever holiday food that was put in front of me. The morning before the tear, I had met a couple of people at breakfast and had tried a couple of coffee with liquor drinks that they had made up,(was on vacation, I thought what the hellwink. Went to the bathroom in my hotel room at the Roosevelt a couple of hours before seeing my jazz singer, very hard stool, pain, and a bowl full of blood. All that blood scared me to death, made me feel as if I may need to get my affairs in order so to speak! I laid down for about 2 hours, felt a little better, and proceeded to the concert, wasn't going to miss what I thought could be my last time of seeing my favorite artist of all time! Flew back to Northern California the next day, feeling a little better when I returned home, but still blood in my bowl. A week later I called my GP and asked for a proctologist reference, fearing the worst. Was examined, a chronic anal fissure said the doctor, and that she could see all the way to the muscle! She prescribed nifedipine cream and sitzbaths. The cream made me sicker than a dog, physically. So I went online to forums such as this and found my own treatment path, took me about 2-3 months to feel much better. Was taking 2-3 sitzbaths a day,(would come home for lunch and take one), cleaned my butt after every bowel movement with cool water, then hydrogen peroxide with a cotton swab, then swab with a generous amount of petroleum jelly. About three weeks into this, I was at the drug store and saw this pillow called the total pillow, basically a daisy shaped pillow with a hole in the middle, and I'll tell you, I will never sit without one of these the rest of my life. Fissures need blood circulation to heal, and when you are sitting on a hard surface, or even a not so hard surface, you are pushing the blood away from the fissure area. I believe that helped a good deal in my healing and staying healed.

     Ok, fast forward to July of this year, went to North Carolina for 10 days, (my other half was working and I tagged along). Came home and 4 days later came down with something called travelers diarrhea, fever, and HORRIBLE diarrhea, doctor gave me antibiotics, but the sickness had already broken my fissure wide open. I was so sick I didn't even notice the fissure much, until I flew the next week to Las Vegas to help empty out my other half's home that was sold. My proctologist had told me the first time around that flying is a lot of pressure on your rear end and fissure. Forgot my pillow for this flight as well.

    I still felt pretty decent on that Friday when I got to the house near Las Vegas. We got ready for a garage sale on Saturday, I drank beer,(only about 3 as it was hot), and sat on a hard chair all day, and did the same thing on Sunday, sunday night we had two beautiful filets, a fabulous dinner and a bottle of wine. All a Big Mistake!!! Monday morning my first bowel movement was excruciating, my second bm, I was crying, my third, I damn near passed out. I then laid on my side on the bed for about two hours. Later that night I searched blogs, this tear was 10 times worse than the 2012 episode. 

    Within a week, I was feeling MUCH better, thanks to blogs like this. Here is the regiment I used.

    1. Took three baths a day for five days, with about a 1/4 cup of coconut oil,(fabulous stuff, and thanks to the blogger that suggested it),1/4 cup of epsome salts, and a couple tablespoons of extra virgin olive oil. About 6-8 inches of warm water in the bath, and sat in the mixture for 30 minutes.

    2. After the bath, a cotton swab with hydrogen peroxide all around and in my anal fissure area, then a cotton swab with a generous a,out of coconut oil, then a cotton swab with a generous amount of vasoline and a little triple antibiotic ointment. And an ibuprofen after dinner.

    3. No alcohol, no red meat, no plug up food, even though this tear was caused by diarrhea.  just fruits and vegetables, and a lot of fluids, water,  a lot of Popsicles.. Didn't eat much the first three days, as I usually have three bowl movements a day, (usually all  in the morning) and wanted to try and decrease that to one or at least two. 

    Within 5 days,  by Friday, I felt about 75% better. We are home now and I am still treating the fissure, 1 bath a day now, no liquor, no red meat, no processed food,(which I didn't eat anyway), getting enough good sleep, not sitting anywhere, even the car without my pillow, and trying to keep the stresses of life at bay.

    well, if you made it this far, thanks for reading my novella! And thanks to the all the bloggers!!!!

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