Anal Fissures anyone??

[AboutToStart]

Have had horrific anal pain for several weeks now. My HIV doctor tested me for a few STIs that came back ok. He didn't see anything externally (though I emphasized the pain is external and I can see some leisons) and decided it's prolly internal hemorrhoids. Gave me some hydrocortisone ointment and sent me on my way...

Two weeks later, pain is still horrific (to the extent I need to take prescription pain medication to be able to sleep at night..). I went to see a colorectal surgeon who immediately saw my external fissures, changed my medication to nifedipine ointment 0.2%, and said if no improvement in 6 weeks - will need surgery. In the meantime he said NO anal sex (which is not a problem at all.. I can't even "think" of sex at all for weeks now..)

Anybody else had this "wonderful" experience with fissures that just don't go away?

[randym431]

Had one back in the late 1990's. I know your pain. Fissures are worse than kidney stones (i've had both), or can be worse as far as the pain goes. And many doctors miss finding them on exam, so you suffer and are given junk like stool softeners or prepH, or told to maintain a high fiber diet. None of which will ever make things better.
It took me 8 months of pure hell to get diag back then. First they did the cancer thing, even a scope, and found no cancers but they also missed the fissure.
After 8 months of hell, more tests, many tests, many doctors, I found this old doctor just by chance that I had not seen before on my HMO list.
Five minutes with me with an exam and he found the fissure right away. 5 minutes it took him, finding what all the other doctors missed for 8 months.
He told me surgery is and was the only answer for fissures. They can get better temporally, then will always get worse, but they never will heal on their own.
I went in for a simple out patient operation, had a little discomfort after for a few days, and after about a week I was finally back to normal (a perfect Ahole once again  ).
And that discomfort that few days after surgery was nothing ""NOTHING"" compared to the daily pain before surgery.
That old doctor was a real life saver. He retired shortly afterwards and I still wonder how many suffer from all the other crackpot doctors out there that missed the diag of a fissure for 8 months...
Shockingly there are a lot of just plain bad doctors out there. And too few really smart experienced good ones.
You'll probably need surgery, and in my case it was not bad at all. Especially when compared to the pain I know you now go thru every day.
If you google anal fissures and surgery you might get scared, but those nightmare cases are rare and not the normal. Good luck and at least you seem to have a good doctor, in that he/she found the problem without months of wortless tests for cancers and everything else under the sun (like me).

[GNYC09]

Have you tried very warm (almost hot) sitz baths?  The first few moments in the water might seem like a shock but hang in there - it really helps.  Plain water is fine but you can also add Epsom salts.  Soaking in a sitz baths loosens up you anal area, gets the blood to flow and is really helpful. 

The baths help whether you have anal fissures, hemorrhoids, or other booty problems.  This was the remedy that helped me the most when I had butt surgery a few months back.  Good luck!

[AboutToStart]

Wow... what a story!!! 8 months??? I would just shoot myself after 4 (I'm already considering it after just 6 weeks...). I forgot to mention I have seen a second doctor before seeing the surgeon today - a gastroentrologists who performed a colonoscopy on me (I was scheduled for that for a while now, totally independently of my accute pain). He said he didn't see any external leisons (how can he not see it??? I can see it with my untrained eye via a simple hand mirror??!?!?), and since he found a couple internal benign hemorrhoids he was quick to conclude that that's what causing me the pain. To his credit I would say that after 10 more days, when I called him crying of pain, he admitted it is probably a fissure and referred me to see a surgeon.

On the one hand, I don't regret having all those tests run on me as it's quite a relief to know I don't have any colon or anal cancer, no STI's or HPV. I'm glad I insisted the pain was external and that the leisons (i.e. fissures) are there. Surgeon believes his medicine (the nifedipine ointment 0.2%) is quite effective, but prepared me for the chance of surgery. In the meantime -  Sitz Baths are the best part of my day: 15 mins of pure sanctuary 3-4 times a day

[tednlou2]

It is funny I came across this post.  Just today, I contacted my doc about my anal problems.  He had checked down there 2 months ago and said he couldn't find anything.  He was suppose to refer me to a butt doc, but I found out he never did it.

I have symptoms similar to what I read about with hemmoroids.  They get really bad, then get better for a while, and then bad again.  My pain seems to be coming from around the anus.  I find blood on the toilet paper--not a lot.  I have the discharge you read about.  It is a kind of clear mucous discharge.  I sometimes see the mucous stain in my underwear.  They sometimes get very itchy.  Everyday when I shower, I can actually smell the blood smell as I'm washing down there.  The smell reminds me of how my old girlfriends would smell during their periods--back when I was "straight." 

The thing that worries me is everything I'm reading about anal cancer.  HIVers and those who've had anal sex have higher rates of anal cancer.  The symptoms often are the same as hemmoroids.  There's something called anal dysplasia I'm just reading about.  I guess it can turn into cancer.  It is caused by the HPV virus that most adults have.   

Anyway, I feel your pain.  I will look into the fissures thing.  I hope that is all it is.  I don't think it is internal hemmoroids.  As I said, the pain is around the anus.  And, internal hemmoroids usually aren't painful--at least from what I've read.  Maybe it is time to stop using toilet paper.  I've always been so anal (no pun intended) about wiping.  I wipe and wipe until there is nothing on the paper.  I'm sure this isn't good for our holes. 

[Miss Philicia]

The thing that worries me is everything I'm reading about anal cancer.  HIVers and those who've had anal sex have higher rates of anal cancer.  The symptoms often are the same as hemmoroids.  There's something called anal dysplasia I'm just reading about.  I guess it can turn into cancer.  It is caused by the HPV virus that most adults have.   

So stop obsessing with what you read on the internet and go see a colorectal surgeon.

[Ann]

I have the discharge you read about.  It is a kind of clear mucous discharge.  I sometimes see the mucous stain in my underwear.  They sometimes get very itchy. 
 

When was the last time you were swabbed for anal gonorrhea and chlamydia or other STIs? Going by those symptoms, it could be one of those - and hemorrhoids as well. I've had 'roids in the past but never had a clear discharge with it. External 'roids can cause itching, but so can the discharge from an STI. A discharge like what you describe says STI to me. You'd be prudent to get that checked out.

[AboutToStart]

Great replies guyz, thanks ya'll. I'm def gonna try adding Epsom Salt to my Sitz Baths. No clear drainage/ discharge is associated with fissures (or hemorrhoids I think). Bleeding on occasion yes, but no discharge - so tednlou2 I'd definately get tested for STI's if I were you..

[AboutToStart]

Also, tednlou2 - if you're concerned with working to hard on that toilet paper - try Tucks Medicated Pads or PreparationH Medicated Wipes.. they're much easier on the sensitive/inflamed skin down there and contain medication to avoid irritation and itching. But nothing, nothing, compared to 15mins in a warm Sitz Bath.. both cleanse you down there and relaxes your poor muscle spasm (blood circulation etc..).

[Ann]

Also, tednlou2 - if you're concerned with working to hard on that toilet paper - try Tucks Medicated Pads or PreparationH Medicated Wipes.. they're much easier on the sensitive/inflamed skin down there and contain medication to avoid irritation and itching. But nothing, nothing, compared to 15mins in a warm Sitz Bath.. both cleanse you down there and relaxes your poor muscle spasm (blood circulation etc..).

Unscented baby wipes are good too - especially ones with aloe vera. They're a lot cheaper thanTucks or PrepH pads which is a bonus. Also, they don't sting, whereas the others often do if you have any broken skin in the area. The only draw back is that you can't flush them, but a small, lidded trash can, lined with a small plastic trash bag, by the toilet takes care of that problem. I always have baby wipes in my bathroom and I also carry a travel size with me for those inevitable bathroom moments away from home.

Ann

[pozniceguy]

thought I would add two cents to Ann's comment about baby wipes  if you look carefully there are   "flushable" wipes.  just check the package for the little symbol showing a  "flushable" logo . many brands have both types.    For those  that have WalMart they have their own brand at about 1/3 less cost...  just had  colonoscopy so happen to be up on subject of anal issues....


Nick

[MitchMiller]

I'm surprised the docs didn't put you on an antibiotic.  Anal fissures can become infected (especially with feces passing over them).  The infection can be life threatening.  I had one many years ago.  I also began to feel a throbbing pain in my butt after about a week of minor discomfort.  The problem occurred one night when I suddenly began running a fever that hit 108 by the time i got into the emergency room.  That's border line brain damage.
I was put on an antibiotic for ten days.  It didn't clear up, so the doc put me on a really nasty, but powerful antibiotic called floxin.  It was really nasty as it killed all bacteria in your body.  My mouth tasted like a medicine cabinet smells.  However, it worked!  No operation required.  It just needed time to heal on its own.  Never had any problems since.
Perhaps my experience was different from yours since my fissure was internal.  Actually, I've always assumed that was what an anal fissure was... an internal tear in the anal canal.

http://www.bing.com/health/article.aspx?id=articles%2fmayo%2fe2d5b25c8dc3504fbefcd48e12819b75.html&br=lv&q=anal+fissure

Definition

An anal fissure is a small tear in the lining of the anal canal. This type of tear may develop in adults from passing hard or large stools during bowel movements. Anal fissure is also common in infants between 6 and 24 months. Anal fissures are less likely to develop in older children.

An anal fissure may cause you to experience pain and bleeding. More than 90 percent heal without surgery, and you can use topical creams or suppositories to provide relief as they heal. Anal fissures that fail to heal may become chronic and cause considerable discomfort.

If you develop an anal fissure that doesn't heal, surgery may relieve your discomfort.
Symptoms

The main signs and symptoms of an anal fissure include:

    * Pain or burning during bowel movements that eases until the next bowel movement
    * Bright red blood on the outside of the stool or on toilet paper or wipes after a bowel movement
    * Itching or irritation around the anus
    * A visible crack in the skin around the anus

When to see a doctor
See your doctor if you have pain during bowel movements or blood on stools or toilet paper after a bowel movement.
Causes

Causes of anal fissure include:

    * Large or hard stool passing through the anal canal
    * Constipation and straining during bowel movements
    * Inflammation of the anorectal area, such as is caused by inflammatory bowel disease (IBD)
    * Anal sex, less commonly

[randym431]

Well I have to disagree with a lot of this.
Anal fissures are not visible, because they form on the interior.
They will not heal on their own.
They seldom cause bleeding, usually just a clear discharge.
Outpatient surgery will correct the problem.
Some may be comfusing hemorrhoids and hemorrhoid issues with fissures.
A bleeding hemorrhoid, internal or external, is not a fissure.
Hemorrhoid's can heal on their own, a fissure will not.
I can tell from the op, AboutToStart, that his pain issues are not hemorrhoid related
and he is in much worse pain then any hemorrhoid causes.
And yes... its shocking that many doctors miss seeing fissures on examine.
The issue is, how long does one want to live with daily "chop your arm off" pain?
During my fissure's and living with that awful daily pain, that was the only time i too actually wondered if
ending it all was to be the only answer.
When you live with that much pain on a daily basis, life becomes secondary.
A good surgeon can fix the fissure with simple outpatient surgery.
The recovery and disconfront those few days after surgery is nothing compared to the pain you now go thru on a daily basis.
And its true, most butt doctors will first shoot for cancers or whatever. After finding none, send you home with creams and ointments. None of which will ever heal the fissure. Bad doctors...

[pinkadam]

Fishers are horrible and it takes years for it get cured.
Stay away from anal sex.

[Ann]

Fishers are horrible and it takes years for it get cured.
Stay away from anal sex.

Speak for yourself.

[pinkadam]

Speak for yourself.

 :
Is your experience any different. Iam only saying what my doctor told me

[tednlou2]

Hey guys, thanks for the advice.  It wasn't my original thread, but the advice can help everyone. 

My doc was suppose to refer me to colorectal doc back in Sept.  I just found out he never did it.  I'm kinda of mad at him, but people make mistakes.  I had called a few times over last 2 months and was told it would take a while cause butt doc really backed up--no pun intended.  So, the last 2 months were wasted.  I have to wait longer now.

Also, I will ask about STD's.  I know I was checked for just about everything.  The clear discharge is a common symptom of both hemmoroids and fissures.  I will double check to make sure I was tested for all STDs. 

[Ann]

:
Is your experience any different. Iam only saying what my doctor told me

Sorry, when I quoted you before, I meant to only leave the bit where you said "stay away from anal sex". I'm sure fissures are  pretty horrible and that it can be difficult to get them to heal. Goodness knows I know how nasty 'roids and anal herpes can be. But, anal sex doesn't have to lead to fissures. Using plenty of lube will go a long way towards reducing the risk of getting them, unless your partner (or sex toy) is unusually large. And yes, I do speak from first-hand experience. I've never had a rip or tear there - but I always make sure plenty of lube is being used. Be nice to your bottom!

Ann

[David_CA]

Ann's not so bad, and certainly not horrible!  She was a 'fisher' in the past...

Sorry, when I quoted you before, I meant to only leave the bit where you said "stay away from anal sex". I'm sure fissures are  pretty horrible and that it can be difficult to get them to heal. Goodness knows I know how nasty 'roids and anal herpes can be. But, anal sex doesn't have to lead to fissures. Using plenty of lube will go a long way towards reducing the risk of getting them, unless your partner (or sex toy) is unusually large. And yes, I do speak from first-hand experience. I've never had a rip or tear there - but I always make sure plenty of lube is being used. Be nice to your bottom!

Ann

Fishers are horrible and it takes years for it get cured.
Stay away from anal sex.

[Ann]

Ann's not so bad, and certainly not horrible!  She was a 'fisher' in the past...

I missed that typo!

[MitchMiller]

I think some of the posters may be confusing a fissure and a fistula.  When I had the fissure, my doc at the time was a gay man himself with a huge gay clientele... so he had seen it all.  After a few personal questions, he diagnosed it with a basic rectal exam.  He seemed to imply that small fissures are not that uncommon, but can lead to a blood infection (which is what happened to me... given the fissure opens a path for fecal bacteria to invade the bloodstream).  Mine was definitely torn from anal sex.. let's just say my partner was blessed.

The doc said a fistula was like a big fissure (although that sounds somewhat different than the Wikipedia definition below).  This was about 25 years ago, but at that time, the standard treatment for a fistula was surgery.  He said basically the surgeon has to cut a hole from the outside down to the core of the fistula, drain it, then pack the opening with stuff to keep it from getting infected... and I believe he said the packing was slowly removed over several visits until the hole completely healed shut.

I would expect medicine has progressed beyond this procedure.. at least I hope!

http://en.wikipedia.org/wiki/Anal_fistula

From Wikipedia, the free encyclopedia
Jump to: navigation, search
Anal fistula
Classification and external resources
ICD-10    K60.3
ICD-9    565.1

An anal fistula, or fistula-in-ano, is an abnormal connection between the epithelialised surface of the anal canal and (usually) the perianal skin.

Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.

Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It then points to the surface again, and the process repeats.

Anal fistulas per se do not generally harm and they often do not hurt, but they can be irritating because of the pus-drain (and, it is not unknown for formed stools to be passed through the fistula); additionally, recurrent abscesses may lead to significant short term morbidity from pain, and create a nidus for systemic spread of infection.

Surgery is considered essential in the decompression of acute abscesses; repair of the fistula itself is considered an elective procedure which many patients elect to undertake due to the discomfort and inconvenience associated with a draining tract.