Chronicle of My 90 Day Anal Fissure Recovery
I had an anal fissure for around 7 months. Without knowing what it was, my treatment did not start until I probably had it for 3~4months. This chronicle records my three month treatment journey. I am fortunate to say the outcome is positive. My BMs are no longer painful. I’m well aware that fissures can be tricky and return. So I intend to continue with my self care routines. Some of the routines are great health habits anyway, e.g. diet.
Diagnosis –
In the middle of April this year, about four and a half months after my hemorrhoidectomy (surgery to remove stage 3 hemorrhoids), I went to see to a proctologist (my surgeon has left her practice) for continued painful BMs. I continued to feel like pushing broken glasses. The pain was brief, only during BMs, however it did not appear to go away either.
For the initial two months after the surgery, my recovery seemed to be on the right track – I had no pain other than BMs, swollenness had noticeably reduced and stopped eventually, my surgical site looked close to normal. Yet the pain with BMs remained the same week after week without obvious improvements. Frustrated of course, I attributed this as a non-healing incision wound.
I did notice some online posts on fissure and its symptoms, such as pain during BMs, were alarmingly similar to what I was experiencing . Yet I never had fissure before, and did not knowingly associate my issues with a fissure. So I waited patiently for my “incision” to heal and the next doctor’s appointment.
After giving me a brief Q&A and a very painful anoscopy (a tube-like equipment to open up anus for doctors to check inside), the doctor told me I had a fissure slightly above (deeper inside than) the incision. The incision itself actually had been healing OK by then. My pain was not caused by the incision, instead it was caused by a fissure. How I developed this fissure was a mystery to both me and the doctor, although I did, at the early stage of my recovery, suffer a bad round of diarrhea and constipation, both can cause fissure. Another possible factor was the use of hydro-cortisone to control swollenness early on after my surgery. I applied the ointment for two to three weeks. Hydro-cortisone causes skin thinning, which, as I now ponder, can leave the skin prone for a tear or fissure.
Nevertheless, the verdict was in. I had no choice but to switch gears and hop on the chronic fissure treatment train. It was “chronic” because I knew I had the fissure-induced symptoms for quite some time by then. (According to NIH, a fissure that’s longer than 4 weeks is considered chronic.) Had I knew it’s a fissure, I would have sought for treatment earlier. This goes back to the frustration many hemorrhoidectomy patients have complained – nobody knows for sure what an individual’s recovery looks like and therefore patients are generally ill-informed on what and when they should be alarmed.
Treatment (First Month)
The doctor prescribed Rectiv three times a day as my first line of treatment. This brand-name non-generic ointment initially cost $250 with my insurance with BCBS. After I contacted my insurance, they said there’s a manufacturer discount which dropped the final cost to $140. So do check out about manufacturer discounts next time you face a high cost medication.
According to Rectiv’s application directions, this ointment should be squeezed onto the tip of one finger and apply on fissure site, either outside or inside. If too painful to go inside, applying the ointment outside is fine too. The ointment contains high nitroglycerin which increases blood flow to the application area, therefore enhancing the healing process. This explains why the ointment works even when it’s applied in the vicinity of the wounded spot. However, I assumed applying the ointment on the wound would be more desirable. After consulting with my doctor, I adopted this way of application for internal fissure(s):
- Cover a Q-tip with Vaseline Ointment
- Squeeze desired amount of Rectiv ointment on Q-tip
- Push ointment into anus and gently touch wounded spot
Rectiv gave me strong headache only after the initial few applications. It’s a tightening sensation on both temples. Don’t let this sensation scare or stop you from using this medication. This medication is the only FDA approved medicine for chronic fissure. Anyone suffering chronic fissure should give this a try.
Before Rectiv, I was experiencing “pushing broken glass” type of pain. After a few days of Rectiv, I did feel pain relief during BMs. The pain would still be there during BMs, but it was not as sharp, more like a strong poking/pinching pain.
In addition to Rectiv, I also attempted two ~ three warm/hot sitz bath a day. Another great pain relief method I tried was BM during warm/hot sitz bath. This helped my sphincter muscles to relax, which seemed to be a common issue with fissure sufferers. After three weeks, I felt good enough that I even stopped Rectiv (bad idea – never stop medication without finishing the treatment cycle).
Then suddenly, I suffered mild diarrhea and had to have two to three BMs a day for two days. I noticed the increased pain during BMs. Then on the third day I was at work and did not have access to a warm sitz bath and needed to have a BM. I ventured it in a public bathroom. I had the worst pain since my treatment and fresh blood. This was very discouraging. I cried so bad that night.
The next morning, I decided there was one more thing I hadn’t tried consistently because of my previous dubious belief. That thing was “exercise”. I had thought when a wound was healing, it should be left alone and as little disturbed as possible. However, at this point I also realized the importance of increasing blood flow to heal wounds. I started fast walking, and even some small jogging everyday. The result was positive. I started to feel better again. I stayed clear of diarrhea inducing triggers. My BMs were back to regular. I was back on Rectiv.
Treatment (Second Month)
I went back to see the doctor. She checked the outside and did a finger check of my anus. I opted out of an anoscopy for the fear of pain. Her finger did not cause as much pain as before – I took that as a positive sign, although the pain sort of came a few minutes later and stayed for a few hours afterwards. I was happy I did not go for the anoscopy. She reassured me that things are healing. It’s always wonderful to hear it is healing. But to us fissure sufferers, is that reassurance enough? Does it mean we are good to go? The doctor sent me home with no new treatment suggestions.
It’s been two months now since my fissure treatment started. I still have painful BMs, although the pain was mostly poking/pinching pain with a couple fleeting seconds of sharp pain in between. I cautiously feel the pain is better.
Regardless though, chronic fissure sufferers know very well how volatile the recovery could be. One bad BM could send us back where we started (although my own experience has proven I do bounce back better much faster now). I continue to live with lots of anxiety and caution. My day won’t actually start until I am done with the BM in the morning.
I read Dave‘s fissure healing story, and realized it took him several months to completely heal. So I try to remain positive and hopeful! I did add Dave’s recommended fissure oil to my treatment regimen as well.
Treatment (Third Month)
As I started my third month of treatment, I decided to take on a new attitude. Although fissure seems to have so readily taken over our lives, we should always remember there is a lot in life we should appreciate and fight for – our loved one and our otherwise healthy body, for example. In the last six months, I lost noticeable amount of weight because of the restrictive diet I was on. When people inquired how I lost this much weight, they seemed more interested in, even envious at, the weight loss, than sympathetic towards my sufferings. I couldn’t blame them though, because their reaction reminded me that I looked perfectly healthy otherwise. In fact, beside the morning BM regimen, limited food choices, and avoidance of travel long distance, I can pretty much do anything I want.
My weight loss had improved my overall energy level and I felt good otherwise. So in this new month of treatment, I decided not to mindfully focus on fissure whenever I can. During my BMs in the morning, which had given me a lot of anxiety in the past, I now focused on what I could do and accomplish after my BM that day. I am sticking to an evening jogging and walking routine. After all, thinking about fissure all the time does not make it more friendly. Instead of letting it define my life, I might as well enjoy what I have and deal with what I don’t.
Recently I found the Q-tip I use to apply medication could actually help assess the level of pain or healing. Last month immediately after I had the re-tear, the Q-tip would cause sharp pain and come out with a little red (blood) on it. Now I could still feel the pinching pain (same as during a BM), not as sharp as before, and also with no blood. I actually applied Rectiv right on top of the painful spot and tried to hold it there for half a minute. I don’t know if this eventually would lead to positive results (so far, no negative, at least). It did give me a sense that I was “hitting the nail in the head” 🙂
Treatment (End of Third Month)
I’ve experienced a positive milestone recently – For more than a week now, the Q-tip could not find any painful spot. In other words, I could no longer find the fissure. My BMs still cause some discomfort, but no more sharp pain. The discomfort is more associated with the surgical incision from my hemorrhoidectomy. I don’t want to call my fissure completely healed – don’t want to jinx it :), but I am definitely not as afraid of the morning BMs as I did in the past several months.
I am now into the beginning of the fourth month. I am pretty sure my fissure is no longer there as the pain spot is gone. I will continue with my diet and self care for as long as I could manage. I am slowly getting my life back – it is a great feeling!
I hope my readers can get some inspiration from my post and achieve an ultimate recovery naturally!
P.S. I recently learned one family member and a friend both had fissure and both healed on their own. Fissure never returned to them. So positive outcomes do exist, more likely more common than negative ones. Problem is we won’t know unless they have a reason to tell us. So I urge everyone out there to start communicating on anal ailments more openly so we live in a community of inclusion, not isolation when it comes to facing anal diseases.
Awesome to hear …
Hi what diet were you on? What were your restrictions?
Pure veggie diet. My biggest restrictions are alcohol, hot spice, rice, or bread. The goal is to avoid constipation and irritation.
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