I had an anal fissure caused by constipation about 4 years ago during Covid . I was fortunate that due to the extreme discomfort after a bowel movement I had a minor operation where Botox was injected to relieve the spasm and I had no more pain . I’ve recently had open heart surgery to replace a faulty valve and had a bout of constipation after leaving hospital due to the medication . Sadly I think I have developed another fissure as it feels exactly the same and for the last 8 weeks I’ve been in a lot of pain after going to the toilet which can last up to 12 hours . My GP prescribed GTN cream 3 weeks ago but that hasn’t helped at all so due to the delays in getting treatment on the NHS I have made an appointment to see a private consultant early next week . Im hoping I can have another Botox injection as that worked perfectly last time as things went straight back to normal with no pain or issues post op. Has anybody had more than one fissure requiring surgery and what would be the cost of going private this time if the NHS won’t see me urgently . The pain is making recovery from my heart surgery difficult as I can’t exercise as I’m supposed to and I’m stressed out most of the time trying to live with the pain so can’t relax .
Anal fissure: I had an anal fissure caused by... - IBS Network
Anal fissure
I had anal fissure last year for months but it did not require surgery. 2 things that helped me were
(1) Sitz bath . Sitting in warm water for 15mins daily before bedtime really helped me. Check with your doctor if you can have sitz bath as you have had surgery
(2). Taking Movicol. This keeps the bowel moment soft and regular.
I also tried various creams but in the end I think only nifedipine helped a bit.
Hope this helps.
Thanks , I’ve tried the sits bath with no relief . As I’m on medication following my open heart surgery and take Bisoprolol I doubt a calcium channel blocker would be considered so I still feel the Botox may be the only option
you should try bath in magnesium salts.
Yes, the magnesium in magnesium chloride or magnesium sulphate (Epsom salts) is absorbed through the skin and may relax the anal sphincter/ decrease the spasm that is causing the pain.
I have had an anal fissure for about 2 years brought about by chronic constipation. I have had some success in controlling it. First I took Laxidol regularly which may be like Movicol. If this is not an option another stool softener is essential in my view to prevent overstretching of the anus.
The GP prescribed Rectalgesic ointment but this just inflamed things. My breakthrough was discovering Pranicura 5 through a YouTube video. The ointment, together with following the strict instructions for application started the healing process and reduced the pain. After9 weeks I felt cured.. however an unexpected bout of constipation and large hard stools reopened the fissure.. I am now well into my second attempt. The lesson is that anal fissure is not cured and is likely to reoccur with constipation.
My sympathies. Anal fissure is very annoying and not easily treated.
Thanks for that, I use Laxido one sachet every other day . It’s keeping my stools soft but I still suffer many hours of pain after a bowel movement . It’s been nine weeks now and is getting me down , sometimes I simply can’t find any position to sit that relieves it . I’ll look into Panicura 5 as GTN hasn’t helped at all
Sorry to hear of your fissure problems. I had my fissure for 10 years or so, and what cured it was the Rectalgesic ointment. It didn't heal it immediately, it took 2 tubes of it over the course of 2 summers and having hot baths before I applied it. Good luck.
My heartfelt sympathy re the pain, especially as you are also trying to recover from major surgery. Mine was about 20 years ago now, and as ridiculous as it sounds, the only way that I could relieve the pain was to bend over double whilst also putting pressure on the perineum (area between anus and scrotum/vulva). At the time, I wrote out what had helped me as it is such a horrible pain and my GP asked if he could copy it for other patients. I'm sure that you'll already know all of this, but just in case there's a little snippet that might help..... And some of the fibre advice may not be appropriate for IBS patients. Not sure if Botox was available for treatment then. Rectogesic was about to be launched! I do remember that sitting in the car and bending over the sink to clean my teeth triggered it ie certain positions, so I found ways to worked around being in those trigger positions.
" ANAL FISSURES
Firstly, many sympathies. Not only is a fissure (a split or tear in the very sensitive skin of the anus) extremely painful and inconvenient, but it’s not something that is very easy to discuss with other people, even though fissures are quite common!! Secondly, it can take a great deal of trial and error to work out how best to manage your own problem and can seem to take forever to heal. With a fissure even simple basic tasks and positions such as travelling by car as a passenger, let alone driving, become surprisingly troublesome.
Obviously avoiding it happening in the first place would have been best and easy with hindsight, but once you’ve had one, you’ll certainly be extremely determined never to let it happen again.
The most common cause of a fissure is constipation. If the diet contains insufficient fibre, the stools become too hard in consistency because they lose water as they pass through the intestines too slowly.
Acute (sudden onset, rapidly healing) fissures
There is typically some loss of bright red blood with the sensation of “passing razor blades” each time the bowels are opened (a stool, faeces or poo passed) and for a short while afterwards.
Putting off going to the toilet is counterproductive and will only be more painful when you do eventually HAVE to go! It’s better to just get it over with. Products with some local anaesthetic eg. Germaloids or similar (available “over the counter” directly from your pharmacy without a doctor’s prescription), applied a few minutes beforehand can ease the pain and help you to relax. Prolonged use (more than about seven days) can cause the skin around the anus to become sensitive and worsen the soreness. Although you may dread the discomfort of each bowel movement, try not to tense up. Breathing slowly and deeply with an open mouth may help you to relax and in fact speed things up.
The next important factor in helping to relieve the pain and help healing is to make the stools softer by increasing their fibre (and as a result, water) content. The recommended daily intake of fibre is 18-30 grams per day (about 24 g for women, more for men and less for children). Please see attached sheet but also look at the nutritional information panel on the packaging of many food products. It is advisable to increase the fibre intake gradually to avoid abdominal discomfort and diarrhoea. Any problems with increased “wind” should settle as your body becomes used to more fibre. Higher-fibre foods need more chewing and are more slowly digested so keeping you feeling satisfied for longer. This can be particularly helpful if you are also trying to “watch your weight” and a higher-fibre diet is healthier for your intestines.
Remember to drink plenty of water too. The stools should ideally be the consistency of toothpaste and you shouldn’t need to strain to pass them. Should you need additional help to soften the stools, Fibogel (now renamed Senokot – isphagula husk) may help. Mix it up as directed and then follow it with an additional glass of water. Lactulose can also be very helpful if other measures don’t soften the stools sufficiently. Both Lactulose and Senokot are available “over the counter”.
A hot drink before a bowel movement (if predictable in advance) can also get everything going more efficiently and help you to avoid straining and incomplete emptying.
Also very important in the healing process and to ease discomfort, is cleanliness. The anal area should be thoroughly cleaned after each bowel movement, ideally in a shallow bath or bidet. A large washing up bowl set aside specifically for the purpose may be more practical and save water if you are sufficiently agile! Plain or slightly salty water is best. Avoid products such as bubble baths, soap, shower gels (which can be very harsh on sensitive skin and wounds such as a fissure) and antiseptics unless told otherwise by your doctor. A warm soak for a few minutes will also help to ease any discomfort. Prolonged soaks however will make the wound edges soggy and sore and will delay healing. Dry gently and thoroughly afterwards.
Try to avoid too much sitting around and keep as mobile as possible. Not only does this distract you from the discomfort, but it also improves the blood supply to the area (and therefore speeds up the healing process) and also helps bowel function.
Chronic (long lasting) fissures
Unfortunately, sometimes a fissure may take weeks or months to heal. In addition to the sharp pain at the time of a bowel movement, shortly after, the muscles near the fissure go into spasm, which decreases their blood supply and causes an extremely unpleasant, dull, continuous aching pain which can last for about 6 – 8 hours. This is a difficult type of pain to deal with since, codeine-containing medicines (usually used for such severe pain) tends to cause constipation and should definitely be avoided. Ibuprofen can interfere with the healing process and may not be very effective. Paracetamol, although usually used for milder pain, can be surprisingly helpful.
At this stage your doctor may prescribe GTN ointment (Rectogesic) to apply directly to the fissure 2-3 times per day. (This acts in a similar way to angina medication.) By opening up the blood vessels and decreasing the muscle spasm, the pain is relieved and the blood supply improved so speeding up the healing process. The common side- effect of headache is mild in comparison to the fissure pain, and perseverance should hopefully result in the fissure healing without the need for an operation or anaesthetic."
Wishing you a speedy recovery!
That’s very helpful thanks
Just a quick update, I had surgery about 10 days ago where a fissure was found quite high up in the rectum . Botox was administered and a nerve block injection , the surgeon said I was in spasm . I have a follow up in about a month to six weeks but I can initiate a consultation if required. For the first two days I could not feel anything which was a massive relief but since then I have the odd day where I’m pain free but generally once I’ve had a bowel movement I’m in pain for the rest of the day. It’s not as severe as before but still uncomfortable and unpleasant. They gave me dihydracodein to help but it’s totally ineffective strangely so don’t know what else I can take . I’m assuming the fissure is taking time to heal but I dread going to the toilet now as I know I’m in for hours of pain . It doesn’t hurt to pass a stool as I’m taking Laxido nightly and I’m being scrupulously clean after but it still aches all around my groin area . I’ve read it can take up to 8 weeks for a fissure to heal , I hope it’s sooner .
I'm so sorry to hear that you're in such pain. Sounds like you're doing all the right things. Perhaps you could contact surgical department re some different/stronger pain relief. (Dihydrocodeine not ideal anyway as it can tend to cause constipation, though you are taking Laxido which should help to counter that). Something simple (and 'mild') like Paracetamol may take the edge off - it works in a different way. I'd think that the pain is caused by continued spasm during the healing process, and that will all be helped by making the stools as soft as possible. Drinking plenty of fluids is vital. I found prunes absolutely excellent for this purpose. Wishing you a speedy recovery!
I had an anal fissure 50 years ago, and today I still have the pain, although the fissure is long gone the pain remains. Just classed as unlucky.
Good luck and hope and pray that it turns out well for you
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