How to heal an Anal Fissure without Surgery
Hey there,
Just wanted to hopefully provide some hope. I'm a 35 year male who has been dealing with a chronic fissure for about two years. It's hard to explain how painful, disruptive, and emotionally draining this process can be to someone who hasn't gone through it. But it's really important not to lose hope.
First, you're not alone. I think everyone who has dealt with this has had at least one sleepless night (or 50) where you really begin to question can I deal with this for the rest of my life as you writhe in pain.(TLDR You will get through this, I promise. How long it takes it up to you).
I have healed and re-tore 5-6 times over last two years but through education and trial and error I finally found my solution. I'll start with the bad news; if it's chronic there is no easy answer. There just isn't. You need to think about it in terms of short term/long term goals. I want to try to help you accelerate the process.
I am an active guy with a wife and child, so while I know some people go the LIS route it's just something I refuse to do based on the potential for life long incontinence/ infection risk. YOU CAN STILL RE TEAR WITH LIS. I would never hold it against someone for feeling like there is no other option, but even that route you need to follow some basic rules.
Short-term generally speaking lack of blood and reduced or no pain during defecation are signs of healing. But you can be pain free and bloodless for months without being fully healed - so it is critical to set a minimum 2-3 month protocol window even though you can go pain free within a week. So here is what I have learned..
*It blows my mind how unhelpful 99% of GI doctors are when it comes to AF. They typically give bad advice and will just try to push you into botox or surgery without teaching the life skills. With that being said it's expensive but I did get scoped just to confirm I did not have colorectal cancer. If you can afford it I think it is worth doing.
1) Stool must be kept consistently soft. Go out and get Magnesium Citrate and Miralax. I do 500mg of MC and standard dose of miralax EVERY NIGHT. Drink tons of water - I'd aim for minimum of a gallon a day. If you don't keep your stool soft, expect to continuously re tear in perpetuity.
If you can, I think doing a 3 day water fast does help as less traffic means less stress on your fissure. Getting out of initial pain phase is huge for moral. Fasting or not - for at least the first week or two I'd make sure your diet is super high fiber mostly made up of fruits and veggies. I strongly advise against Metamucil. It softens stool, but it bulks it up and will likely cause you to re tear. Just do fruit and find a broth based soup you like that has veggies. Also toss out toilet paper and use unmedicated wet wipes. NEVER PUSH A STOOL OUT, go when that thing is ready and not a moment before.
2) PRANICURA/ Sitz Bath - look it up and follow protocol. When it comes to dealing with AF the doctor who makes this stuff is the real deal. It is not a miracle cure, but ya gotta get some cream in there and this works better than the medicated stuff from GI and doesn't have the nasty side effects. Ya gotta be consistent. There are no short cuts here.
Do a Sitz bath at least 3 times a day. Especially helpful right after passing a stool. I personally find hot water and a spritz of witch hazel gives best results.
3) Consistency - As I mentioned above you likely WILL get to a point where you think it's healed, and then you will re tear and want to die. We have all done it, but know it's part of the process and not the end result. Stick with the laxatives and cream mentioned above. I can't tell you exactly how long you need to, but it'll be a lot longer than you think.
Mind your diet. Think of it as a lifestyle change. Big hard stools caused it, and can cause it again so this is something you need to change for the foreseeable future and not just the next 2 weeks. Sucks - but that's life. High fiber, a lot of fruits and veggies and try not to over eat. Not to be crude but reality is a lot of food means a lot of poop. Some people seem to have trigger foods (cookies for me). If you notice trigger foods avoid them like the plague.
4) Home stretch - once it's "healed" this is where you can truly end this vicious cycle. Now stick with me. Even healed your anus is now tighter than it was which causes higher than normal chance to re tear. You need to re train your body. It's a two prong approach.
The easy part is doing PT exercises like kegals to strengthen that area. No big deal, it's like stretching.
The awkward part is that you need re-widen the anus. There is something called an anal finger massage. It's awkward, but it works. You will need to lube up a finger (I use pointer but people say different things) and stick it up your butt. If you're not used to stuff in your butt (I was not) lay on your side with a pillow between your legs. You are going to start by making contact and doing a gentle circular motion. Your anus will open up and let the finger in. Just breathe and try to stay relaxed, it gets less awkward. Try and get in about 2 inches - you'll feel it. No need to go deeper than a couple inches. Make a round motion lightly pressing against your sphincter wall and breathe. Over time this will train your anus to open up and allow stool to pass through much easier. I'd say do 5 minutes in the morning and 5 minutes at night.
I know this is a lot of info. But healing an AF is unfortunately a long and complicated journey. If you stay the course you can heal this thing and prevent re tearing. There is a light at the end of the tunnel, but I'm not gonna lie to you it's a long tunnel.
**Update 12/3
Based on traffic I have gotten through this post I decided to start adding some links to resources. Please feel free to check back regularly.
Resources
Stool softening and Bowel Movement Techniques https://m.youtube.com/watch?v=1jugmjpAWnI *Technique can be used in conjunction with squatty potty which is my preferred method)
Your Friendly Proctologist Channel (YouTube) https://m.youtube.com/@yourfriendlyproctologist
I wish everyone here the best, and if you have any additional questions I will do my best to respond. Do not give up, there is always hope. And the sooner you own the situation the sooner you can get back to slamming double cheese burgers.
Cheers!