Healing Anal Fissures

After living with Crohn's disease for almost 15 years, I have finally experienced my first anal fissure. If you are unfamiliar with anal fissures, an "acute anal fissure looks like a fresh tear, somewhat like a paper cut. A long-lasting, also called chronic, anal fissure likely has a deeper tear. It also may have internal or external fleshy growths. A fissure is considered chronic if it lasts more than eight weeks."¹

Hemorrhoid or fissure?

It's amazing how after living with a disease for so long, one can still experience new sensations that are completely foreign. At first, I thought it might be a hemorrhoid. Despite having three children, I have also never experienced a hemorrhoid.

After a quick Google search, my symptoms appeared to line up with a hemorrhoid, however using Preparation H did little to soothe the symptoms. I had pain and itching throughout most of the day, not just when having a bowel movement, and it began to also wear on me emotionally.

My breaking point was when I was sitting in my son's bed to read him a bedtime story and I felt a pop, as if a cut opened right above my anus. The pain that persisted with that "cut" was enough to take my breath away every time I stood up, especially after sitting for an hour or more. It was then that I knew that this was not just a hemorrhoid and medical attention was needed.

Easing the pain of a fissure

Below is a list of ways I have been successful in easing the pain and symptoms of a fissure:

Epsom salt sitz baths

This has become a new routine that I love, both for physical and emotional reasons. I have always preferred showers over baths, but filling the bathtub with 2-3 inches of water and about 1 cup of Epsom salt is relaxing and soothing, and the perfect way to meditate or read a book for 15 minutes. When my fissure was active, I did a sitz bath daily for 10-15 minutes, and now I continue to do them 3-4 days per week. I alternate between eucalyptus and lilac scented Epsom salt for a peaceful respite from my day.

Soft toilet paper

I have never been one to skimp on good toilet paper, and experiencing a fissure is a guarantee that I will continue to only use Charmin toilet paper. My family and I spent a week in a rental house on the beach, using the toilet paper they provided (which was about as soft a sand paper) and I began to feel sore within a few days. Replacing it with Charmin and taking sitz baths upon returning home prevented the pain from progressing, but I am definitely adding "toilet paper" to my packing list from here on out!

Prescribed ointment

My GI prescribed Nifedipine which is an ointment that I used twice daily to help heal the fissure from the inside out. It was rather pricey due to it being made at a specialty pharmacy, but the benefits were worth the $65 tube. The downside of using this is that it takes a few weeks to have a maximum effect, so incorporating sitz baths as part of the treatment plan is helpful in finding relief sooner than later.

Loose clothing

This part might only pertain to the ladies, but selecting looser fitting underwear and bathing suits (aka not the kind that ride up the hiney) keeps everything clean and calm in the area of the fissure. I stayed away from jeans and any clothing that is rough, as well, selecting more dresses or soft pants while healing. I also changed more frequently out of my wet bathing suits to keep the area clean and dry, and to prevent the risk of a yeast infection which would only complicate things further while having a fissure.

Don't hesitate to get medical attention

If you think you may have a fissure, be sure to check with your GI before trying any of the above remedies, and don't ever be ashamed to ask follow up questions about the care and treatment. I must admit, despite living with Crohn's since 2009, there are still some parts of the disease I am uncomfortable and embarrassed about asking my doctor. But at the end of the day the goal is to feel well. 

Letting a fissure go untreated can lead to prolonged pain and possible surgery, so if you are feeling like something isn't right, never hesitate to reach out to your care team to get proper medical attention.