In my case I have had a history of irritable stomach and then irritable bowel with constipation most of my life. I guess I am a little bit anal in that I want to have a BM every day and can’t stand the feeling of fullness from not going- so I sit on the pot and read or do soduko until I feel significantly empty. This has led me into hemorrhoids and then fissures. I have them on and off, like it’s a vulnerable area that weakens and breaks down. I had surgery in 2005 and have been pretty pain free, but I have to have a daily routine of high fiber plant based food, lots of water, and I take Metamucil and oils.
I was taking Metamucil and mineral oil, which keeps things flowing and smooth, however I began to be concerned about ingesting the petroleum every day. I found the alternative for me that works, after experimenting with different oils is a triple omega oil product of capsules made up of flaxseed, fish, and borage oil. I take the Metamucil mixed in a large glass of water followed by a large glass of water followed by another glass of water and three oil apsules twice a day.
All has been okay, except at times of stress or sitting at the computer too much-then I do get some spasms and bleeding, which I do have right now. There is no bad pain like the excruciating tears I once experienced. I simply keep things flowing, use our bidet toilet seat to wash the area after a BM and take baths.

I found it interesting the info having to do with Chinese medicine. There is no doubt that Eastern medicine, Ayurveda, and herbal remedies can help, but I would not go so far as to judge those of us that have this chronic condition. It is something many of us deal with regularly and not from choice. I am going to be seeing a Chinese MD as a health consultant for various things. One of which is a zinc deficiency that I experienced recently. I am wondering if it has anything to do with the oils.

I had the misfortune of having repeted tears after fissurectomy.
Then, I consulted reputed gastro surgeon – he did a digital exmanination of my anus. He suggested me to udnergo surgery again.
 
I took the decision not to undergo surgery and to make life style modifications like walking, taking more vegetables/greens, timely food, regular sitz bath….etc
 
Now I am free from retears / burning senssation in anus.
 
From my experience, I strongly feel that a holistic approach by the sufferer can tackle fissures.
 
You can take cue from my experience and avoid the mistakes I comitted.

I have been suffering with chronic anal fissure for about 3-4 years. My story reads like many: a nasty bout of constipation is the likely start; was misdiagnosed by GP for hemorrhoids. I cant even remember all the prescriptions we tried over time, but i do remember they never worked. Finally the pain was so bad I went to a gastroenterologist and he diagnosed a fissure. He gave me diltiazem and 8 weeks later i was fine. For 10 months i thought it was a thing of the past. I was grateful everyday that the pain was gone. Then, out of nowhere, it came back with a vengeance. Eight more weeks of diltiazem and i was in the clear again, but it lasted only a month. So now this thing has completely dominated my life for the last 6 months. Over this period i managed to function by willing my BMs from their normal AM time to PM. (not easy) For me, just walking after the BM brought on intense debilitating spasms, making daily function impossible. So, by having the BM at night, i could soak in the tub, then go to bed, not aggravating it. This was really an amazing breakthrough for me and allowed me to have a semi-normal life. (I hope someone else may benefit
from this seemingly simple adjustment.) All this time i was on diltiazem and analpram, waiting for it to work again. But after so many weeks it became apparent that it wasnt going to work. I was switched to Nifedipine and for the first 4 days it appeared to be working. Then it was all down hill. Its hard to believe the pain could get worse, but it did. WOW! Now i have such intense spasms that i am up all night. I was given lidocaine for the pain, but it does nothing, in fact it seems to aggravate the situation. My MD said he didnt want to give me narcotic painkillers because they would constipate me. So, i have found in my years of dealing with this pain that only two things have brought me quick relief. The first, of course, is the sitz bath. Even this doesnt always help me. The second i have never seen anyone talk  about. I am (or was-not these days!) a yoga practioner and i found that shoulderstand drains the blood out of the lower regions and reduces the overall blood pressure in the area. So, when i am having a wave of spasms i lay down and get my legs up on the wall, the more inverted the better, and the majority of the time, i feel the pressure and the edge of the pain drain away. (Hope this helps someone else too!) I hold it for several minutes, as long as i can and then carry on. This has been my #1 source of relief, as silly as it seems, it really works. But, not all the time. Not recently. I am now so miserable i am forced to consider that which i never wanted to do: surgery. I havent slept in days, cant work, cant do much of anything- i am at my wits end and i need a solution.
So, i finally get to my point: what would you, fellow sufferers do in my position? Botox? LIS?

A:
These remedies are merely band-aids on something that will not go away. Unless you have a medical condition that will not allow you to have the surgery – go for it. You won’t be sorry. The horror stories that you will here – don’t believe it. Find a good CRS and have the surgery. I suffered for years and was scared to death to have the surgery and when the pain and bleeding became too much, I cried “uncle” and had the surgery (three years ago), and I have not had one problem since.
I have had two botox shots in the past year and they seem to have helped. I thought after the first botox all was healed (still using baths and nifedipine) but then developed an odd mass that also made the fissure retear so i did another botox with removal of the mass. Still healing from that using same diet and bath regiment.
Seems to be coming along but one thing i’ve learned over the years – healing is an extremely slow process – give yourself years before you can say you are in the clear and in all likelihood – i’ll have to be vigilant about diet the rest
of my life -but the fissure can be healed or at least reduced to nothing more than an occasional nuisance.

  An anal fistula is an abnormal communication or tunnel between your rectum towards your anus, it is commonly caused by an anal abscess. Even though the abcess may have healed, there is now a skin tract or tunnel from your rectum, towards your anus. This tract will stay there until you have surgery done. What is done is usually called a fistulectomy, or fistulotomy. Tracts can course either to the front or towards your back. Tracts towards the front are straight while tracts towards the back are curved. If it really is a fissure, I recommend you see a surgeon and get your answers from them. The tract might get infected and will lead to more pain and suffering on your part, not to mention possible complications.
An anal fissure on the other hand is simply a nick or wound in your anal area,usually superficial but still painful and very prone to infection. Usually it is caused by trauma or passing of hard stools.
The ano-rectal region has a rich blood supply and veins, these veins sometimes get inflamed, enlarge and form what we call hemorrhoids. Men has anal fissures as well, but pregnant women are the majority of the sufferers. There are external hemorrhoids, which are superficial, and internal hemroids which are deeper. Hemroids usually present as painful masses which come out during a trip to the toilet. some hemorrhoids go back in by themselves, some don’t.  Some of them bleed, and some of them do not. In any case, a surgical consult is warranted.
So, what do you have?
If you feel that you have a superficial wound in your anus, it might be a fissure.
If there is a small hole beside your anus that may or may have no secretions, it may be an anal fistula.
If you feel a mass that seems to be attatched to your anus or it seems coming from inside, it may be a hemorrhoid.
Go see a doctor so that you can get treated before it gets worse.

I have received this request – can anyone provide a reference?

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I’ve been dealing with anal fissures on-and-off for 7 years. Writing this down helps me 
feel less alone and embarrassed about this debilitating condition.

When the condition started I didn’t know what was wrong. I went to three doctors, one
who was a colon-rectal specialist, and even had a mini-colonoscopy, which I now realize
probably made the condition worse. After all that, the doctors kept telling me that they
couldn’t figure out why I was so uncomfortable. Needless to say, I’m extremely angry at
these doctors for practically dismissing the agony I was in. I was young, embarrassed and
naive, so I didn’t pursue the issue further and tried to figure out how to live with the
extremely uncomfortable symptoms.

I’ve had long periods of time in the last 7 years without suffering from the symptoms. But
the fissures are back with a vengeance. I gave birth 9 weeks ago. During the pregnancy I
had horrible morning sickness. The only thing that helped to reduce the nausea was a
medication that made me constipated. Anyway, by the end of the pregnancy I had anal
fissures and the vaginal birth only made things worse. During the pregnancy, I kept
complaining to my OB about pain and spotting during BM’s. She told me it was
hemorrhoids and there was nothing I could do.

I was finally diagnosed 2 weeks ago as suffering from anal fissures. While I was grateful to
finally know what was causing my symptoms, I’m extremely concerned that I may never
recover from the fissures. I’ve been using the nitroglycerin ointment for about 1.5 weeks.
There is some improvement but I doubt that the ointment will heal everything. The doctor
said that if I didn’t see a significant improvement after using the ointment for 2 weeks,
then I’d need surgery to get rid of the fissures.

The idea of a surgery that could leave me flatulent or incontinent is absolutely terrifying.

I’m going to get a second opinion in a couple of days. I live in Seattle. Does anyone have
recommendations for doctors, acupuncturists or naturopathic doctors that can help with
this condition?