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07-12-2016, 01:08 PM   #1
Ihurt
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Fissure question?

Hi everyone.

I have not been diagnosed with Crohn's but have been having issues for a few years with intestinal pain and issues. My gastro did tests two years ago that did not show much. He claims IBS. I am unsure though.

Anyhow, two months ago I was having issues with feeling irritated in my anal area( inside the anus). I went to my gastro doc and he said probably a fissure. He basically said it should heal on it's own in time. He gave me a script for this stuff( I asked for it) that is like a Nitrogycerin cream that can help heal fissures. I did not end up using it because it seemed to get better on it's own. I felt like it was gone for the last few weeks. Today I used the toilet and I felt that pain n that area again and assume I irritated it again. I did not even push or strain really, I mean I pushed a little to get the Stool out, but no where near a strain so not sure why that irritated things again.

I am obviously worried now that it wont ever heal. My hubby thinks it will eventually heal, it just needs time to fully heal. It does not hurt horribly or anything, but I can tell it is irritated again .

My anal area on the outside gets irritated easily so I often use Zinc oxide ointment around the outer area and that usually helps with outer irritation. The fissure is not on the outside though, it is just inside the anus from where the pain is. Is there anything that will help heal this once and for all? I literally felt like it was gone for the last 4 to 6 weeks. Any ideas? I am worried that a crack in this area will cause an infection or abscess due to it's area.
07-12-2016, 01:28 PM   #2
MEgal
 
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Join Date: Mar 2013
Location: Gainesville, Florida
Hi everyone.

I have not been diagnosed with Crohn's but have been having issues for a few years with intestinal pain and issues. My gastro did tests two years ago that did not show much. He claims IBS. I am unsure though.

Anyhow, two months ago I was having issues with feeling irritated in my anal area( inside the anus). I went to my gastro doc and he said probably a fissure. He basically said it should heal on it's own in time. He gave me a script for this stuff( I asked for it) that is like a Nitrogycerin cream that can help heal fissures. I did not end up using it because it seemed to get better on it's own. I felt like it was gone for the last few weeks. Today I used the toilet and I felt that pain n that area again and assume I irritated it again. I did not even push or strain really, I mean I pushed a little to get the Stool out, but no where near a strain so not sure why that irritated things again.

I am obviously worried now that it wont ever heal. My hubby thinks it will eventually heal, it just needs time to fully heal. It does not hurt horribly or anything, but I can tell it is irritated again .

My anal area on the outside gets irritated easily so I often use Zinc oxide ointment around the outer area and that usually helps with outer irritation. The fissure is not on the outside though, it is just inside the anus from where the pain is. Is there anything that will help heal this once and for all? I literally felt like it was gone for the last 4 to 6 weeks. Any ideas? I am worried that a crack in this area will cause an infection or abscess due to it's area.
It's possible it did heal, but came back again. As a Crohns pt, I have fissures ALL the time and having tried the gambit of nitro cream, diltiazem ointment, etc I can wholeheartedly say the best things are:
1. To heal them: steroid suppository. After trying everything else, this finally took care of all 7 of them!
2. Symptom relief: lidocaine ointment, applied with gloved finger. Not the most pleasant to put on/in, but it works for albeit temporary relief
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This has gotten me through many bad days and hospital stays:
http://www.crohnsforum.com/showthread.php?t=37266

Tried:
Pentasa, Apriso, Budesonide, Pred, Asacor,
Now on:
tramadol, zofran, budesonide, protonix, Humira

Last edited by MEgal; 07-12-2016 at 01:28 PM. Reason: grammar
07-12-2016, 01:36 PM   #3
Ihurt
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Wow, see I asked my Gastro doc about steroid cream when I first got the fissure and he said it would be useless to heal a fissure. He said sometimes the Nitro ointment can help but it has a nasty side effect of causing severe headaches. He said basically time and warm soaks are what helps. However, warm soaks are Not an option for someone who has IC( Interstitial Cystitis) which is a bladder disease. I am also Very prone to Urinary tract infections so I am Not allowed to take baths or soak at all as it is too much oh a risk for UTI's. Anyhow, I cannot see how soaking would help a fissure that is on the inside anyhow.

I can ask my primary care for a script for the Steroid suppository. I am sure she would be okay with me trying it. Do you recall the name of the suppository you used?








It's possible it did heal, but came back again. As a Crohns pt, I have fissures ALL the time and having tried the gambit of nitro cream, diltiazem ointment, etc I can wholeheartedly say the best things are:
1. To heal them: steroid suppository. After trying everything else, this finally took care of all 7 of them!
2. Symptom relief: lidocaine ointment, applied with gloved finger. Not the most pleasant to put on/in, but it works for albeit temporary relief
07-12-2016, 01:57 PM   #4
MEgal
 
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Join Date: Mar 2013
Location: Gainesville, Florida
Docs are split when it comes to steroids and anal fissures, which is annoying (although, I'm in the steroids aren't always bad camp...so grain of salt ) If your doc doesnt think you have IBD, that might (?) be why he doesn't think they'll help. Dunno.

The down side is mostly that they thin the skin with continued use (more than the 14 days the prescription lasts...frankly more than a month before you should start worrying) and it makes it easier for fungal infections to flourish, which in the anus is unlikely but possible. Personally, I'd take healing a fissure over those small risks any day.
You can use steroid foam or suppositories, based on what your doc likes. The foam is from what I remember like pentasa, in foam form, for rectal crohns/UC--so that wouldn't work for everyone. The suppositories are just Hydrocortisone AC (25mg)
(generic for Anusol HC 25mg) and you use one in rectum at bedtime for 14 days. It might not work for everyone, but it worked for me after the diltiazem, sitz baths (did Not a damn thing-though ppl swear by them), nitro cream, etc failed.

Disclaimer--I'm posting from experience, not MD

Hope you feel better! and in the mean time--the lidocaine does help
07-12-2016, 05:13 PM   #5
Ihurt
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Thanks for the information, I appreciate it. I do have lidocaine gel that the GI prescribed for the pain. I am going to ask my primary care doc about the hydrocortisone suppositories when I see her. I am glad it helped heal your fissures. I hope maybe I can heal mine too. I know there is surgery for them but my GI Doc basically said I did not want to even go there as there is a risk for becoming incontinent. No way would I risk that being so prone to UTI's that are very hard for me to treat ( I am resistant to many antibiotics and the ones I am not resistant to I am either allergic or have severe side effects). This sucks .
07-12-2016, 10:12 PM   #6
Mommy22
 
Join Date: Aug 2015
Location: New York, New York
Hi Ihurt,
I'm sorry to hear about what's going on, fissures are awful awful awful.
To make a long story short, I suffered from recurring fissures for around a year (during which I was also more gassy and nauseus than usual and was told I had IBS by GI #1). In that time I tried a whole bunch of things including creams (OTC and prescription), baths, baths with coconut oils, manuka honey, stool softeners, fiber, botox procedure--the whole nine yards! By the end of all this, and after having visited 2 colon rectal surgeons (CRS) and 1 GI, the 4th CRS I went to said, "hey, these skin tags and fissures look like perianal crohns, have you ever thought you have that?" A little while later, I ended up flaring for the first time and got a clear diagnosis from the 5th doctor (GI #2) I had seen in this looonnnngggg journey. Since being treated for Crohns and having now been in remission for around 6 months, my fissures have improved tremendously. I still bleed on occasion but they don't hurt anymore. THANK YOU GOD! Anyway, I guess the moral of my story is that once I started treatment for crohns (now on Humira + 6mp), my fissure issues have more or less totally resolved.

You mentioned you had tests 2 years ago that were inconclusive. I don't know what tests you had, but I would encourage you to either have testing done again with your current doctor or seek out a 2nd opinion if the fissures dont resolve with the available treatments/remedies.
I would also suggest reading http://anal-fissure.org/ Its a similar forum (slightly different focus which has lots of helpful suggestions and tips.
Best of luck to you!
07-13-2016, 08:11 AM   #7
Ihurt
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Thanks for the advice. Sorry you had to deal with them too.

I started having gut issues back like 5 years ago after I got a stomach bug. I also was on long term antibiotics for recurrent UTI's at the time. I honestly think that stomach bug screwed me up. Well fast forward I went to my GI doc who said IBS. My main symptom at the time was crampy pain that was quite severe( left me sitting with a heating pad all day a lot of days). I did not have any bowel changes at that point though. After suffering for over a year and half my GI finally did some tests ( MRE of small bowel which was normal, CT which was normal, blood work that was normal and stool tests that were normal). I still had symptoms so a year after that we did a colonoscopy with biopsies which was normal. So my GI doc stands by his IBS diagnosis.

Also back last year in July I was taking a medication for my other health issue( I have Interstitial Cystitis of the bladder) called Uirbel( a low dose too) for a few months. It ended up messing my intestines up. I started having loose stools every morning it seemed( only once a day though). I however went to see a functional practitioner and she ordered more comprehensive stool tests and they showed elevated Calprotectin levels and elevated SigA levels. That was like almost a year ago. Well things seemed to improve some after a few months. Three months ago I felt like I was irritated in my anal area. I do have hemmorhoids, but they are not severe or anything. They do act up once in a while. One day I had this awful pain, like a charlie horse in my rectum. It literally felt like a huge cramp up there. Very painful. It passed after like 5 to 10 minutes. Well after that I felt more irritated in there. Then I felt that sharp pain( I am guessing the fissure). I went to my GI doc and he felt in there and said it was likely a small fissure and that they were common. He said it should go away in time, and to avoid constipation( which I do Not have usually). I even had my internal medicine doctor re-do the fecal calprotectin test and it was normal this time. I have no clue what to think is going on.

I am not to in a hurry to re-do the tests as they are very invasive, especially the colonoscopy. After the last one I ended up with a Vaginal infection as well as a UTI and that was with being super careful and clean. I think because I have IC of the bladder that makes me very prone to getting infections so I have to be careful. Of course if I have to have it done, I will, I just hate to make my other health issues worse. For me infections are Bad because I cannot take most of the antibiotics out there( I am either resistant to them and they do not work or I am allergic to most of them). It really sucks.

I wondered about anal Crohns. I know if I brought it up to my GI he would fluff it off and say no, it is IBS, especially if he cannot see anything down there when looking. I also think I probably have SIBO which can cause all sorts of gut issues.














Hi Ihurt,
I'm sorry to hear about what's going on, fissures are awful awful awful.
To make a long story short, I suffered from recurring fissures for around a year (during which I was also more gassy and nauseus than usual and was told I had IBS by GI #1). In that time I tried a whole bunch of things including creams (OTC and prescription), baths, baths with coconut oils, manuka honey, stool softeners, fiber, botox procedure--the whole nine yards! By the end of all this, and after having visited 2 colon rectal surgeons (CRS) and 1 GI, the 4th CRS I went to said, "hey, these skin tags and fissures look like perianal crohns, have you ever thought you have that?" A little while later, I ended up flaring for the first time and got a clear diagnosis from the 5th doctor (GI #2) I had seen in this looonnnngggg journey. Since being treated for Crohns and having now been in remission for around 6 months, my fissures have improved tremendously. I still bleed on occasion but they don't hurt anymore. THANK YOU GOD! Anyway, I guess the moral of my story is that once I started treatment for crohns (now on Humira + 6mp), my fissure issues have more or less totally resolved.

You mentioned you had tests 2 years ago that were inconclusive. I don't know what tests you had, but I would encourage you to either have testing done again with your current doctor or seek out a 2nd opinion if the fissures dont resolve with the available treatments/remedies.
I would also suggest reading http://anal-fissure.org/ Its a similar forum (slightly different focus which has lots of helpful suggestions and tips.
Best of luck to you!
07-13-2016, 07:20 PM   #8
Mommy22
 
Join Date: Aug 2015
Location: New York, New York
I understand your perspective and hesitations re-testing given your previous experiences . I guess another big difference is that I had very large skin tags/hemorroids, so the overall presentation looked like (and was) perianal crohns. Once again I am learning how despite overlapping symptoms, we all (as in, people have different bodies and experiences so it is hard to generalize....
Either way, I hope you feel better (on all fronts!) soon. Check out analfissure.org , maybe you will find helpful tips there.
Good luck and hope you feel better soon!
07-13-2016, 08:32 PM   #9
Ihurt
Senior Member
 
Join Date: Mar 2012
Location: United States

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Thanks so much for the support,advice and info, I really appreciate it. It sure sucks being sick.





I understand your perspective and hesitations re-testing given your previous experiences . I guess another big difference is that I had very large skin tags/hemorroids, so the overall presentation looked like (and was) perianal crohns. Once again I am learning how despite overlapping symptoms, we all (as in, people have different bodies and experiences so it is hard to generalize....
Either way, I hope you feel better (on all fronts!) soon. Check out analfissure.org , maybe you will find helpful tips there.
Good luck and hope you feel better soon!
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