• Ava Hoffman

the fissure end

***Disclosure: This post may contain affiliate links meaning I may earn a small commission when you purchase, at no extra cost to you. I only recommend products I would use myself, and all opinions expressed are my own.


CW // anal everything; crude humor and language; ableism; and general TMI






I waddled across the room, tears streaming down my face and cringing with every step. I fell face-down on my bed, burying my face into the blanket to muffle my moans. My hands fisted, twisting the quilt, grasping anything that could possibly ground me as I rode the waves of agonizing pain.


One hour.


Sixty minutes of total anguish. Torment that twisted my insides and made catching my breath difficult. The burning, searing, ripping radiating from my butthole was all-consuming. It felt like I was being split open.


It began to fade, and as I began to feel sleepy, I realized this nightmare was far from over.

 

Mayo Clinic defines an anal fissure as "a small tear in the thin, moist tissue that lines the anus." It's usually accompanied by pain and bleeding when pooping. Sometimes, it can also cause spasms of the anal sphincter.


If you were to Google "anal fissure," you'll get a list of resources from prestigious institutions that say roughly the same thing and recommend almost identical generic treatments.


Which I find extraordinarily irritating.


I have a J-pouch. It is physically impossible for me to be constipated and/or have large and hard poops. Advising me to take more fiber and keep my poop soft is useless...my poop is soft!


In the sparse patient forums I was able to track down, a majority of the patients do NOT have inflammatory bowel disease (IBD), and their experiential advice amounts to "take a bath and wait it out."


Personally, I poop nine times a day, and I don't have time, energy, or the pain tolerance to wait out the 6-8 week healing time.


The other mainstream experiences of those with anal fissures fall into one of two categories - anal intercourse or postpartum.


Anal intercourse is an absolute no-go over here, so this advice is completely useless, and I'm not a postpartum mother, so this avenue of advice isn't helpful, either. Actually, as a woman who may not be able to biologically have children, it was really difficult to read through those stories.


My pelvic floor therapist recently told me that she sees anal fissures in more of her male clients than female and sees more IBS patients with anal fissures than she does postpartum moms.


I searched for "anal fissure treatment" on Amazon and was given a list of hemorrhoid creams. Just to be clear, a hemorrhoid is tremendously different than a fissure. Treatment for one is not effective for the other.


I share all of this with you to illustrate this:

There is a grand lack of resources for those who do not fit into the medical mold or the target market. There is an abysmal shortage of information on accessible at-home treatments for those of us trying to manage fissures.


Which, again, I find extraordinarily irritating.


So.


In case your anus ever decides to rip open, use this as a resource. I hope these links can provide you options for relief.


In case your butt ever starts burning, this is here to help. I hope the following can aid in a speedy healing process.


And in case you ever find yourself at your wits end because no one gets it and your story is missing from the narrative, I'll be here ❤


And if you find yourself reading this as someone with the privilege of never thinking about your poop, your sphincters, your butthole, or how to shit painlessly, let this also be a resource! Bless a butt-hurt friend or family member with the gift of potential relief, and if nothing else, let this be a window into our experience.

 

I found I had four stages with my recent anal fissure, and I needed different things for each phase. I've broken this down by those stages, complete with my experience and the products I needed, used, loved, and found relief through.


By the way, should you visit these product links (or go search for your own), feel free to ignore the branding. Just because it says "female," "baby," or "bedridden patient" does not mean that you can only use it if that's you. Believe me - I made my husband (who is none of those) try these, too!


hell hath no fury

These were the God-awful days. I'm pretty sure shitting knives would have been a more pleasant experience. The searing pain and the burning sensation were always present but unbearably worse after pooping. Unbearably.


I couldn't walk normally post-poop. I couldn't sit post-poop. Laying horizontally on my stomach offered the most relief as my anal sphincter spasmed and protested and eventually relaxed. Nights were the worst, and my sleep schedule was WHACK.


My entire crotch was swollen and inflamed. My vulva was mad, my perineum was irate, and my ass had quite literally blown a gasket. If I wasn't crying by the time I'd finished pooping, I certainly was by the time I finished wiping.


At first, I was using flushable baby wipes. I always have these on hand, so this was an easy switch to make. I went through a 3-pack in about six days, so I personally will be purchasing the pack of 5 straight away!


The wipes were not enough, though. While certainly gentler than even the softest of toilet papers (I only buy the best, thank you!), my groin was redder and more inflamed than ever. I was seriously thinking about showering after every poop!


And then I discovered the peri bottle. Think handheld bidet. No contact with inflamed parts. Gentle water-cleansing and still sanitary. It was a relief to no longer need to wipe! Do keep a soft towel on stand-by, though, and PAT dry. I repeat, PAT dry. Gently.


I was also taking baths with epsom salt at this point. I filled the bathtub with hot water - as hot as I could stand it - and soaked for 20 minutes. Those nights where I couldn't sleep from the pain? This helped.


I was in survival mode for these days. I focused on hydration. Powerade Zero and Liquid IV are my go-tos. If your butt split open due to constipation, increasing fluids and ensuring your liquids are quality is especially important!


I also avoided foods that I knew would be unpleasant coming out - popcorn, raw vegetables, apples, spicy foods, fried foods, brown rice. Your list will probably look different, but take it from my experience - go gentle with the foods!


acclimated

It was probably day 5 when the pain was more manageable. It didn't last as long, and I wasn't crying as much. I'm not sure if the pain was truly better or if I was just more used to it, but either way, it was nice!


I went back to using wipes, and I gave up my bathtub for a true sitz bath and herbal epsom tablets. The powers-that-be recommend using HOT water for the sitz bath, so I went ahead and moved my electric kettle to my bathroom. While you don't need it for fissure care, I found this made my life easier, and the water stayed hotter longer than hot tap water.


I also started using a hot/cold perineal pack around this time! If my anus wasn't in pain, it was itching, and these helped with both experiences. I found cold to be more helpful personally.


Now, most perineal pack options are girly and flowery and cute (including the ones I linked above), and as I've discovered, many men experience fissures, too! So this link holds an option that isn't pink or floral while also being washable and reusable 😊


As my days and nights got better, I was able to regulate my schedule which helped me focus on nutrition! I've seen the healing power of food in my own story, so I incorporate whole foods as much as possible normally. When I'm trying to heal something (viral, infection, etc.), I add foods to my diet that are anti-inflammatory and immune supportive.


I chose to still be gentle food-wise so smoothies are my best friend! I can pack all the nutrients I want into a digestible form that won't rip my insides apart more. Spinach, kale, cinnamon, ginger, turmeric, carrot juice, citrus, and mixed berries are some of my staples.


itchy itchy itchy

About two weeks in, I realized the pain was mostly gone, and in its place was the most heinous dreadful itching.


I was pumped! Itching means healing, and I'm all about the healing!!

I was less enthused when I found myself clawing my ass at all times of the day.


For little itches, I find Tucks to be extremely helpful! This is another product I always have on hand. With my anal fissure, I'd take a pad and let it sit directly on my butthole for 30ish seconds and then swab around a bit, and it almost always removed the itch. God bless witch-hazel.


But for big itches, Calmoseptine is the way to go! I use this butt cream all.the.frickin.time. It protects my skin from leaks and accidents, protects my butt crack from getting raw, soothes itching, and promotes healing. I seriously don't know how to be a J-poucher or Crohn's patient without this stuff!


I also found myself gravitating to adult diapers, affectionately referred to as "diaps," in this phase. I did not want the pink sticky goo known as Calmoseptine on my panties plus I experienced frequent accidents as my sphincter and anus were healing. I personally prefer either the Silhouette style or these Assurance ones. There are numerous options for men, too, and all of these are pull-up style (dignity is important over here!).


Cold packs also provided substantial relief during this healing period!


I think food played a huge role in this stage for me. I found that farting caused my fissure to pull apart aka get worse aka hurt like hell. I know what foods cause flatulence in my body, and I avoided them like the plauge!


Baseline, avoid onion and garlic. I don't care who you are or what your intestinal anatomy looks like! Stay away from broccoli, asparagus, and cauliflower. Take it easy with raw veg. I'd also lowkey stay away from fried food, too. And keep hydrating!


recovery

When the itchy itchy is over, the pain is gone, and we consider it all healed, we're actually doing ourselves a gross disservice.


See, oftentimes a healed fissure comes with scar tissue. If you've had numerous fissures, you get scar tissue build-up. This causes an anal stricture or narrowing which leads to pain when pooping, straining, bleeding after pooping, leakage, etc. Sound familiar?


It very much can be a vicious cycle. Which is why this recovery phase is so important!


And it's all about pelvic floor therapy!


Find a pelvic floor therapist who does rectal work (not all PFTs do this). They can address any underlying muscle and fascia issues that may have contributed to the fissure in the first place.


For example, I have massive pelvic floor trauma due to surgery, disease, and altered anatomy. My anus has been tight ever since my first surgery in 2016. It is likely this extreme tightness contributed to this fissure.


My pelvic floor therapist knows this and has techniques (both internal and external) to help relieve this tightness AND retrain my muscles to choose a more relaxed state. Some of this can also promote the blood flow your ass needs to heal well!


One of those internal techniques is an internal massage. This can actually prevent scar tissue! No scar tissue in my anus means less fissure reoccurrences, no nitroglycerin, no Botox, no blood pressure meds, and no surgery! Yes, these are all treatments for anal fissures.


Recovery is all about complete healing and prevention. I don't know about you, but the last thing I want is another fissure. Or unwanted pharmaceuticals in my system. Or surgery that may cause incontinence.


If you've had a fissure, regardless of the cause, find a pelvic floor therapist who works with butts!


other considerations

I want to preface this by saying - know why you have a fissure!


For example, mine was caused by the not-so-simple fact that I have Crohn's Disease. The treatment options I chose were steered by this fact!


I understand you might not know exactly what caused your fissure...do your best to pick a category.

a. Constipation (hard/large poops)

b. Diarrhea (usually chronic or long-term)

c. Straining (pushing really hard to get that shit out)

d. Postpartum

e. Anal penetration

f. Disease (IBD, cancer, HIV, certain STIs)


What I've shared can be applied to all of these! HOWEVER, there are a few differences in treatment that I want to highlight.


There were a couple days where I chose to take Immodium. It allowed me to go from nine bathroom trips to six! And lemme tell ya - when you have a lacerated asshole that is a game-changer!


BUT if you have a fissure due to constipation, DO NOT take Immodium! That will make things WORSE! You'd need laxatives (Miralax is my personal preference) and stool softeners.


Another example - I tried to wait as long as possible between poops. Holding it caused pain but it was less than actually pooping! BUT if you are constipated, this is a TERRIBLE idea.


Childbirth will require a whole extra set of care requirements. Certain diseases need additional courses of prescribed medications or have a higher risk of infection making seeing a doctor more important.


Knowing the why can also help identify if your body needs support in other ways. I cannot encourage you enough to address your health holistically!


If your constipation is related to stress, treating an anal fissure while incorporating stress-reducing techniques could be really helpful! Or if your diarrhea is actually anxiety pooping, reaching out to a mental health professional might be the best route.

 

Pooping should not result in tears or tears, friend. Gotta love a good heteronym! My hope is that somewhere in this mess of an experience, you find relief. Perhaps from something I mentioned, maybe something you discovered.


If you have a way of treating and/or coping with a fissure that I didn't name, would you leave a comment and share it with me?!


I feel like this needs a benediction of sorts. "Of sorts" being the key part of that.

May the butthole from hell Who could raise the dead from their graves Flee in the face of the fissure end And may the balm for your aching ass Rest upon your bum and dwell in your nether regions This day and on all days where shitting hurts.

XOXO

a fellow butt-hurt friend

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