Anal Fissure

---

• Good Colon Rectal Surgeon for anal fissures?
• Painful BMs in 20-month-old with anal fissure
• Anal fissure after childbirth

---

Good Colon Rectal Surgeon for anal fissures?

August 2008

Hello: I have been suffering with painful anal fissures for the past 7 months since the delivery of my first baby. Does anyone have a good recommendation for a Colon Rectal surgeon in the Berkeley area? Also did anyone have a good experience with a Lateral Sphincterectomy.

I have literally tried everything in the book...high fiber diet, tons of water, nifedipine .3% and lidocaine, strict vegetarian diet and everything else in between. The pain is so excruciating everyday that it is hard to even enjoy motherhood. I am also nursing my 7 month old and want to continue doing so as long as I can. I am also a grad student at Cal and will be starting school in Fall 2008. I am scared that I won't be able to continue school with so much pain in by butt everyday!

Any suggestions are welcome...desparate for recommendations. MT

---

I'm sorry for your discomfort - I experienced a similar issue post-delivery of a very big baby and was recommended to Dr. Barry Gardiner for minimally invasive rectal surgery. He was excellent and I am recovered. If indeed surgery is the best treatment for your fissures, he is worth consulting. He works out of San Ramon Medical Center and is in Hills Physicians Group (and ABMG I think). I had an excellent experience with the staff there (and I'm a nurse who is fairly critical). The drive was worth it.

BTW - have you tried nitroglycerin suppositories? You didn't mention them, though I assume you have tried them. These have helped my patients with your issue quite a lot. Best wishes, Anon

---

YOu poor soul- I also had fissures-multiple ones-after childbirth (and like you,in grad school also!)I think my son was 6 months old. Mine were severe as it sounds yours are too (or they likely would have healed on their own).I felt just like you do because the pain is so excruciating that your life pretty much starts to revolve around what you eat and the bathroom experience. After trying it all, I saw Dr. Bitar in Berkeley. There are mixed reviews on BPN about him. At first I thought he was not warm and fuzzy (but being a colorectal surgeon can't be the most pleasant job) but on subsequent visits he became friendlier and more important, he was completely professional and extremely capable throughout. I would highly recommend him. I had the sphincterotomy which was a procedure that was very quick (done at Alta Bates) and you're sent home-no hospital stay. If memory serves, I think the relief was immediate and I experienced no ill side effects. It did not interfere with breastfeeding at all either so that was good (I can't remember if they gave me local anesthetic- I think they did that plus something to relax me but I was not out completely). I did not have them happen again after that although just recently after I had my second child, I think I have had a few small ones but they did not last long, went away on their own and even at their worst, the pain was nothing in comparison to the pre-surgery fissures. If you have tried everything, it might be time to think about surgery- the pain is was so horrible and all-consuming, I am so glad I did. Just in case, I still don't eat bananas!

---

I strongly recommend Dr. David Bitar, of Berkeley. Robert

---

Painful BMs in 20-month-old with anal fissure

May 2007

My 20 month old daughter has had an external anal fissure for about three months now. Every day when she has a BM, she screams her poor little head off until it's over. There is sometimes a little blood (from the external fissure), so it's obviously re-cracking every time. Ugh! The pediatrician said fissures can take months to heal. She eats a very high fiber diet and doesn't have constipation at all. But this happens every day and it's obviously causing her distress. After the poo is done, she's happy and normal, right away. Does anyone have any advice on this? How long does it last? Any treatment besides Aquaphor or Vaseline? Thanks! Waiting for it to pass

---

Hi: I am an adult and have suffered from anal fissures for a long time. They are the worst. I don't know if they are the same for kids, but mine bleeds at times when I have a B.M. and often it just aches so much for hours after a B.M. The best thing for anal fissures are warm sitzbaths. Just sitting in a bathtub 3-4 times per day for 20 minutes at a time will heal it very quickly, as soon as a couple of weeks time. This is a must. I find that more natual creams with things like Comfrey, Aloe, Calendula etc are better than vasoline etc. You can go to Pharmica, Elephant, Whole Foods and get a a good topical cream/salve for this. Can you see the fissure, with mine you can, there is a visible slit in the skin, at times I can even see it bleeding if I look with a mirror right after a BM. I would google fissures and children/treatment, but baths are the best treatment for me though and this is what the dr. (proctocologist) had recommended to me. Good Luck.

---

Oooh, I had the same problem when I was little, and continued to struggle with fissures until early adulthood. It's horribly painful, and if you don't take care of it, it can have psychological ramifications for a child (they can start witholding in anticipation of pain). My recommendation is that you make sure there is not even the tiniest strain on her anus when she poops for 6 months. You can do this by giving her a laxative like Miralax (this stuff is amazing - check with your pediatrician for dosing information) every day, to keep the poop super-soft, as even a moderately formed stool can cause pain and disrupt the healing process. The other thing to do are baths -- this makes such a difference! With the warmest water she can tolerate, 20 minutes twice a day. When there is no longer any blood when she poops, you can drop back to one bath a day, but two is really helpful (the more, the better!). If you follow this regimen, she should be home free in six months. After that, keep up your good regimen of fiber foods and especially liquids to keep her stools consistently soft. For my own kids, I mix a tablespoon or two of flax oil into their applesauce or yogurt -- really helps with regularity! If the origin of the problem was a bout of constipation and hard stools, you might want to find out if your daughter has allergies to wheat or dairy (eliminating these solved the problem for me). Best of luck to you! Been there

---

My husband had one of these last summer. We had to cut our vacation short because of it! In my husband's case, they gave him some pills or some glycerin suppositories to soften the feces, which was much easier on him. If your doctor isn't suggesting this/isn't in favor of it, then find another doctor. That's relatively simple and will make a lot of difference.

This site also suggests sitz baths. All in all, I'm not very impressed with the support that you're getting from your doc. http://www.nlm.nih.gov/medlineplus/ency/article/001130.htm

Amazingly enough, this person has an ''anal fissure'' web page (!) She talks a bit about babies and anal fissures and why they get them. This is an interesting site. http://www.ambiguous.org/quinn/medical/fissure.html good luck! another mom

---

Regarding the anal fissure (please note I am NOT a doctor; I would have a conversation with your daughter's provider about what I mention here in this posting): I would make sure that after your daughter has a BM that you clean the area thoroughly with very warm water (the warmer the better, as hot as she can stand it without burning her of course) in a bath would be best, for a few minutes - this will help blood circulation in the anal area as well as keep the wound clean. Although I am certain that treatment for adults and children vary greatly, I have seen Kaiser surgery dept. for this very problem and they gave me nitroglycerin 3% ointment for the fissure area (helps with blood circulation and promotes healing). The other thing you could try is a lidocaine ointment (help with the pain) - again, ask your doctor about this. So sorry to hear about this problem with your little one, I know that it's extremely painful. Kristina

---

When I was 30 (13 years ago) I had a few years where I was getting anal fissures a lot. I needed to work hard on my diet to make things improve (more fiber, more water). I learned alot about fiber...mostly that you need insoluable fiber and that not all doc's really know what is insoluable fiber.

Anyway, a fissure takes at least 1 month to heal and sometimes longer. I found that anal hydrocortizone suppositories helped mine to heal faster (which meant in about 1 month)..I would use them for about a week whenever I got one. I think what it did was calm down my hemorroids so that I didn't have that pain and could relax more during bowel movements, but I'm not sure. However, I don't know if this is okay for children, but you might ask your pediatrician.

I haven't had a fissure in years now...I drink Citracel every night and drink lots more water and try to eat more whole grains. So I know that it can and will get better. Anon

---

Is a high fiber diet the best idea for someone with an anal fissure? Sounds like a bad idea, since passing that fiber is tough on the anus. I would be inclined to go for a softer diet and maybe a stool softener until the fissure is healed. alexis

---

Been there as an adult - it's pure hell. The good news for her is that the pain stops after the BM, and that it's external so you can easily treat it. You might find a proctologist or ano- rectal specialist and ask about my suggestions first... applying dibucaine ointment maybe night and morning pre-BM - it's numbing. The only thing I've heard of (and experienced) that actually treats and slowly heals a fissure is nitroglycerin in a petroleum base, an Rx. You have to be extremely careful with the dosage on this because this is the same stuff that heart patients use. Start small small small and look for any sign of faintiness/lightheadedness. A small amount I did 4x a day, that closes it up. The amount per application is the issue, not frequency over the day. Another thing, you might have to ask various people because not all MD's are in the know - but witch hazel can be very healing for many rectal problems, not sure how it is with a fissure. There's a Dr. Moser in SF on either Castro or Duboce who is excellent on these questions. I met him personally and he's way ahead on these things. One 15-minute consultation would be well worth the price. Also of course, tons of water, fr's, minimal or no white flour products or beef, until this is healed. been there and healed

---

Poor little thing! I have them, and this is what I do when they flare up. In my experience, she will heal within a week if you use this protocol:

- Buy some Preparation H oinment and apply it with tissue to the area so that it becomes numb JUST BEFORE a bowel movement. It works very quickly, so it can be applied lightly before she goes, and this will significantly reduce the pain she feels. I put some on a tissue and lightly tap the oinment on so that there is no friction but so that the medicine makes contact with the raw flesh.

- Buy Preparation H wipes to clean her anus with after each bowel movement. You could probably use these to wipe her with beforehand, too, instead of buying the oinment seperately, but the oinment is more soothing upon the first touch. Tell her to ONLY clean her anus with the wipes. She should use regular tissue for the vaginal/urethra area.

- Use a little anti-bacterial ointment on the fissures after cleansing with the Preparation H wipes. You can also use antibacterial spray, like Bactine.

I know these are heavy-duty items to use on a child, and please understand that Preparation H contains shark products and sharks are endangered animals. These concerns did not stop me from using these products because the pain fissures bring is something I can honestly compare to childbirth (I delivered vaginally). Anyone who has them can attest to the pain your child is experiencing. When I get them, a tear or two still rolls down my cheek as I make a bowel movement, and I'm 40 years old. The products should only be used while she's in pain from the fissures. I have had rectal fissures since I was in my teens, and this is what I do about once every couple of years when they flare up. I was told that I would always get them since the skin ruptures in the same place over and over. This may not be the case with your child since she is so young.

Good luck, and please tell her that many people go through this. She is very brave. Knowing that you have to face that kind of pain during flare-ups is hard on my old, grown-up psyche, and I know that she must dread it when she knows she has to go. If you would like to communicate with me about this, please contact the moderator for my email address. I am happy to discuss ways that I cope so that your little girl doesn't have to suffer so much. anonymous, please

---

Try some mild hydrocortisone cream 2-3 times per day and definitely MAKE SURE she's not constipated at all. Add extra water to her bottles or give flax seed oil 1/2 tsp twice per day to keep the stools as runny as possible. That should help the pain. If she poops at a particular time of day, you could put some kind of numbing ointment on it (like a lidocaine ointment) but I don't think most babies are so regular that you could plan for it. I would definitely use the hydrocortisone, though, cause 3 months is WAY too long to watch her suffer. Dr. Nancy

---

I know someone who has suffered with anal fissures for a few years now. All the doctors including the specialists did not help her very much. A website that helped her a lot is a self help page for anal fissures . The address is www.boardsailor.com/jack/af. She said to try the random information page link on the website. There she found advice to use tinactin(athletes foot medicine). She used it on two smaller external anal fissures and it worked to heal them. Unfortunately she is still dealing with an internal one that will not heal. She has found to help relieve the pain for that one she has to sit with her legs elevated for a time after she goes the bathroom to take the pressure off of it . Pain relievers only provided temporary relief and the side effects of taking them were not good for her. I know how painful it can be from hearing her talk about it. I hope that your child heals quickly. friend who suffers also

---

Triple Paste is highly recommended for this and esp. for diaper rash or prickly heat. It keeps moisture away, isn't greasy (doesn't stain), and should speed healing. You may have to go to a specialized pharmacy (I got mine at a compounding Rx whose name I can't remember) or from a dermatologist to purchase it. Kathy

---

I didn't see the original posting on anal fissures but do have experience in caring for them.

I see 3 main issues - 1)retraumatizing of the area with each BM - this is why so many of the treatments involve high fiber diets and supplementary stool bulkers or softeners. If the stool is hard, the sphincter will stretch more and the stool will be abrasive, thus keeping the fissure open. As a mom, knowing your child's diet preferences, tailor the many stool-softening suggestions to be the most palatable to your child. Good hydration is probably more important than anything.

The second cause is contamination of the open tissues with bacteria from the stool. This doesn't necessarily result in infection, but cells are so busy fighting off the bacteria that they don't manage to heal. Keeping the area clean and protected between BMs is the key to healing. How to do this? There are several thick, stool-resistant protective ointments available. The three that I've had the best results from are 1)ProShield Plus by Healthpoint - a bit goopy but not oily. 2)ILEX ointment - this is a thick, very protective. 3)CriticAid a zinc-oxide based paste that can be mixed with ProShield for easy application. One of these should be applied after cleansing with each BM. There are cleansers that are gentle and made for incontinence where the spraying action is more gentle to remove debris than friction. A last product that is easy to apply is a barrier spray by 3M called Calvilon No-Sting. This is identical to Nexus liquid bandage - a water-proof film. You could apply this first and then an ointment. All of these are available at Johnstons medical supply, or for less money, on the internet.

The third issue is caustic elements in the diet that irritate delicate tissue. I'm not as versed on this but know that caffeine (colas, chocolate), red meat and highly processed foods can be culprits. Without going into detail, the much touted nitroglycerin is no magic bullet and should be avoided at all costs in a child. My two cents! Feel free to contact me if you want to talk more. Chris

---

May 2008

Anal Fissure- follow-up

I've been meaning to write for a long time now to thank all those who gave me advice about my 18-month-old daughter's anal fissure. Reading your posts about how extremely painful it is made me really jump to action to heal hers. I just wanted to let you know what worked for us in the end. What seems to have been the most effective, over ointments or sitz baths or any other approach, was giving her food and drinks that would keep her stool as loose as possible. So, we threw out our worries about rotting teeth and put her on a regimen of 2 cups of undiluted apple juice per day, as well as lots of fruit. The fissure started healing quickly once her stools were very loose from this diet. We kept her on that diet for about six months and the gradually withdrew the apple juice. She's now a happily potty-training 2 1/2 year old and the fissure has not reoccurred (fingers crossed!). So thank you for all your advice! Happy Parent of a Happy Pooper

---

Anal fissure after childbirth

December 2003

A week or so after I delivered my baby (vaginal delivery, minor tearing healed quickly), I developed an anal fissure. I saw my primary care doctor, who said there was not really any treatment for it and it would go away on its own. And, she was right, it did go away, but then it came back. Then it went away. Then it came back. Then it went away. Then it came back. My baby is now 7 months old, and this is still happening every few weeks. Has anyone else experienced this? Will it eventually go away for good? Is there really no treatment, even for what seems to be a chronic condition?

---

Recommendations received for physicians:

• Dr. Bitar
• Michael Verhille

  ---

  This happened to me when I was 17. I actually saw a proctologist who performed an outpatient procedure on me to heal the fissure, and release some pressure in the area, and the fissure never returned. I suggest seeing a specialist for another opinion.

  ---

  As someone who has struggled with anal fissures since the tender age of six months (I'm now 41), I feel qualified to give you some advice! Here's what you have to do: take hot sitz baths twice a day when you have a fissure, 5-10 minutes each time. Dose yourself with Metamucil, prunes, bran cereal, lots of water, etc. Avoid sharp foods like popcorn and seeds (i.e. rye bread). Once the fissure is no longer hurting or bleeding, you can stop the sitz baths but continue all the! other remedies for...well, about a year. The key is to completely, absolutely 100% avoid the possibility of a hard stool opening the fissure again. You have to be very dilligent. But if you can keep up the routine for a year, you probably won't have to deal with the problem again. Good luck!

  ---

  I can relate- I got anal fissures when I was pregnant & in the early postpartum months, too. My Dr gave me some cream for it- maybe hydrocortisone? But the most important thing is changes to your diet- lots of water, fiber, etc- so that your stools are soft. Also my midwife said it probably had to do with pregnancy & breastfeeding hormones, so if you are breastfeeding it may improve once your baby slowes down. Good luck!

  ---

  I also had a fissure after my first child. After suffering for many months I went to a proctologist. He gave me two options. One was to use this vasaline type ointment that had nitroglycerin in it (required a prescription) and to up my fiber intake greatly. This is what I did and I haven't had a fissure in 3 years. The other option was surgery which I've heard can also work.

  I now eat multigrain oats with flaxseed meal with some almonds and fruit in it just about every morning. Also lots and lots of water. Good Luck and hope it heals!

  ---

  Heavens! No treatment? Please go see a proctologist. I also developed an anal fissure after (or during?) the birth of my first child and I spent about 9 months trying to get it fixed via primary care physicians. (They all said I had hemorroids.) You don't mention the pain of an anal fissure--I was in agony--so getting the right professional to help you is really important.

  Going to a proctologist is not fun--I'd suggest developing a sense of humor right off the bat. But there are things that can be done. I had one surgery that, unfortunately, didn't ''take'' and the fissure opened up again. (This is not usually the case.) Then the doctor did another procedure involving ''freezing'' the fissure back together. Neither of these procedures were fun, believe me, but the latter one did work and I've never had a problem since.

  In addition to having a sense of humor about your butt problem, it's really good to have a few confidantes with whom you can giggle, talk about the pain, and maybe even discuss your embarrassment about the whole issue. Anal fissures don't make good cocktail chatter--my sister and my best friend really helped me get through this ordeal with my dignity (and eventually my bottom) intact!

  ---

  oh boy do i know what you are going through. i had the same thing happen to me after my daughter was born. i eventually went to see a proctologist when my daughter was about 8 months old. he had me eat a high fiber cereal every morning with millers brand sprinkled on top. i also had to drink lots and lots of water. the reason your pain keeps coming back every couple of weeks is because it isn't completely healed. this takes a while to happen so you need to keep your stools VERY soft. now! , 16 months later i think my fissure is finally healed, but i am still very careful about re-tearing it. good luck!!

  ---

  I used to get anal fissures a lot in my early 30s, before having kids. It was caused by passing hard stools. They took a VERY long time to heal (at least 1 month to really). The problem is, if you continue to have hard stools, they keep opening up.

  If you are breastfeeding and not drinking enough water then you may be having hard stools.

  To get them to heal, I would take Colace (or the generic equivalent) until they healed completely and also use Hydrocortizone suppositories (prescription strength) for a week or two. (The suppositories may have helped me because I also had hemmorhoids.) Use the Colace WITHOUT the laxitive. Colace simply helps you keep water in your stools so they stay soft.

  To stop getting them altogether, I had to change my diet. Drink tons more water, less caffiene. More insoluble fiber (whole wheat bread, fruit, veggies, etc). Less white bread, white pasta, white rice. I also took Colace for years...I later switched to Citrucel. I still take this.

  Once it heals, you want to try and keep your stools soft so that they don't reoccur.

  Also, don't delay going to the toilet...go when the urge strikes.

  Note, that some doctors don't really know what is soluable and what is insoluble fiber in foods. Soluable fiber (like Oatmeal) does not help your stools stay soft. You have to have an insoluble fiber like wheat bran. (That said, I am always confused by the label on the Citrucel bottle...it says insoluable fiber, but it works.)

  I did a lot of research on the web. Things are much better now, even after having children.

  ---

  I just posted a response...I wanted to add a few more things...

  Learn to pass stools without straining...learn to relax the muscles, this can be very helpful especially when healing.

  Also, some high-fiber snacks are raw carrots, nuts, high fiber cereal such as SmartStart, Mini-Wheats, dried apricots, prunes etc. But make sure you drink lots of water (a glass an hour) or you may make things worse, rather than better. Anon

  ---

  I know that frequent, long, warm baths work wonders at promoting relaxation and thus healing of the area. Good luck. Anon.

  ---

  I had the same experience a year ago and went through terrible pain. I pushed my primary care physician to get a referal for a specialist (see recommendations for Dr. Bitar .) Take as many warm baths as you can and try to relax.