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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
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.
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
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
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.
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
Waiting for it to pass
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.
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!
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.
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.
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
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.
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.
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&veg'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
- 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.
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.
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
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.
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.
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
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:
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
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.
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)
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
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.
that frequent, long, warm baths work wonders at promoting
relaxation and thus healing of the area. Good luck.
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.
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