Fissures
Fissures
14 Soothing Solutions
The similarities between anal fissures and hemorrhoids are largely superficial. Hemorrhoids are generally swollen veins. In contrast, fissures are ulcers, or breaks in the skin, which just happen to occur in the same general area.
Fissures are very much like those painful tears that sometimes develop in the corners of your mouth, says J. Byron Gathright, Jr., M.D., chairman of the Department of Colon and Rectal Surgery at the Ochsner Clinic in New Orleans, Louisiana, and an associate professor of surgery at Tulane University. Both the oral and anal variety occur where skin meets delicate mucous membrane. In the anus, a common cause of such tears is the passing of a large, hard stool, says Dr. Gathright.
If you have fissures, you know that these little sores can make your life—or at least your sitting life—miserable. They burn, they sting, they often bleed. Below, the experts tell you how to get to the bottom of the problem as quickly as possible.
Ban hard stools with fiber and fluid. The anal opening was never meant to accommodate large, hard stools. Generally a by-product of a Western diet lacking in fiber, rock-hard stools tug and tear at the anal canal, which can result in anal fissures as well as hemorrhoids.
The solution? Adapt yourself to a diet high in fiber and fluids that will produce soft bowel movements. Eating more fruit, vegetables, and whole grains, and drinking six to eight glasses of water a day is "the best remedy and preventive measure," you can use for anal fissures, says Dr. Gathright. Once your stool is soft and pliable, your anal fissures should begin to heal on their own.
Try the petroleum solution. Eating more fiber will soften your stool, but you can also protect your anal canal by lubricating it before each bowel movement. A gob of petroleum jelly inserted about 1/2 inch into the rectum may help the stool pass without causing any further damage, says Edmund Leff, M.D., a proctologist in private practice in Phoenix and Scottsdale, Arizona.
MEDICAL ALERT
Signs of Something Serious Fissures are generally not dangerous. "The real caution with fissures is not to put them off forever—an ulcer that doesn't heal may be a cancer," says Lewis R. Townsend, M.D., a clinical instructor of obstetrics and gynecology at Georgetown University Hospital in Washington, D.C. "If you have fissures that don't heal within four to eight weeks, go get them evaluated," says Dr. Townsend. "Remember that a sore that will not heal is one of the seven classic warning signs of cancer." In addition, if you notice a mucous discharge from your anus, have it checked out by a doctor. "Abscesses can be very serious in that area," says John O. Lawder, M.D. |
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Buff yourself with talcum. Following each shower or bowel movement, brush yourself with baby powder. This will help keep the area dry, which can help to reduce friction throughout the day, says Marvin Schuster, M.D., chief of the Department of Digestive Diseases at Francis Scott Key Medical Center in Baltimore, Maryland, and a professor of medicine and psychiatry at Johns Hopkins University School of Medicine.
Watch out for diarrhea. It may seem odd, but not only can hard, constipated stools worsen anal fissures—so too can diarrhea. Watery stools can soften the tissues around them, and they also contain acid that can burn the raw anal area and give you a form of "diaper rash" to add additional misery to your condition, says Dr. Schuster.
Keep your nails away. Anal fissures may make you want to scratch. Fight the urge. Running sharp fingernails over your tender anus can tear at the already sore tissue, says Dr. Lawder.
Shed those excess pounds. The more weight you carry, the more you're likely to sweat. Perspiration between the cheeks of your rump will only slow your fissures' healing, says Dr. Lawder.
Use a little dab. Nonprescription topical creams containing hydrocortisone can be very helpful in reducing the inflammation that often comes with anal fissures, says Dr. Gathright.
Try a vitamin cream. Particularly helpful for soothing pain and helping to heal fissures are those nonprescription ointments available at the drugstore containing vitamins A and D, says Dr. Schuster.
Jump into a hot tub. Whether you fill your bathtub with hot water or slip into an outdoor hot tub, warm water will help to relax the muscles of the anal sphincter and so reduce much of the discomfort of fissures, says Dr. Leff.
Steer clear of certain foods. While no food will cause fissures, some foods may provide excess irritation and discomfort to the anal canal as they pass through the bowels. Beware of hot, spicy foods and pickled foods, says Dr. Schuster.
Buy yourself a special pillow. Sitting on anal fissures can be unpleasant, to say the least. You can help ease the pain by picking up one of a number of either doughnut-shaped or liquid-filled pillows available at many pharmacies and medical supply stores, says Dr. Lawder.
Wipe yourself oh-so-gently. Rough toilet paper and overzealous wiping will impede healing of your fissures. So wipe gently and don't skimp when picking a brand of toilet paper. Be particularly choosy when it comes to color (you want only white) and scent (you don't want one). Perfumes and colorings can provide irritation to the already irritated area, says John O. Lawder, M.D., a family practitioner in Torrance, California, specializing in nutrition and preventive medicine. Dampen each wad of paper under the faucet before wiping to remove most of the scratchiness, says Dr. Lawder.
Treat yourself to the best. The Rolls Royce of toilet paper isn't a toilet paper at all. Facial tissues coated with moisturizing lotion offer the least amount of friction to your fissure-plagued bottom, says Dr. Lawder.
Try liquid toilet tissue. Rubbing dry toilet paper over a tender bottom can be a most unpleasant experience. But there is an alternative.
From Hepp Industries of Seaford, New York, comes ClenZone, a small tool that diverts water from your bathroom faucet to underneath your toilet seat. A narrow stream of water, aimed right where you need it most, does all your "wiping" for you. There's no need for toilet paper, except for one or two sheets to pat yourself dry.
"This is a neat little appliance that offers a real nice way to get clean after a bowel movement," says John A. Flatley, M.D., a colon-rectal surgeon in Kansas City, Missouri, and clinical instructor of surgery at the University of Missouri-Kansas City School of Medicine. Dr. Flatley, who says he uses a ClenZone in his own home, maintains that this product, intended for both fissures and hemorrhoids, "is not a cure," but it does offer "a gentle, soothing way of cleaning. I'd suggest it for anybody."
The ClenZone costs about $22 and is available through Hepp Industries, Inc., 687 Kildare Crescent, Seaford, NY 11783.
PANEL OF ADVISERS
John A. Flatley, M.D., is a colon-rectal surgeon in Kansas City, Missouri, where he also serves as a clinical instructor of surgery at the University of Missouri-Kansas City School of Medicine.
J. Byron Gathright, Jr., M.D., is chairman of the Department of Colon and Rectal Surgery at the Ochsner Clinic in New Orleans, Louisiana, and an associate professor of surgery at Tulane University in New Orleans. He is also president of the American Society of Colon and Rectal Surgeons.
John O. Lawder, M.D., is a family practitioner specializing in nutrition and preventive medicine in Torrance, California.
Edmund Leff, M.D., has a private practice in colon and rectal surgery in Phoenix and Scottsdale, Arizona.
Marvin Schuster, M.D., is chief of the Department of Digestive Diseases at Francis Scott Key Medical Center in Baltimore, Maryland, and professor of medicine and psychiatry at Johns Hopkins University School of Medicine in Baltimore.
Lewis R. Townsend, M.D., has a private practice in Bethesda, Maryland. He is a clinical instructor of obstetrics and gynecology at Georgetown University Hospital, and director of the physicians' group at Columbia Hospital for Women Medical Center, both in Washington, DC.
