Perianal Health
Do You Have Fissures?
Here’s what you can do about them.
An anal fissure is a small tear in the lining of the anus. It can cause sharp, cutting, or burning pain, especially during or after a bowel movement. You may also notice a small amount of bright-red blood.
For people living with a J-pouch, fissures can be particularly painful and difficult to heal. Frequent bowel movements and repeated wiping can irritate the delicate tissues around the anus.
J-pouch output can also contain bile acids and other digestive substances that can make the moisture around the anus irritating to already-sensitive skin and tissue. This irritation can make an existing fissure significantly more painful and may interfere with healing.
What Can You Do?
Six gentle, practical approaches to support healing.
Keep the area clean without over-irritating it.
If you have a bidet, gently rinse with water rather than repeatedly wiping.
No bidet? You can create a simple rinse using a squeeze bottle filled with warm water or keep a travel bidet handy. Travel bidets are readily available to order through Amazon.
You can also use a soft wet cloth or gentle, unscented wipes.
If possible, take a warm shower after every bowel movement until your fissures have calmed. This doesn’t only calm the area, it also helps to soothe your nervous system, which is important for healing.
Avoid rubbing.
Protect the surrounding skin.
A good barrier can make a significant difference when the skin is repeatedly exposed to irritating moisture.
Calmoseptine can help protect your skin from moisture and irritating digestive contents.
Cavilon is another option that creates a protective barrier over the skin.
You can also tuck a small piece of very soft, unscented tissue or soft material against the painful area. The gentle pressure can help soothe the area while the material wicks away acidic moisture, preventing it from sitting against irritated skin. Change the tissue or material frequently. If the material becomes stuck to your skin, do not pull or tear it away. Wet it thoroughly with warm water and allow it to release gently before removing it.
If it becomes stuck to your skin, do not pull or tear it away. Wet it thoroughly with warm water and allow it to release gently before removing it.
Be gentle before and after every bowel movement.
Before a bowel movement, applying gentle warmth to the area may help relax the anal muscles and reduce tension. A very warm, soft cloth held gently against the area for several minutes can provide soothing warmth and may make passing stool more comfortable.
Afterward, gently cleanse the area and pat it dry.
Try warm baths.
A warm sitz bath may help relax the anal muscles and provide temporary relief from pain and discomfort. This also helps to calm your nervous system, which is important for healing.
Talk to your physician about prescription treatment.
If a fissure isn’t healing, your physician may recommend medication specifically to help it heal.
Diltiazem is one medication physicians may prescribe. Applied topically, it helps relax the internal anal sphincter. Reducing sphincter spasm can decrease pain and improve blood flow to the area, creating better conditions for healing.
Lidocaine may also be included in the compounded Diltiazem preparation to provide local pain relief.
Your physician may instruct you to apply a small amount of the ointment internally. Follow your physician’s instructions carefully for the best relief.
I personally use diltiazem with lidocaine and it works like magic for me. Speak with your physician to make sure this type of treatment is appropriate for you.
Don’t simply push through the pain.
A fissure can become a cycle of pain and muscle tightening that makes healing more difficult. If the pain continues or keeps coming back, get it assessed.