Patient 21 - Non-surgical success!!

Patient 21
Non-surgical success!!

Date: Thu, 07 Jan 1999
Subject: Non-surgical success!!

Hi Jack,

Please withhold my name and e-mail address if you use this on your web-page

First, let me thank you (who ever you are). Your web-site and its contributors has allowed me to return to a healthy and pain-free state *without* surgery. For this I cannot thank you enough. I'm writing to offer my own story, and hopefully some helpful advice and information that might help others who suffer from this wretched condition.


I am a 36 year old male. I was recently diagnosed with anal fisures after I switched doctors. I had come to this same conclusion two years ago after reading your excellent web site. My diagnosis came after years of trying to treat the "hemoroids" that doctors thought I had. After going through this for several years, I can only echo the excruciating pain, bleeding, angst, issolation, suffering, and pre-occupation that others on your page have described. My condition had gotten to the point where I was uncomfortable most of the time, especially while sitting, walking, moving, coughing, sneezing, laughing, etc.

I had all but given up on the medical profession after being painfully examined and run through needless proceedures (including sigmoidoscopy) while doctors failed to understand my problem.

Theories, Observations and Ramblings

(Note: these are my theories only... consult physician, YMMV, etc.)

- I have come to believe that you don't so much
  heal the body as bring the body to a point where
  it can heal itself. I don't particularly believe
  in miracle cures. I've tried to look at anal
  fisures in this light.

- After what I've read, I think that it is common
  for most people to suffer small anal injuries
  at some point in their lives. For most, there is
  some temporary discomfort followed by healing.
  In some of us, these injuries don't heal and
  become painful fisures which are constantly
  re-injured (torn) with each bowl movement. Stopping
  this constant re-injury is the key!!

- I also seem to suffer from a wierd thing which
  I think is Proctalgia Fugax - a spasming of the
  autonomic sphincter... This strange and uncomfortable
  condition sometimes wakes me in the middle of the
  night and keeps me up for a while. This condition
  may contribute to lack of healing of fisures.. or
  may be caused by it. Note: I have not had this
  since I started using the Nitroglyceryn (see below).

- I'm actually confused as to how surgery can help
  with anal fisure. If an injury is not healing now,
  how will you heal from the surgery? Perhaps it is
  helpful in extreme conditions but it sure sounds
  risky/painful to me. I have found that most Doctors
  like to move to surgery quickly... they "solve"
  problems and make money. My new doctor wanted to
  re-evaluate for surgery after only *a week* (again,
  I've had this for years... what's the hurry?).

- On the workings of Nitro...There has been much
  noise about the effects of Nitrogen on blood flow (see Nobel
  prizes from last year and the Viagra debacle). Nitro
  does seem to relax the Autonomic Sphincter (the one
  you don't control). This may be why it has helped
  with the Proctalgia Fugax. Also, if the Nitrogen
  absorbed by the tissues increases blood flow, perhaps
  it aids in healing.


(Again, I'm not a doctor... I don't even play one on TV.... consult your physician, etc.)

So, the basic approach is to keep from re-injuring yourself and allow your body to heal naturally. This is best done by softening the stool (diet and stool softeners). In addition, application of .2% Nitroglyceryn ointment seems to aid in healing. This approach may take some time... some of the Nitroglyceryn trials I have seen quote six to eight weeks. Today I am pain free after three weeks of doing this approach!!! Each of these things would be good by itself but I think the power in this approach is in the combination.

  1) Change your diet, eat *lots* of fruits and vegetables
     Eliminate or cut down on read meats. Eat regularly
     (don't fast, skip meals, etc.)

  2) Take a fiber supplement (Two tablespoons of
     Metamucil per day for me, one in the morning,
     one at night). Note: I did this by itself for a couple
     years with no long-term success. Only when combined
     with the other things did it seem to help.

  3) Take a stool softener. I take a generic from Walgreens
     Each liquid cap is 100mg of Docusate Sodium. I take two
     in the morning and two at night with my fiber. This
     is twice the recommended daily dosage but I was desperate!

     Note: Drink *lots* of water if taking a stool softener.
           Stool softeners work by pulling water into the
           bowel so you need to replace it in your body.

  4) Apply .2% Nitroglycerin ointment digitally *inside*
     the anal canal. I did this at least three times/day
     and/or after each bowel movement. You learn to wash
     your hands *alot*! This may be painful at first but
     becomes easier as you heal. I don't think its essential
     that you put it *on* the fisure... just get it inside.

     Note 1: Most doctors will not have heard of Nitro. You
             will have to persuade them to perscribe it.
             My doctor had read some literature but I had
             to talk him into prescribing the stuff. His
             comment was "well OK, I guess it won't hurt you"
             (doctors don't generally like to be told what
             to do).

     Note 2: The pharmacy filled my first prescription for
             .2% Nitroglycerin with 2% Nitroglycerin (two
             percent vs. two tenths of one percent). This is
             because .2% is not yet commercially available.
             They didn't notice!! I did, and refused the
             perscription. 2% is a *VERY* high dose intended
             for heart patients and will almost certainly give
             you severe instantaneous headaches. Have your doctor
             instruct the pharmacy to cut the Nitro down to .2%

     Note 3: Even with the proper .2% Nitroglycerin, you will
             have to experiment to find an amount that doesn't
             cause headache. The first time I tried it I ended
             up in bed for hours. After using smaller amounts
             more frequently I have been able to avoid headache.
             You may also feel some "heartburn"... remember that
             Nitro is used for heart/angina patients (yet another
             reason for talking to your doctor). Keep trying!

  5) Get some exersize!! This can be walking, running, cycling,
     swimming, etc. Exercise helps keep you regular.


Don't give up! I initially had a couple pain-free days and then had a very painful setback. I tore again and had more bleeding and pain. This was very discouraging but I kept at the above regimin. I now feel almost completely normal. After so much time it is a wonderful feeling indeed!

Thanks again for your help and I hope this helps others.

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