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Thursday, August 2, 2012

Savage Love SL Letter of the Day: Fighting Anal Fissures

Posted by Dr. Debby Herbenick on Thu, Aug 2, 2012 at 1:02 PM

I am writing to you in desperation.

I am a healthy woman, but I have had an anal fissure for one year since I gave birth to a baby. It comes and it goes, but it always returns. It is painful and when it gets really bad, I get extremely depressed. Without pain medications, I cannot function.

The usual methods are useless: drinking 5 L of water, taking fiber, eating nothing but wholesome foods ... various cremes that are supposed to help are useless ... I don't want surgery because there is a risk of incontinence. Doctors don't seem to realize how debilitating it is.

I have heard that anal fissures are prevalent not only in the "post-partum community" but also in the gay community.

What do you know about this disorder? How can I make my butt work properly again? How long does healing take, and how can I accelerate it? What is a butt plug, would that help? Would stopping breastfeeding do the trick?

Pain in the ass

I’m sorry to hear you’ve been experiencing anal fissures (anal tears). They can be challenging to treat and treatment/prevention strategies can include stool softeners/laxatives (so as not to further stress the area or cause straining/tears), topical creams (including hormonal or steroid creams), and even Botox injections.

Because genital and anal tissues are more vulnerable to tearing while a woman is breastfeeding (thanks to low levels of estrogen in the body), topical estrogen creams are sometimes prescribed to women in the post-partum period. You didn’t say which creams you’ve tried, or what’s worked well or not, but those are some options to talk with your healthcare provider about. If your doctor/nurse isn’t familiar with current treatment options, you can always print out some of these recent studies.

It’s also the case that some conditions, including skin conditions such as lichen sclerosus (which I mentioned on Monday’s SLLOTD) are more common during the postpartum and can also make women more prone to genital or anal fissures. As such, it wouldn’t hurt to check in with a dermatologist or someone experienced diagnosing/treating genital skin disorders to make sure there’s no skin disorder at the root of your fissures.

If low estrogen seems to be contributing to the issue then, yes, stopping breastfeeding may help—but then again, adding a topical estrogen cream may help too (ask your doctor/nurse for advice). Although butt plugs can help women and men become comfortable with anal penetration, and can simply be fun for some folks to use, I don’t know of any research looking at them as part of effective treatment for anal fissures. That said, butt plugs can help prepare for anal play if and when you feel you’re on the mend and ready to get (back?) into anal play or anal sex.

Treatment for anal fissures can be intensive. It can take time, dedication (in terms of diet, drinking lots of water, etc). So I’m sorry to say that it’s not always an easy fix. That said, many women and men who experience anal fissures do find improvement and relief, and I’m hopeful that you can, too.

And, of course, if any helpful readers would like to share any tips with you, I’m sure they’ll do so in the comments… hang in there!

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Comments (30) RSS

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Worst mascot name EVER.

Posted by Cracker Jack on August 2, 2012 at 1:08 PM

@1
Zing!

Posted by Urgutha Forka on August 2, 2012 at 1:19 PM

Anal tears? Where do the tears come from? Anal tear ducts? Does your anus cry when its sad or just when you've been cutting onions with your ass? Which gay men do for kicks or something?

Posted by Ph'nglui mglw'nafh Cthulhu R'lyeh wgah'nagl fhtagn

on August 2, 2012 at 1:26 PM

@1: you said it. Also, good god what an awful problem, and one I sincerely hope I never have.

Posted by NateMan on August 2, 2012 at 1:31 PM

@3 you are a complete jerk. anal (and genital) tears happen primarily to women who give birth to assholes like you.

Posted by onion on August 2, 2012 at 1:37 PM

Do you men realize that this is a common problem for women who have given birth? Laugh away, ha ha ha, but go ask your mom. Did she rip her twat or her ass open to give birth for you? It's likely that for a good number of you the answer is yes.

Posted by onion on August 2, 2012 at 1:39 PM

"What is a butt plug, would that help?"

God help me, how I laughed.

Posted by balderdash

on August 2, 2012 at 1:47 PM

Baby wipes instead of toilet paper always helps me as does sitting in a warm bath. This relaxes the sphincter and helps w healing (I've been told by doctors)

Posted by stuck in boston

on August 2, 2012 at 1:47 PM

I have used a nitroglycerin ointment with great results (http://www.webmd.com/digestive-disorders…). I still have my fissures, but they are no longer swollen or painful. It's like they don't exist at all. Sitz baths are surprisingly helpful, and I stopped eating foods that I noticed I had a reaction to (try keeping a food diary) like gluten, dairy, and sugar.

Posted by intenselyfraught on August 2, 2012 at 1:48 PM

As a pre menopausal 42 yr old woman, I suffered from anal fissures. They are awful. It took about 4 months for them to heal. I used moist towelettes to wipe myself and then applied preparation h. The cause of my fissures was deemed to be medication. The best thing is to keep on top of it with rituals because it only takes one day to reverse the healing process.

Posted by who me what on August 2, 2012 at 1:58 PM

If your kid is a year old, it's about time to wean anyway. So stopping breastfeeding sounds like a good idea to me :)

Posted by I have always been... east coaster on August 2, 2012 at 1:58 PM

Do NOT use a butt plug if you have anal fissures!! That will make it worse. Try the botox injections, there's no risk of permanent incontinence with them. If that doesn't work, then definitely seek surgery. It's one of those most effective surgeries out there.

Posted by Mowgli3 on August 2, 2012 at 2:00 PM

My boyfriend has these and its severly limiting our sex. Does anyone have good advise for men dealing with this. He's scared of the surgery too.

Posted by helpusplease on August 2, 2012 at 2:01 PM

Olive oil rubbed on the skin and a little inside is supposed to help keep the skin soft, too, though that may just be myth.

Or cheap lube, I can't quite recall...

Maybe just for diaper rash?

Posted by Allyn on August 2, 2012 at 2:06 PM

PITA, speaking as a gay man, I had FOUR of those happen to me - about 6moths to 1 year apart each.. ((I've never had a baby, so I'm sure comparisons are futile, but I can tell you - that first one was the worst pain I've ever endured)) I finally went to Swedish Colo-rectal clinic and saw Dr Bastawrous - I can honestly tell you - he was empathetic, reasonable and professional. We discussed all my options. I had a fissure and decided to have surgery to correct it. Total cost WITH insurance was about $2000, however the staff at Swedish were outstanding and the results are that I have not had another since. I'm very very glad I did.

Posted by Just wanted to help.. on August 2, 2012 at 2:09 PM

@5

Onion fanatics. Jesus, will you people give it a rest? If we weren't meant to eat them how come onions are made out of onions? Answer me that question, freak.

Just because you said that I'm going to eat some tasty, tasty French onion soup for lunch.

Posted by Ph'nglui mglw'nafh Cthulhu R'lyeh wgah'nagl fhtagn

on August 2, 2012 at 3:02 PM

She should talk to a GI doctor. My mother has Crohn's disease and gets fissures at the time. It hurts her so much that she screams and cries sometimes. She has a medication that seems to help her now. I'm not exactly sure what it is called, but it has nitroglycerin in the ingredients so she is convinced she rubbing explosives on her anus...

Posted by ScienceNerd on August 2, 2012 at 3:07 PM

Providone iodine ointment. Not easy to find, but this is seriously what this woman needs. I know, as it happened to me. Apply 3 times per day and be meticulously clean. I suffered for months and this cured it in 2 weeks. Must be the ointment, not the liquid.

Posted by Gee on August 2, 2012 at 3:21 PM

@6: Do you men realize that this is a common problem for women who have given birth?

So what? Squeezing a baby out of your twat doesn't make you a saint or a hero, and it certainly doesn't make jokes about your anus any less funny.

Posted by seandr on August 2, 2012 at 3:31 PM

19 - So you think Ph'nglui mglw'nafh Cthulhu R'lyeh wgah'nagl fhtagn is funny? That's some sense 'o humor you got there.
Now, I think cancerous prostates and erectile dysfunction are a barrel of laughs.
No one here ever said that mothers were heroes (hey but now that you mention it...). Just that the complications that they experience aren't something to be laughed at.

Posted by onion on August 2, 2012 at 3:42 PM

Surgery can help. At least that's what this guy says:
http://www.zug.com/scrawl/analbob/

Posted by ObeyTheFist on August 2, 2012 at 4:01 PM

@20: The reason Ph'nglui isn't funny is that he lacks a sense of humor, not because he's talking about maternity ailments. His comment would be just as unfunny if anal fissures were not a side effect of giving birth.

Posted by seandr on August 2, 2012 at 4:16 PM

21. I was wondering when someone was going to bring up Anal Fissure "Bob."

Posted by Sandiai on August 2, 2012 at 4:26 PM

I called into the Lovecast a few months ago - I was the breastfeeding mom with zero drive and some lingering discomfort/pain during sex from a vulva tear I'd gotten giving birth. I called Dan a year after I had the baby, and he advised patience and getting the baby off the boob for the drive issue. (I weaned, it worked.) But now I'm putting it together that my pain in the torn area and the recurrence of it feeling raw or itchy stopped when I weaned as well! I had no idea how much damage that low level of estrogen was doing to my body and spirit... Just another good reason not to let the Lactivists intimidate you into breastfeeding for years & years.

Posted by got my tits back on August 2, 2012 at 5:03 PM

I swear by a hand-held shower head with adjustable spray - my fits on the bathtub faucet. Warm, gently pulsating warm spray several times a day. Tremendous relief.

Posted by k8b on August 2, 2012 at 5:27 PM

If you can afford it buy one of those bidet toilet seats. Keeping the area cleaned and not having to wipe (just gently blot dry) helped me heal up mine.

Posted by Tacless on August 2, 2012 at 6:06 PM

Only 26 comments so far on anal fissures?

Wow, I guess we're more of a hemorrhoids crowd.

Posted by seandr on August 2, 2012 at 11:07 PM

I had a horrible year with an anal fissure and turned out my problem stemmed from tumor in parathyroid. I had anal surgery which helped, then got kidney stone and it's kidney MD that discovered parathyroid problem, an organ I'd never heard of before. If this woman is desperate she should have blood work to check this possibility out. Not saying it's common but after a while you want to try every possible solution.

Posted by anal fissure sufferer on August 3, 2012 at 6:17 AM

Nitroglycerin cream. I'm the (male, bi) un-happy owner of an ass with a fissure, and this stuff kept me from losing my mind a few years back. The reason an anal fissure cannot heal is that the muscle spasms. The nitroglycerin cream prevents the muscle from spasming, thus allowing it to heal. That said, I still have minor issues with mine and have been generally unable to make use of the area for penetrative sex. I feel (some) of your pain - best of luck!

Posted by hurtinglikeyou on August 3, 2012 at 11:34 AM

vitamin e oil, several times a day. helps heal all wounds.

Posted by buddhacat on August 3, 2012 at 1:08 PM