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Hello! I have had a nasty fissure for about a month. My surgeon did a pouchoscopy 2 weeks ago - he said my pouch is very healthy.

But I was right - I do have a fissure, diagnosed as deep and severe. On the fissure biopsy, it said the fissure was inflamed but it did not point to crohns disease. thank god!

however, my surgeon is baffled as to how i got this fissure and why its not healing, because my pouch is healthy. it could be related to pelvic floor dysfunction. i am seeing a pelvic floor physio for pelvic spasms and pain during intercourse anyway, so he has referred me to look into this too. in my heart, i think my pelvic floor is the culprit but my surgeon is not convinced.

i was prescribed nifedipine + lidocaine ointment, he said to apply as much as tolerated throughout the day. he said if this fissure does not heal in 8 weeks, we will try botox. if things are still inflamed after that, he said we may have to assume chrons as the cause. but he would need to consult with my GI at that point. He is very doubtful it is chrons, as the biopsies said it's not and he saw it himself, not believing it is chrons. and i only have the one isolated fissure.

i just really dont want to have chrons! i have only been using the ointment for 2ish weeks, so i may just need to wait longer for healing to occur.

has anyone been through something similar and come out the otherside?


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Your fissure is in the perianal region, outside the sphincter muscle, right? It has probably nothing to do with Crohn's. Reasons for fissures are stressed skin (because our stool is more aggressive as that from a colon and we have more BM than other people) or reduced blood flow due to spasms / muscle contraction in the sphincter area. They can also originate from very hard stool stretching the anal canal, but that does usually not apply for j-pouchers.

It should be ok to try that ointments for some weeks and hope that it heals. It is strongly recommendable to keep the fissure clean after a BM by cleaning it with a water jet. Have you looked up the posts in this forum about bidet attachments for the toilet? There are also several posts about anal fissures, perhaps you find some insights there.

If it does not heal, you will probably need a minor surgery to remove the scar tissue that prevents the fissure from healing.


Google “sitz basin”.  Yes, that’s the way it is spelled. It’s a small plastic wash basin that you sit in. I had awful fissures early on and was desperate. My home care nurse told me about sitz baths. You can always fill an entire tub with hot water and sit in it, but a sitz basin is more efficient and doesn’t use as much water.

A sitz basin is a small plastic basin (similar to a basin for washing underwear or doing dishes, but a sitz basin has a cut out hole at the back end. You’ll understand why the need for the hole when you see it. You place the empty sitz basin on your toilet (put the toilet seat up so you place the basin securely on the toilet rim). Then, fill the basin 1/2 way with *very* warm water. Just plain water. No Epson salts or soap or baby oil or anything. Just warm water. Slowly lower yourself until you are sitting comfortably with your bum in the basin. Any extra water that you displace will simply flow out the little hole and into the toilet, no water will spill onto your floor. Your bum / anal area will be in the warm water which will be very soothing. Just sit and relax until the water cools. The very warm water increases blood circulation to that small area that is sore, raw, and burning from internal fissures. The increased blood circulation drawn to that area will help heal your inside / outside fissures. You don’t need to wash the sore area or do anything except sit and relax until the water cools. A plastic hose and bag comes with the basin so you can add more wam water.  

I bought my sitz basin from Amazon six years ago after my j pouch surgery. They are also found in bigger drugstores, or health care specialty shops where you’d find crutches or walkers or shower chairs, etc.  I used my basin twice a day for maybe one week. My fissures healed themselves completely. I’m not kidding. I never had to use the little basin again, but it’s in my closet if I ever need it. I tried creams, ointments, but nothing worked. The sitz bath worked. My fissures were so bad it looked like I had deep cuts around my anus. If your fissures are deep inside, then creams and ointments won’t reach it. Try to increase blood circulation by sitting in a sitz basin. I think it cost around $15 back then. Good luck. I remember what it was like.

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