things to never, ever type into a google image search

no pictures, please. no, really.

after a while though, you stop making jokes. this is because you can't access the language centers of your brain anymore, which have been converted along with everything else into additional pain centers.

i've become something of a connoisseur of pain in my time. it's been kidney stones, kidney infections, GERD, IBS, catheters of various stripes, a cone biopsy of the cervix without any anesthetic, childbirth without drugs, and two years of backfiled taxes- i feel as though i qualify as something of an amateur expert on the subject. if there was a job which only required sitting in a room and hurting i feel i would be eminently qualified to do so. it's not my kink or anything, i just know how to endure buttloads of senseless pain. let me assure you, anal fissures hurt like hell. you aren't a wimp, it's not in your head, other people aren't living with this all the time far more gracefully than you ever could. this shit hurts.

a quick word about squick

what causes it?

getting an anal fissure is not a freudian thing, it doesn't mean you rebelled against your parents by practicing anal retention and practice makes perfect. there's a good chance you need more fiber. if you have an anal fissure, the atkins diet may simply not be for you. i suspect i had a proto-fissure brewing for a while, but childbirth traumatized the area and very very hard stools post- childbirth ripped me a new one. many people look back and see their diet wasn't all it could have been. others discover that lactose intolerance or other food intolerances are the hardness culprit. every once in a while you're just kind of built that way, and laxatives may need to be a way of life for you. if your sphincter just likes to spasm and tighten all the time, the only thing that may work for you is surgery to cut the sphincter. both of these are extremes, but they happen, and when they happen, they aren't anyone's fault.

it's also pretty common to be constipated after giving birth. partly it's the lovely hormone jig, partly because the nerve that tells your rectum, and consequently you, to expel its contents can get a bit damaged. again, the longer material stays in your rectum the dryer and harder it gets. this is why it's important to go often, go early. that can be hard to do once you have the anal fissure- consciously or not, the anticipated pain can make it very hard to work up the willingness to do your business.

getting better

a combination of medications, diet, relaxation and even surgery can help you manage these two things. but even when you do manage them, getting better can take a while. you have to heal up down there, and that can seem like it takes forever. be patient, and look for little gains.

the medications come in two varieties: things you swallow and things you stick up your butt.

things you swallow

this brings me to a side point: there's a very good chance the baby jesus did have an anal fissure. most children get fissures when they make food type transitions, because they often get terribly hard stools while their digestive systems adjust to the new form of food. for this reason, potty training while making a food type transition can be hell for a little one. there may be nothing you as a parent can do for your suffering child except be thankful infant amnesia means they won't remember it. i've had mineral oil suggested, but this is a controversial solution, and one i don't feel qualified to weigh in on. what a lovely segue that makes to mineral oil.

*intestinal lubricants - the idea is to slick things up so they come out more easily. the main way you do this is by drinking mineral oil. some people think you should substitute natural oils, but there's no point in doing that. if the oil is digestible by humans it won't be a lubricant coming out. mineral oil coats, soothes, relieves, and i was pretty grateful for it. finding the right balance of oil can be difficult, though. too much oil will cause incontinence, which is embarrassing at parties. also, feces mixed with oil is one hell of a stainer. mineral oil is very unpleasant to drink. it doesn't taste like anything at all, but the coating, greasy texture hits some post-industrial do- not-drink-this instinct. the trick is cutting it with at least an equal part orange juice and stirring vigorously.

there are some long term doubts about drinking mineral oil. mainly, that it can block the uptake of certain vitamins and other nutrients you need. the way around this is to eat your good food and take your vitamins several hours before or after your mineral oil. you shouldn't drink mineral oil less than an hour after eating anyhow, and you'll find you don't want to. mineral oil is a controversial treatment, but for some people it gets you from slow decline to slow healing. like all medical treatment, you have to weight what you get against the risks.

things you stick up your butt

as an alternative for people who get headaches from even the .2% nitro, compounded diltiazem 2% can work. it isn't, IME, as potent. and it takes a little longer to work, but for those who simply can't do nitro it offers another possibility.

i was also given analpram, the worst-named medication ever. what the hell was that marketing department thinking? in addition to invoking images of giant butts in strollers, it didn't help in any way i noticed and it hurt to apply. so i stopped using it, c'est la vie. for some others it may be a lifesaver, i don't know.

applying topical medications to the anus

what you can do about the pain

diet for a small stool

conversely you may be already be deep in the fiber, which i was. raw broccoli and carrot sticks have been my staples for ages, so i was pretty bitter about getting the diet talk. however i did learn to spread my fiber through the day better. i get at least 12 gms per 1000 calories, and usually much higher in the course of the day, and i note the fiber content of every meal. since i'm on a vegetarian high-protein diet (as a nursing mother) this can be tricky, but two words have come to my rescue: soy beans.

sadly, this like most other gi disorders means you can't safely eat mexican food. and chili, hot lovely chili... that's a good way to loose a week of you life/a pint of blood.

a word about beans and other "fermenting fibers"

learning to relax

the truth is it took a long time for me to start doing this. i was in so much pain the thought of touching myself down there was unbearable. and, for the love of pete, they were telling me to shove my finger up my ass. but in time it wasn't as bad, and i'd lost a lot of shame anyhow. learning to do this squatting and then sitting on the toilet saved me from re-tearing when i had to go and i didn't have my medication. for this i am grateful.

really learning to relax: botox

the distance: lateral internal sphincterotomy

past the distance: dilation

ending on a positive note