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I have been experiencing a great deal of pain in my anus and bowel such that I can neither lie down nor sit comfortably. The pain wakes me at night. I have some bleeding, but very little and it is mainly associated with bowel movements. My doctor has done a digital rectal examination which was extremely painful. He feels that I have a fissure in my anus and that it will heal with the use of sitz baths and a hemorrhoidal cream. I have looked up the causes of fissures and do not seem to have the risk factors. I am 48 years old with no prior history of this. I have no external swelling, do not engage in anal sex. I do not have hard stools or constipation, eat a balanced diet, and drink 6-8 glasses of water daily. I hate the thought of getting a second opinion because of the pain of the examination but feel uncomfortable about the diagnosis.
Anal fissures are a common condition and fairly frequently found in individuals for no apparent reason. The usual treatment is stool softeners, sitz baths, good hygiene, cotton underwear so the skin may breathe, and avoiding anything scented or with dyes (for example, scented or colored toilet tissue, etc.). Recent studies have shown that fissures not responding to the usual medical measures often respond to local applications of nitroglycerine paste or local injection with botulin toxin. Dilation of the anus also has been used.