Anal Fissures, Terrible Pain + The TMS Connection

Although the TMS wiki and forum have been a HUGE support to me over the years, and I have posted many, many private matters on here, I have hesitated to post this on here till now. Not so much because it's a very sensitive and embarrassing issue, but because I thought it was not TMS, and that is partially right.

A bit of backstory:

I have a lifelong history of TMS from infancy colic to childhood tummy aches, teenage chronic earaches and sore throats, to young adult issues spanning the gamut from allergies to back pain. As an adult in my 20's my TMS manifested as IBS, Pelvic Floor Dysfunction (non-specific prostatitis), all kinds of weird pains, all showing no definitive medical diagnosis. "Anxiety" was the main diagnosis, lol. I have endured much, including the death of both parents, and may other terrible traumas, but I've managed to survive and grow into the 49 year old I am now. I feel blessed, despite it all.

I skated through my 30's (relatively) pain free, but at age 42, in 2013, I had a nervous breakdown, resulting in severe Neck Pain, Back Pain, Shoulder Pain, TMJ pain, foot pain, panic attacks, crippling anxiety and depression, you name it. It took me years (and a lot of money and wasted time at chiropractors, PT's, neurologists and dentists, and well meaning but misguided healers of all kinds, etc...) before coming upon Dr. Sarno's work and it changed my life. I was able to heal 95% of my neck and shoulder pain, back pain, all of it...through serious introspection and self-discovery. I saw Dr. David Schecter, read all the TMS books I could find, became active on the forum, worked a bit with Nicole Sachs, and went full force with treating TMS. It took a lot of work, and I still get pain, but now I know what it is and can get out relatively fast. Dr. Schecter told me I have "TMS on steroids"...I fit the personality to a "T", pun intended. I am a perfectionistic, people pleasing, obsessive, repressed rage, 'gooodist' and I fit the perfect bill for TMS. I've had (and cured) pain from my toes to my teeth, my head to my stomach, my back to my hips, and beyond. I believe that almost all chronic pain is TMS, or has a HUGE TMS component. Including what I am suffering now, and suffering, I am. It's a medical condition, and it has a physical cause, but I think my TMS personality is protracting my pain. I need help.

Currently, I am suffering the worst pain I've ever had in my life, hands down. I have a "anal fissure" which is basically a "cut in the butt". It started a few months after a serious throat infection earlier this year, requiring me to be on SUPER strong antibiotics for over a month, leading to constipation, which eventually, opened an anal fissure. At first I thought it was just a hemorrhoid, and I was treating it with all kinds of creams and crazy fiber supplements, ice, heat, etc. I was making it worse and worse. I didn't go to the doctor, until about 6 1/2 weeks ago, after I began to bleed from the rectum and have serious pain, and I became quite alarmed.

I went to see my GP, who is very good, and to my surprise, he could not find a hemorrhoid. Seeing the agony I was in, he immediately referred me to a Colorectal Surgeon/Proctologist. The Proctologist saw a fissure immediately, and told me they can take 6 to 10 weeks to heal, and 95% do not require surgery. The good news is it isn't cancer. The bad news is it HURTS like HELL.

I am VERY SLOWLY healing, but here is my question...sorry for the novella.

How much of this is TMS? Here's what makes me think it is TMS...the cut in the butt isn't responsible for the pain, a rectal SPASM is. The Colorectal doc said that the body is trying to "protect itself" so the anus and entire pelvic floor goes into spasm, and the spasm RESTRICTS BLOOD FLOW and this is why fissures take months to heal. A cut of this sort, anywhere else on the body, would likely heal in a week or two. But because it is inside the rectum (or in my case, luckily, just outside) it can become chronic (as mine has) and take 10=12 weeks to heal or longer. Because of SPASM and LACK OF CIRCULATION. Sound familiar?

I saw my proctologist just yesterday and he thinks I am well on the road to recovery. Bleeding has long stopped, cut is slowly healing just fine, and the spasms have lessened from day and night to just a few hours a day. But it's agony, and it's awful, and I am beating myself up about why it isn't healing faster. I also know FOUR people who have had a fissure, and they are all TMS personalities, big time. Tight asses. Literally. My doc said as soon as the sphincter releases, it will heal. He is confident it will heal without Botox (first intervention) or surgery (final measure). Many who get the surgery have them recur. I am avoiding that route. Also, my cut is relatively superficial and in a good place (near the outside). My doc thinks it will absolutely heal, with patience and care. I am doing all he says to do, using a healing cream specific for fissures (a muscle relaxing compounded cream), gently increasing fiber, walking, taking Sitz baths, and other than this pain, feeling fine. I am in good health, despite all this. My diet has never been better.

But this is scary, enraging, and SLOW, and I am NOT a patient person. Every time I get upset, the spasms start. And the pain is unreal.

Should I begin doing TMS treatments for this, journaling and such? Has anyone reading this had anal fissures? Any kind help or hints, or thoughts appreciated. I'm so angry and I know this is not helping.

2020 is a doozy and this stinks.

 

That sounds dreadful! I went through hell after childbirth I can only imagine. I also had a bout with bladder spasms years ago and it was all TMS. It's really important that you stay calm and are easy on yourself because this will heal for sure. If you start obsessing and worrying it can easily turn into TMS. It does sound like there is a TMS component going on with the spasms and it also sounds like you are catastrophising big time. Have you considered taking any anti anxiety meds or something in the anti depressant category? I think it might help you while you are healing from the surgery. Patience and shifting focus will be key as well.

 

Thank you! Yes I need to relax. Also, I’m not having surgery just pain. Doc thinks it’ll heal WITHOUT surgery. Just to clarify. I’m just being hard on myself and I’m a huge catastrophic thinker. And yes, anxiety medicine helps the pain, which makes me confirm TMS is part of this. The doctor said the more I can let go and allow my body to heal, the faster it’ll heal and he is certain I will not need surgery, and he’s a surgeon! Thank you for your kind words!

 

Oh I see I read that wrong ! Definitely give it a couple months and trust that your body will heal. All injuries heal and we just need to get out of our own way and not give in to health anxiety and rumination. Tell yourself every day "I'm getting better and better". I've had disaster haircuts where I would tell myself every day that it was growing lol. Some were so bad they took a year so at least with this it's a couple of months at the most. Your best bet is to shift focus to your life and let your body do it's thing.

 

Hi Donovan.
On some of these 'physical' things it isn't as easy to see how the TMS mechanism is involved, BUT from a long term standpoint ,looking back at your whole experience, they make absolutely perfect good sense. The scientist in us doesn't like that as there seems to be no cause-effect correlation like there is with say, a fight with my GF and a back spasm..... but then again:

I have had a lot of accidents that have resulted in Injury. When I look back at them and what was going on in my life, I NEEDED the distraction or I thought I needed punishment... not consciously, mind you... the 'under-me' that was discarded by his family and is useless and doesn't even deserve to live.

Remember that deal with your toe? Didn't you actually smash it? This might be a good time to quote the old "We are not physical beings having a spiritual experience, we are spiritual beings having a physical experience"

When I fell off the ladder, when my hand went though the glass, when I fell and broke my arm, when I got Pneumonia, Hell even the attacks of Bugs that bit me but ignored the other people on the job.... they all make perfect sense in a larger context.

So, YES I would treat the whole thing in the same manner I would treat any TMS thing. Follow up with the Doc's instructions but give it the least amount of your attention you possibly can. When you catch yourself fixating on it, turn your attention to a recurring sore subject in your life... the old Sarno simple stand by's. Tell yourself "My body will heal this and I don't need to think about it... next?" and you won't need to worry about all of those possible outcomes

 

I think it will just take time and what you're doing so far is a reasonable approach. As long it doesn't get infected and your bowel movements are ok, you're good. It's ok to admit that it hurts.

 

When you have been in pain for an extended period of time & have experienced a host of symptoms over the years your brain changes the way your body responds. The flight or fight system is on high alert & catastrophic thinking becomes the norm causing us to over worry & over react.

Constipation is common in today's world where people are eating unhealthily, not chewing enuff coz they are always in a state of rush or they are preoccupied, stressed out, not drinking enough fluid etc which is possibly why there are more cases of fissures too.

I would treat this as an acute problem. Follow the doctor's orders, take the prescribed meds, relax & don't allow yourself to get yourself wound up into dissecting whether this is TMS or not. Don't allow your thoughts to change this into a chronic condition.

Allow yourself to heal.

Good Luck

Mala

 

I agree with Mala. Try to remain calm and not obsess. This will allow you nervous system not to kick into overdrive.

Be Well.

 

Read that again. The cut is superficial! That's really good news!

 

Hey Donavan,

Feeling your pain (literally) in the ass right now. However, it also sounds like you already know the answer to your inquiry However, here is a story time to make you (hopefully) feel better and less alone!

I developed a fissure in the exact same scenario (antibiotics for a serious GI bug --> constipation and bam) in 2015. At the time, I was in a bit of distress about it but the doctors told me it would heal on it's own if I just left it alone. It was hell for a few weeks, but once I started ignoring it not only did I not really have muscle spasms with the pain anymore, it did heal on its own by not making too many lifestyle changes. It took a few months but eventually I just stopped bleeding when I wiped, and I stopped noticing/giving attention to it at all! As a note, I did none of the recommended lifestyle changes to deal with it when this occurred.

Fast forward to 2019 where I was having massive stress in my life related to a major TMS incident. I got a stomach bug again, antibiotics again, and fissures are back (two this time). I was in complete distress as I know how uncomfortable they can be so obviously I was fearful of them and seeing blood on the toilet paper is terrifying for most people, but I was also dealing with an insane amount of stress so everything was very hard to deal with. At this time, I was also working through pelvic pain, and my physiotherapist said my pelvic pain was from the fissure, and that I needed to solve the fissure in order to solve the pain and to get my pelvic floor to relax.

Guess what? This led me to doing everything humanly possible to fix the fissure. I ate all the right things, did laxatives, took magnesium oxide, multiple sitz baths, all the different compounding creams, and low-fibre diet (this is better than high-fibre as it makes you stools smaller and easier to pass - high fibre may make them softer, but definitely not SMALLER which is the problem if there is a tear). The fissure never got better, and my pain and anxiety over it got worse to the point I basically stopped eating this past spring as I was so terrified of going to the bathroom due to pain. My fissures were the ONLY thing I could think about for nearly 6 months. This led to clenching of my pelvic floor out of fear, making it into a big huge cycle. But guess what the academic literature says about fissures? That they are more often than not caused by lack of blood flow and poor circulation to the area. From what? From clenching. So if you are a "TMS" personality, guess what you are doing....?

In my opinion, people who have fissures are just TMS sufferers who hold primary tension in their pelvic floor. My dad is a classic TMS personality, and he has struggled with them too. We know pelvic floors are an area of concern for TMS given the high incidence of pelvic pain, hemorrhoids, and urinary problem sufferers with TMS.

As for immediate pain relief to heal the cut: Order pranicura cream (it increases blood flow to the area and also has a cooling effect - I have tried EVERY prescription from a doctor for my fissure and this is the only thing that has ever healed the cut for me AND provided immediate pain relief so I could calm down about it and not worry about); try not to hyperfocus on your fissure by having multiple sitz baths a day (mine got better when I stopped trying to have three baths a day and would only do it if I was having a really acute flare up); keep the area DRY (pat toilet paper on the area any time you are in the bathoom); eat as you normally would and just take a stool softener for the time being (not a laxative) for a month or so until the cut heals; stay active to keep blood flow going; learn some pelvic floor relaxation techniques (I believe both "Flower Empowered" and "femme Fusion" have pelvic floor physio relaxations specifically for men on their Youtube).. and KEEP DOING THE TMS WORK.

Remember my initial story? When I wasn't giving any attention to my fissure in 2015, it hardly gave me any pain and issues and just went away. When I started hyperfocusing on it this past year and was putting so much time and energy in trying to make it go away, that is when my fissure pain and spastic colon was SUPER bad. I have just really dug into my TMS journey the last few weeks, and while my fissure has been completely gone for 3 months, I had a particularly emotional day with a lot of stress earlier this week and when I went to the bathroom I had HORRIBLE pain. I was certain my fissure re-opened so I panicked. When I wiped, no blood, so obviously the pain is not from the fissure itself but from the stress I was holding down there. This is 100% - in my opinion - TMS.

You WILL get better and you will NOT need surgery. Constipation is a classic problem for many with TMS, so the more you do that work, the more you are going to have success with avoiding a fissure down the line. Message me any time if you are panicking. Sending a big hug as I know this is the WORST pain in the ass - ever!!!!!

 

Hello, can You write an update on your situation? I have been struggling with a fissure aswell. I am also not dure if it si TMS ir not, or both.
My symptoms started last year, everything has been extremely confusing, very hard to figure out.

It started last year, out of the blue, I stood up from a chair and noticed an acute disconfort around my pelvic area, but not painful.
After a couple of days, my anus area became very painful. Nothing in particular trigerred the event, I can only recall sitting for longer than usual. At this point no blood in my stool at all, no pain when passing stool.
But I had pain every single day. I went to a urologist, who diagnosed prostatitis, which was very strange for me to get it out of they blue. He prescribed antibiotics but I did not want to take them.
After a couple of months with more pain. I went to a proctologist. He noticed " an old fissure that has healed" that should not cause pain. He found internal hemorroids, he prescribed medication, I took the treatment but no improvement at all.
After more months with pain, something very weird happened. I saw blood in my sperm( this had happened to me a couple of years before, but it was painless and went away on it's own), I freaked out, but figured it was definately prostatitis, probably the first urologist was right.
I took three weeks of antibiotics, felt slightly better, blood in the semen went away.
But still had a lot of pain, all the time.
After about 5 months in pain, I finally saw blood in the toilet paper after wiping. Went to another proctologist. He inmediatly saw a fissure.
Why did I have prostatitis and a fissure? Blood in my semen, blood in my stool? All without a clear cause.
The fissure never got better, the proctologist gave me several expensive creams, no improvement. Still blood in stool.
Past december, I figured to use the tms aproach.
I felt 60 percent better, finally some days without pain all the time. After a couple of months of feeling better ( but still blood in toilet paper), I had a very bad week, a lot of pain. Proctologist sent a more expensive cream, nitroglicerine or something. It work a little bit, felt better for about a month. But one day I had particular hard stool, saw significant blood in stool. Felt very very sad and defeated.
Tried another cream, had a very good couple of months, O thought i was having a major breakthrough. While feeling a lot better, I decided to try a homeopathic oil, after a couple of weeks, major regresssion, a lot of pain, blood on toitlet paper.
Something very confusing is that most of the time treatment makes my problem flare up. I feel better with no treatment but at the same time don't get completely well.
Today back to square one, a lot of pain, blood. Very defeated and clueless as to what the heck id going on.
I don't want yo have surgery, it si very expensive.
Important info:
I had three very very stressful years.
Tms personality big time, anxiety, ocd.
Prevously had two very tough years with back pain, got 100% better with tms aproach.

Any thoughts? How yo get better? Is it tms???

 

In my experience (after years of struggling with this) fissures are definitely rooted in TMS but can also be "managed" with other physiological treatments. Prostatitis is 100% TMS, and so is most constipation (often the cause of fissure flares). I work my daily TMS (Curable App, Alan Gordon's work, and such) and I have been fissure free for over a year now after struggling on and off for a decade.

For symptom management, I take magnesium oxide or magnesium citrate as a stool softener with a good probiotic and try to not eat complete garbage but I am pretty lenient on this and do fine even as a smoker who doesn't eat super healthy. When I had a fissure, I would use Pranicura cream to support healing to the tissue and it would provide good acute relief (expensive, but worth it - I had tried everything). However, all of these things alone did nothing pain wise until I started a regular TMS program (promoting feelings of safety, taking more rest, doing gentle movements daily). I also had a complication - Pelvic Venous Disease. I am certain the root of that condition was TMS, but I also suffered from internal/external hemorroids and had blood in my urine that was unexplained... so even though I was 95% pain free with my fissures after a year of TMS work, I did seek assessment from a venous surgeon who said there was so much blood pooling in my pelvis from venous insufficiency that there was no way my fissures would've healed on their own (I went to the Whiteley Clinic in the UK). Since getting treatment from that, which I am still CERTAIN was long-term TMS induced, I have had no issues to date. I do get pelvic pain flares or constipation when I am under a lot of stress but everything is now easily manageable, and the best part... no pain!

I hope you find answers and can find healing. There is almost nothing more terrifying than passing blood in the toilet bowl or upon wiping, so this is very much fear based. The more we stress about avoiding activities that may stop bleeding (really restricted diets, not sitting lots, having regular sitz baths, using all the medications, etc etc etc) the more we are stressed and have issues and fear around it. When I finally just let go and said "fuck it, whatever happens happens, I am not going to let a small amount of bleeding dictate my whole damn life and I am no longer scared of it..." then I started to make leaps and bounds. Acceptance, acceptance, acceptance. You will find what works for you, but fissures do heal! I don't believe surgery is necessary, but treating the underlying cause (TMS) will ease the constipation that will stop giving you flares. Taking a stool softener for a period of time can also make thing easier so you're not so scared about going to the bathroom and create a more positive association around that, as I know how uncomfortable it can be A pelvic floor physiotherapist may also be able to help you retrain your brain by introducing positive associations with that private area, too.

In your post I am reading: stress, fear, and the fact that the prescribed treatments aren't working. If it was a purely physiological problem, they would! But I do not think it is.... Wishing you well!

 

Thank You so much!
Your post is very helpful and brings me hope.