Anal Fissure and Crohn's: Botox, Nitroglycerin, and Surgery

So this past Sunday (Sunday October 7) I was on the toilet and after a solid bowel movement noticed some blood. However the blood wasn't coming from a different source (other opening in the region) which was bizarre. For some odd reason I thought of an anal fissure. I did some research and found it online. From what I read it looks like something that can be taken care of. Some things I noticed were taking hot (sitz) baths and eating more fiber helps. I plan on trying this a while and see if it gets better healing on its own. When I walk I literally feel like I have a pain in my rear (feels more like pressure).  It has been a little hard to sit.I have in the past had times when my rear does feel some pressure but usually it goes away This evening I had a bowel movement with no blood and perhaps the event yesterday was a one time event. I was trying to figure out what may have caused the fissure. The only thing I can think of was little sleep (had to wake up early over the weekend) and performing a hardcore workout on the elliptical on Saturday night (burned over 500 calories and felt amazing). When I was taking dicyclomine I did notice my bowel movements were very solid (a little constipation).

This event is interesting since I did take dicylomine which does relieve cramping however my GI did say to stop it if I felt constipated. Also I did have an issue with defecation syncope while on the toilet not to long ago which could have lead to a minor crack while on the toilet. I wonder if this contributed to my situation now. Tomorrow morning I plan to call my GI just to get his opinion. I have a feeling he may tell me to take some type of fiber supplement.

It appears anal fissures are pretty fixable. According to this Medscape article 80% of fissures are acute (meaning they are just a minor nuisance). From what I have read the first step for anal fissures is hot baths and increasing the diet to high fiber. If that fails people then try ointments or creams. Nitroglycerin ointment has a success rate of 55% (according to this article).  Actually what is interesting is even Botox can be used to fix the issue (which has a cure rate of 79% according to this article). Surgery is highly successful for people with anal fissures and according to this article has a 90% success rate (however carries a 10% risk of incontinence).  I also learned of another interesting procedure for anal fissures called endoscopic anal dilation which has a cure rate of 93% after one month according to this article.

Every day it seems like my bum hurts and my stomach is perfectly fine. It would be nice to get things back to the way they use to be.