I am writing to you in desperation.

I am a healthy woman, but I have had an anal fissure for one year since I gave birth to a baby. It comes and it goes, but it always returns. It is painful and when it gets really bad, I get extremely depressed. Without pain medications, I cannot function.

The usual methods are useless: drinking 5 L of water, taking fiber, eating nothing but wholesome foods ... various cremes that are supposed to help are useless ... I don't want surgery because there is a risk of incontinence. Doctors don't seem to realize how debilitating it is.

I have heard that anal fissures are prevalent not only in the "post-partum community" but also in the gay community.

What do you know about this disorder? How can I make my butt work properly again? How long does healing take, and how can I accelerate it? What is a butt plug, would that help? Would stopping breastfeeding do the trick?

Pain in the ass

I’m sorry to hear you’ve been experiencing anal fissures (anal tears). They can be challenging to treat and treatment/prevention strategies can include stool softeners/laxatives (so as not to further stress the area or cause straining/tears), topical creams (including hormonal or steroid creams), and even Botox injections.

Because genital and anal tissues are more vulnerable to tearing while a woman is breastfeeding (thanks to low levels of estrogen in the body), topical estrogen creams are sometimes prescribed to women in the post-partum period. You didn’t say which creams you’ve tried, or what’s worked well or not, but those are some options to talk with your healthcare provider about. If your doctor/nurse isn’t familiar with current treatment options, you can always print out some of these recent studies.

It’s also the case that some conditions, including skin conditions such as lichen sclerosus are more common during the postpartum and can also make women more prone to genital or anal fissures. As such, it wouldn’t hurt to check in with a dermatologist or someone experienced diagnosing/treating genital skin disorders to make sure there’s no skin disorder at the root of your fissures.

If low estrogen seems to be contributing to the issue then, yes, stopping breastfeeding may help—but then again, adding a topical estrogen cream may help too (ask your doctor/nurse for advice). Although butt plugs can help women and men become comfortable with anal penetration, and can simply be fun for some folks to use, I don’t know of any research looking at them as part of effective treatment for anal fissures. That said, butt plugs can help prepare for anal play if and when you feel you’re on the mend and ready to get (back?) into anal play or anal sex.

Treatment for anal fissures can be intensive. It can take time, dedication (in terms of diet, drinking lots of water, etc). So I’m sorry to say that it’s not always an easy fix. That said, many women and men who experience anal fissures do find improvement and relief, and I’m hopeful that you can, too.

And, of course, if any helpful readers would like to share any tips with you, I’m sure they’ll do so in the comments… hang in there!