Postpartum Anal Fissure: The Horrors and The Healing Process

Let me tell you about my postpartum anal fissure and how I got through it.

A fissure is defined by the Mayo Clinic as a small tear in the lining of the anus. And a postpartum fissure is among the most painful issues a woman may experience after birth, yet one of the least talked about.

Given that an anal fissure postpartum is actually quite common though, I think we really need to discuss the issue more openly! (“…anal fissures occur in about 40% of pregnant women and women during postpartum period” according to the National Library of Medicine).

But, it’s really no surprise that we don’t talk about this postpartum issue. Any malady with the word “anal” in it, is the last thing anyone wants to discuss. I am checking my shame at the door though, because I want other women who may be experiencing the horrors of a postpartum fissure to know that they are not alone!

And I also want to share what I did to treat my fissure at home. It took a lot of persistence and patience, but I came out the other side.

Please note however, that in the case of chronic anal fissures, Klein Physical Therapy explains that home remedies may not cut it. Chronic fissures are those that have not healed within 6 weeks.

My fissure healed at just about 6 weeks (thank god), but it reopened a couple of times months later. It was never as painful as it was that first time around though, and I knew what to do right away to start helping it heal.  

So while I can’t say that my bum is the same bum it was before pregnancy and childbirth, I will say I have learned a lot about self care and taking care of what needs to be taken care of! And that I am in a far far better place now than I was at a month or two postpartum. So I hope that offers some hope and comfort to anyone struggling with the horrors of a postpartum fissure and/or hemorrhoids. 

My Experience with a Postpartum Anal Fissure

The delivery of my second child was fast and furious. I went into labor the morning of my scheduled c-section, and things progressed so quickly that I ended up having an unplanned VBAC (vaginal birth after cesarean). My Unplanned VBAC Birth Story is far more interesting than a lovely scheduled medicated cesarean delivery would have been, so at least there’s that.

So with this surprise VBAC and all the straining of childbirth came a traumatized bum hole. And this was NOT something I was prepared for.

I had some mild trouble with hemorrhoids prior to childbirth, but nothing prepared me for what I experienced after delivery. 

The strain of pushing had caused an explosion of hemorrhoids and swelling in my rear end. I’d never experienced anything like it. Never mind the pain of tearing and my perineal stitches, I hardly even noticed that. All I felt was the searing pain in my bum! And a week later, I realized I had developed an anal fissure.

At first I assumed the pain I was experiencing was related to hemorrhoids, since I had never heard anyone talk about fissures as a potential postpartum issue. But after a friend mentioned that she had hemorrhoids and fissures after childbirth, it occurred to me that I too may have had a fissure.

So I consulted Dr Google and came to the conclusion that yes, what I was experiencing was almost certainly a postpartum anal fissure. My OB confirmed my suspicions at a later appointment.

Postpartum Anal Fissure Symptoms

Every time I had a bowel movement, I would break out in a sweat and cringe through the pain. It felt like I was being cut with a knife every time I pooped. And I’m not exaggerating at all here. I would start shaking and just close my eyes and try to breathe through the pain. 

And for hours afterwards, I experienced a strong and deep burning and aching sensation all throughout my behind. This made sitting, walking, and really just existing miserable. And this was a daily occurrence for about 3 weeks. 

And as painful as it was physically, I found myself obsessing over it mentally as well. Because how could I not when I was hobbling around all day with a burning bottom? 

How could I heal my postpartum fissure? How long was it going to last? The thought of pooping terrified me. How could I find a way to sit comfortably for all those hours of breastfeeding a newborn? Would this nightmare ever end? What if it turned into a chronic fissure? The questions and dread were overwhelming. 

Home Remedies for Fissure After Delivery

• Plant Based Salve
• Coconut Oil
• Sitz Soak Salts
• Suppositories
• Flushable Medicated Wipes
• Peri Bottle/Bidet
• Stool Softener
• Prunes or Dried Figs
• Lots and lots of water

What Did Not Work to Heal My Postpartum Anal Fissure

First I want to share what did not help my postpartum fissure. Prior to realizing I had a fissure, I was using Doctor Butler’s Hemorrhoid & Fissure Ointment to help calm all the swelling in my postpartum bottom. I did not experience much relief with this ointment, but I kept using it in hopes it was doing something. 

After I realized I had a postpartum anal fissure on top of hemorrhoids after delivery though, I started looking through the reviews of the ointment on Amazon to see if anyone had success treating their fissures with it.

One reviewer commented that the ointment was actually harmful to fissures long term (beyond a week or 2 according to this reviewer), because there is a steroid in it that thins skin over time. And thin skin is the opposite of what you want when it comes to healing and preventing fissures. 

This same reviewer also stated that the vasoconstrictor Phenylephrine in the ointment is problematic, because it restricts blood flow. And fissures need a good blood flow supply in order to heal. So after checking the ointment’s label myself, I saw that Phenylephrine is indeed listed as an active ingredient.

And oddly, after further looking into the relationship between anal fissures and phenylephrine, I found some advisory information on the Doctor Butler’s site itself. And Docter Butler’s clearly states, “Oftentimes, hemorrhoid ointments contain vasoconstrictors like Phenylephrine, which should not be used on a fissure.”

So to sell an ointment that should not necessarily be used for fissures and to call it “Doctor Butler’s Hemorrhoid & Fissure Ointment” seems horribly misleading and like false advertising to me.

To be fair though, Doctor Butler’s also explains that hemorrhoids can contribute to the development of anal fissures, so treating the hemorrhoids ultimately helps the fissure. So in theory, using the ointment to treat hemorrhoids should help prevent fissures. But in the case of an already existing stubborn fissure, it doesn’t seem like a good idea to use an ointment with vasoconstrictors or steroids in it.

What I Did To Help Heal My Postpartum Anal Fissure

So after feeling disappointed that the goopy Doctor Butler’s ointment I had been smearing on my bum for weeks was likely counterproductive to healing my fissure, I went on a search for another product that could hopefully help speed up the healing process. 

Plant Based Salve

I settled on Thena H-Salve ointment. This ointment is a plant based product with the following ingredients;

Organic Avocado Oil, Organic Coconut Oil, Organic Lavender Oil, Organic Grapefruit Essential Oil, Canola Oil, Organic Olive Oil, Vitamin E, Organic Arnica Extract, Cera Alba (Beeswax White), Organic St. John’s Wort, Organic Oatmeal Kernel Meal, Organic Witch Hazel Leaf (non-alcohol), Organic Yarrow, Organic White Oak Bark, Organic Comfrey Root, Organic Calendula, Organic Arnica, Organic Plantain Leaf, Organic Nettle Leaf, Organic Rosemary Leaf.

So after making sure everything was nice and clean around my bum, I would apply this ointment several times a day. And perhaps it was just coincidence, but I started to notice some very small improvement in my pain level. 

So I continued to use the salve multiple times a day, for several weeks.  

(Pro tip: Get yourself some finger cots! You can buy a bag of 340 for about $6.00 on Amazon. This way you can apply any ointments with a finger cot on, and then just throw the cot away after use. Makes the whole process feel more sanitary and easy.)

Coconut Oil

Sitz Baths with Sitz Bath Soak Salts 

I also used an over the toilet sitz bath as many times as I could in a day. I got to where I was doing 3 sitz baths a day, and this correlated with an improvement in my fissure symptoms as well.

I will say though, that when my hemorrhoids were inflamed, I actually felt like sitz baths made me more uncomfortable. I believe this is because soaking my bum in the hot water caused additional swelling as it brought more blood to the area from the warm water. This is great for promoting healing of a postpartum anal fissure, but not so great when it comes to already swollen postpartum hemorrhoids. 

So on days when everything felt swollen, I would take shorter sitz baths. It was a delicate balance, but ultimately I believe the sitz baths were very helpful for helping heal my fissure. 

And since I was having some success with the Thena H-Salve ointment, I also tried the Thena Sitz Bath Soak. Again, I do not know whether it was just coincidence, but I noticed my fissure symptoms improve even more after starting to use this soak regularly. It really helped soothe the pain more than anything else I had tried.

Suppositories

I kind of hated using these suppositories and the mess of them, but I was pretty much willing to do anything that might help. And since things were slowly improving as I was using the suppositories along with other home care treatments, I do not want to discount them. 

Witch Hazel and Aloe Medicated Wipes

So witch hazel and aloe wipes that are gentle on the bum and help with inflammation are a must. The Up & Up brand from Target are affordable and work well. 

Peri Bottle or Bidet

I also used a peri bottle with warm water for a while to help with the cleaning process. Most hospitals will provide one of these little squirt bottles after delivery. You can also buy them online or in stores like Target. 

And if you are using a bidet (which can be quite helpful), just make sure you are not using a full pressure powered setting on that delicate skin and fissure. 

Relief From My Postpartum Anal Fissure

After what felt like a million years and a billion sitz baths later, I started to gradually have less pain while pooing. It was a long process and required a lot of commitment, but the pain from a fissure is very motivating when it comes to doing everything in one’s power to support healing!

And I will say also that it was not easy or always possible to do as many sitz baths as I wanted to or salve applications. That’s just life. And especially life with a baby and a preschooler in my case. But we do the best we can. And that has to be enough.

I also asked my OB at my 6 week postpartum appointment what she might suggest. She wrote a prescription for Rectiv, which is a nitroglycerin ointment. Aside from being extremely expensive, my hubby who is a surgical nurse said that nitroglycerin is a gnarly drug. So I decided to wait on filling the prescription, and as it turns out, never needed it. 

So I am happy to report that after a horrible month with a postpartum anal fissure (and a few months later with a reoccurrence), I can now poop pain free! I can tell things are still a bit delicate down there, so I am continuing to try and do a sitz soak when I can, but I can’t tell you how relieved I am overall! 

And I can enjoy my time with my baby so much more now.

If you are suffering from a postpartum anal fissure, know that you are not alone. And if you are feeling completely consumed and bummed out by your fissure, I think that is totally normal and that there are lots of other ladies out there experiencing the exact same thing. 

To help other mamas out, feel free to share your experience or any products and strategies that have helped you in the comments below ♡