Postpartum Anal Fissures: The Horrors and The Healing Process

Yep. Postpartum anal fissures. The Mayo Clinic defines anal fissures as small tears in the lining of the anus.

One of the most painful issues a postpartum woman may experience, yet one of the least talked about. And given that the National Library of Medicine states, “…anal fissures occur in about 40% of pregnant women and women during postpartum period”, I think we need to discuss this issue more openly!

But, it’s really no surprise that we don’t. Any malady with the word “anal” in it, is the last thing anyone wants to discuss. But, I am checking my shame at the door. I want other women who are experiencing postpartum anal fissures 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!

It’s important to note though, 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 Experience with Postpartum Anal Fissures

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). 

And 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. 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 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 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 Postpartum Anal Fissures

• Plant Based Salve
• Coconut Oil
• Sitz Soak Salts
• Suppositories
• Flushable Medicated Wipes
• Peri Bottle/Bidet
• Stool Softener
• Prunes

What Did Not Work to Heal My Fissure

First I want to share what did not help my 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 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.

Products I used 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 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

Flushable Medicated Wipes

So flushable wipes that are gentle on the bum and can also deliver some witch hazel and/or aloe vera to the area are a must.

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, 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 pooping. 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!

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, 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 once a day, 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 given the severe pain they can cause. 

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