What this experience covers
This is a composite drawn from many anonymised accounts of people who had a Kenalog (triamcinolone) steroid procedure for a chronic anal fissure. No single person’s story is told here. Details have been combined and changed so that no one can be identified.
It follows a common path: a fissure that has lasted months or years, creams that helped for a while then stopped, an unusual procedure that promised to avoid cutting the sphincter muscle, and results that were far from uniform.
This procedure is uncommon and offered by very few surgeons. The evidence behind it is limited. Nothing here is a recommendation. For the background, see our guide to the Kenalog procedure.
The pattern
Years of creams
Most people describe a long run-up. The fissure came and went for months or years. GTN worked but caused headaches. Diltiazem or nifedipine helped for a while, then caused a rash or simply stopped making a difference. Fibre, stool softeners and warm baths became routine.
Many had also been given steroid or “piles” creams early on, before anyone called it a fissure. Several later wondered whether that delay made things harder.
Looking for something that does not cut
The turning point is usually a surgeon saying the next step is a lateral internal sphincterotomy. For many, the small risk of affecting bowel control was the thing they could not get past. Searching for alternatives, they found accounts of a procedure that treats the fissure itself and injects a steroid, without cutting the muscle.
People describe a mix of hope and unease. The idea made sense to them: treat a stubborn wound like a stubborn wound. But they also noticed how few surgeons offered it, and that other surgeons were sceptical. Some travelled hundreds or thousands of miles. Cost and insurance were a constant worry.
The procedure day
Most describe a short day in hospital. An early arrival, a general anaesthetic or sedation, about an hour in theatre, and home by the afternoon. Many found the surgeon had treated other things at the same time, such as a skin tag, a papilla or a small fistula.
Waking up numb was common, and so was relief. Several were caught off guard by brief leakage while still numb, and wished someone had warned them.
The first week
This is where accounts split. Some describe the first bowel movement as the easiest in years. Others describe it as frightening and painful, often after strong painkillers had caused constipation. Bleeding was common in the first days.
A recurring surprise was a swollen, clotted haemorrhoid appearing after the procedure. For some, this was more painful than the fissure had ever been.
Many describe working hard to get stool consistency right. Not too hard, not too loose. Lying down was often more comfortable than sitting. Most took several days to a couple of weeks off work.
Weeks to months
Results were mixed:
- Some describe the original fissure going quiet and staying that way, with life back to normal within weeks.
- Some describe the original fissure healing but new small cracks appearing elsewhere, sometimes linked to very soft or frequent stools.
- Some describe a second “touch-up” procedure, or moving on to Botox or sphincterotomy.
- A small number describe infection or an abscess afterwards, occasionally serious.
People who were happy often said they would do it again. People who were not often said their overall situation was more complicated than before.
What comes next
People in this position commonly:
- Ask their surgeon how many of these they have done, and what happens if it does not work
- Ask who will look after them if a complication happens after they travel home
- Weigh the procedure against Botox and sphincterotomy with someone who offers all three
- Keep a short daily note of pain, bleeding and stools to see the real trend
Our decision guide and questions to ask your surgeon may help.
When to seek care
After any fissure procedure, get urgent help (go to A&E or an emergency department, or call 999 in the UK or 911 in the US) if you have:
- Fever, chills, or feeling suddenly very unwell
- Pain that gets worse after the first few days instead of easing
- Swelling, redness or darkening skin spreading to the buttocks, thighs, scrotum or labia
- Heavy bleeding, or bleeding that will not stop
- Being unable to pass urine
Contact your surgeon or GP soon if:
- Pain is not settling when you were told it would
- A very painful lump keeps growing