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Fissures

 

ID: 050404222

Science Topic

Fissures

Tears Along the Fist Chute

Education Center | Course ID: 050404222

Publication Details

Author: Finn Vortex

Published: 24 April 2024

Updated: 24 April 2024

Duration: 10 Minutes

Executive Summary

Detailed examination of fissures, including the disease process, risk factors, and treatment. Interventions in fisting and lifestyle that decrease disease manifestation. Mental health considerations and communication strategies for play partners and interactions with healthcare providers.

Seek medical advice from licensed professionals only.

Do not base your healthcare decisions solely on the information contained in this topic. Only your healthcare provider has a full understanding of your condition, its severity, and other comorbidities that may affect healthcare outcomes.

All ailment related topics at Fist Theory™ are designed to help improve communication with your healthcare provider. See Conversations with Healthcare Providers for further information.

If you have firsthand experience with fissures and would like to provide insight or correct any misinformation in this topic, please use the Help Wanted link at the bottom of this course.

Disease Overview

Pathology

Fisters use the term anal fissure to describe a long-lasting deep tear to the first hole. This type of fissure causes significant pain when any type of pressure is applied, including defecation. Fissures of this nature prevent fucking, toy play, and fisting.

In the medical world, fissures and classified as:

  • Chronic | Long lasting tears that remain present for weeks, months, or years
  • Acute | Short-lived tears that usually heal within a couple of weeks

In addition to acute and chronic classifications, fissures can further be identified as:

  • Superficial | Shallow, surface level tears that may be either microscopic or visible to the eye
  • Deep | Deep tears extending into underlying tissue

Acute fissures occur as a result of trauma to the hole during a play session. They heal within two weeks.

Chronic fissures typically have a more complex development cycle:

  1. Trauma or injury ruptures the mucosal lining around the first hole.
  2. Physiological processes associated with wounds and infection in the anus shunt blood away from the affected area. This decreases the ability to heal rapidly.
  3. Physiological processes cause small spasms that decrease the ability to heal.
  4. Defecation and the reintroduction of dick, toys, or fists prior to full healing cause repeated rupturing and decrease the ability of the body to heal itself.
Pathology of Fissures
Figure 1-1: First Hole Fissure

A fissure (B) typically occurs near the lowest part of the anal canal (D). A small sentinel skin tag (A) may form around a chronic fissure whereas acute fissures may only show a crack when stretched. Tears that occur inside the rectum (C) are not usually classified as fissures.

Fisters rarely refer to acute fissures as fissures. Instead, they will use terms such as tears or micro tears and phrases such as a broken hole.

Injury Indices

Damage to Fist Chute

Moderate  

Acute superficial fissures heal easily within a few days of the injury.

Chronic fissures that must be addressed with surgical procedures may decrease the elasticity of the first hole and prevent future fisting.*

Life-threatening Injury

Extremely Low  

Neither acute nor chronic fissures result in loss of life.

Probability of Condition

Moderate  

Acute superficial fissures may happen occasionally during traditional fisting with experienced tops and bottoms. This type of fissure is common with extreme fisting, virgins, or novice fisters.

Chronic fissures are rare.

Symptoms

The symptoms of a fissure may include intense pain while bottoming (for fists, toys, or cock), pain while defecating, anal itching, and blood in stools or on tissue paper. Pain is usually focused in a single area of the first hole.

Micro tears tend to cause pain uniformly around the entire perimeter of the anal canal.

Due to the folds of skin at the anal orifice, a syphilis chancre can be mistaken for a fissure, both may show bright red tissue. Chancres are often painless whereas fissures involve mild to extreme pain.

Anal Fissure
Anal Fissure
Anal Fissure
Anal Fissure
Figure 1-2 [ A - D ]: Various Fissure Presentations

[ A ] A fissure may not be visible until the skin is stretched. The tear will typically appear bright red. [ B ] Chronic fissures tend to develop an exterior skin tag called a sentinel tag. [ C ] Fissures can be large with inflamed edges. An untrained examiner could easily mistake a syphilis chancre for a fissure. [ D ] Fissures may appear relatively close or far from the anal opening.

Risk Factors

There are several modifiable risk factors that may increase the likelihood of acute and chronic fissures. These factors can be subdivided into trauma related factors and membrane integrity related factors.

Trauma induced risk factors include:

  • Lubrication Insufficiency | Lack of sufficient lube increases friction and drag which increases the probability of trauma to the anal canal.
  • Improper Warmup Practices | Rushing in too quickly without proper warmup increases risk for fissures.
  • Punch Play | Punching, rapid punching, excessive punching, and closed-fist punching are, by definition, traumatic actions. Any type of punch carries the risk of fissures.
  • Girth/Width Play | Megapaws (extra large hands), double fisting, triple fisting, jack-in-the-box, large toys, and double penetration stretch the anal canal to its limits and can result in a fissure.
  • Rough Play | Aggressive play usually inflicts some trauma to the hole.
Double Fisting
Figure 1-3: Squeezing in the Second Hand

Without advanced training, the first hole is limited in stretch capacity. Double fisting can increase the likelihood of fissures, even in advanced holes.

Membrane integrity risk factors include:

  • Day/Night Plugging | Extended pressure on the mucosal membranes causes breakdown and blood flow issues which decrease the elasticity of the fist chute.
  • Aggressive, Continuous Play | Non-stop play over several days prevents the mucosal membrane from regenerating. Without regeneration, cracks and tears are more likely to occur.
  • Untreated STIs | STIs result in inflammation and swelling which increase the likelihood of tears and injury.
  • Excessive Douching | Douching damages the mucosal cells of the fist chute, decreased mucous and damaged cells both result in increased tears.
  • Dehydration | Insufficient water consumption weakens epithelial (skin) membranes all over the body.
VOCABULARY

Day Plugging / Night Plugging

  1. Verb The act of wearing a butt plug for several continuous hours without removal.

Jimmy walked a little awkward all afternoon because he was day plugging with Topped Toys Gapekeeper 108™.

 

Nonmodifiable risk factors include many intestinal diseases/conditions such as IBS, IBD, proctitis, colitis, and Crohn's disease. Although many of these diseases are associated with conditions that occur in deeper parts of the fist chute and GI tract, they often trigger inflammation along the chute, spasms, diarrhea, and constipation. These symptoms may irritate existing fissures or cause membrane-associated trauma that can lead to fissures.

Treatment

Most fisters do not seek treatment for acute fissures that heal within a week. Many may incorrectly diagnose a syphilis chancre as a fissure.

Treatment varies based on the fissure's classification, its age, the impact it has on your life and health, and the severity of the fissure. Treatment of chronic fissures may involve very intrusive means that can affect your ability to bottom.

Address the Cause

Every treatment plan involves treating the cause of the condition. Repeated acute fissures can leave scar tissue which can make fisting painful for years. Healthcare providers will encourage you to alter your fisting practices to decrease trauma to your hole. This may include eliminating rough fisting, punch play, and girth/width activities.

Altering lube practices may also help, including lubricating your douche nozzle and your hole with a small dab of lipid- or petroleum distillate-based lube prior to cleaning out. You should also apply the same type of lube to your hole at the beginning of your session before switching to PEO or water-based lubes (an activity known as base coating).

Increasing intake of water and fiber to prevent hard stools that might irritate your hole. On fisting days, double your fluid intake.

Closed Fist, Rapid-fire Punching
Figure 1-4: Closed Fist, Rapid-fire Punching

Punching of any sort introduces stress to a previous injury site. Tops lose the ability to work around a sore or tender area with closed fist or rapid-fire punching.

Non-medical Interventions

Many fissures heal on their own without assistance from your doctor.

To expedite the healing process:

  • Apply Soothing and Protective Barriers | Application of a numbing cream, such as anusol, or petrolatum (petroleum jelly) prior to defecating can reduce pain and decrease infection. Preparation H or hydrocortisone cream may also decrease discomfort. Avoid continuous application to allow the tissue to heal.
  • Take a Sitz Bath | Sit in a sitz bath with epson salt twice a day to clean the area and calm the nerves.
Sitz Bath Toilet Seat Adaptor
Figure 1-5: Toilet Seat Sitz Bath

A toilet seat adaptor called a hat allows you to take a sitz bath without using your tub. Simply insert the sitz hat, fill with warm water and epson salt, and relax for 10 minutes.

Medical Interventions

Common medical treatments include the following:

  • Topical Medications
    • Anesthetics | These can help relieve pain and discomfort. Lidocaine ointment or cream is commonly used.
    • Calcium Channel Blockers | Medications like diltiazem or nifedipine help relax the internal anal sphincter muscle, promoting healing and reducing pain.
    • Nitroglycerin | Nitroglycerin ointment increases blood flow to the anal area, promoting healing.
  • Oral Medications
    • Stool Softeners | These can help soften stools, making them easier to pass and reducing strain on the fissure.
    • Pain Relievers | Over-the-counter pain medications like acetaminophen or ibuprofen can help alleviate discomfort.
  • Botulinum Toxin Injection | For chronic anal fissures that do not respond to other treatments, injecting botulinum toxin (Botox) into the internal anal sphincter muscle can help relax the muscle, reduce spasms, and promote healing.
  • Surgery | In extreme cases, surgery may be required to remove the fissure:
    • Lateral Internal Sphincterotomy | This procedure involves cutting a small portion of the internal anal sphincter muscle to reduce spasm and promote healing.
    • Fissurectomy | This procedure removes the fissure itself in severe cases.
    QUICK REFERENCE

    Always discuss with your healthcare provider and surgeon the importance of fisting in your life prior to taking any surgical interventions. Providers and surgeons may modify their procedures or refer you to other providers to minimize treatments that may prevent you from fisting in the future.

Physical and Physiological Considerations

After receiving a diagnosis of fissure, stop fisting until fully recovered. After full recovery, your fisting practices, preparation, and routines may require some significant modifications. The scope of change is based on your risk tolerance and associated conditions that triggered the diagnosis.

Risk Mitigation

Tactics that help decrease your chance of developing a fissure or re-opening a healed fissure include:

  • Eliminating Extreme Fisting Practices | Eliminate closed fist punching, marathon punching, and rapid punching. Avoid extremely firm toys, toys with texture and ridges that can catch and tear the first hole, and large circumference toys.
  • Base Coating the Anal Canal | Use lipid-based lube such as Crisco or non-viscous petroleum distillate lube such as petrolatum (petroleum jelly) in your warm-up. Coat the entire anal canal with this type of lube before switching to more viscous lubes.
  • Listening to Your Body | If you feel a pinching around the first hole, apply more lube. If there isn't complete resolution to the pinching, terminate the session.
  • Allowing Time for Healing | After diagnosis, take three to six months off for the fissure to heal. After that time period elapses, use the medium or large Slink™ from Square Peg Toys to test for healing and to train for fists.
  • Applying Lube Prior to Douching | Coat your douching equipment and your first hole with water repellant lube (lipid- or petroleum distillate-based).

Diet

Increasing fiber will prevent stools that can cause or exacerbate existing fissures.

Increasing fluid intake until your urine is consistently light yellow ensures that your large intestine has enough fluid to pass soft bowel movements. Remember to increase water intake when drinking alcohol, coffee, or caffeinated soda as these beverages result in dehydration.

Clean-out

Douching with high-powered washes and without base coating can create fissures, open previous fissures, and trigger inflammation that increases fissure risk while playing.

Daily douching can weaken the membrane, which may increase the likelihood of fissures or other trauma.

Lubrication

Insufficient lube application is a primary cause of fissures. Avoid dry fisting, spit fisting, or inappropriate lubes.

Numbing additives decrease recognition of membrane fatigue and inflammation: avoid if possible.

Play Modifications

Because of variations in fissures, restrictions and modifications can vary substantially. Once your chronic or acute fissure has healed completely, some modifications in play may be necessary.

Restricted Activities

Scar tissue will form as your fissure heals. This tissue has less elasticity than the original. Certain types of play may cause the fissure to split open again.

Suggested guidelines include the following:

  • Eliminate activities that put extreme pressure or your fissure site, including double fisting, jack-in-the-box, closed-fist punching and pistoning.
  • Avoid activities that put repetitive strain on the first ring: punching, rapid-fire punching, closed-fist punching, marathon punching.
  • Decline play with men that have extra large hands (megapaws).

Modified Techniques

Consider the following modifications to your fisting sessions:

  • Always ensure that your hole has a base coat before douching and before penetration of a fist.
  • Overlubricate your hole during the session.
  • After base coating, use a viscous, water-based lube (glycerine, PEO, waterlock, etc.) during your session instead of instead drag inducing lubes such as Crisco.
  • Discuss with your play partner in advance any weak areas of your hole so he can modify his topping techniques to decrease stress on that area.
  • Use the duckbill formation for entrance and exit.

Toy Considerations

Implement these changes to your toy play routines:

  • Eliminate day/night plugging (extended plug wear).
  • Avoid rapid pistoning with toys.
  • Exclude toys that are larger than 30 cm (11.5 inches), firm toys, and toys with excessive texture.
Egg Butt Plug
Figure 2-1: Egg Plug

SquarePegToys' Egg Plug is smooth (no ridges) and comes in many sizes. Smaller sizes of this plug are ideal for retraining after healing from a fissure.

Psychological and Social Considerations

Mental Health

Any health condition that affects the fist chute can cause anxiety and significant mental distress. Temporary loss of the ability to fist may be is traumatic and may require the help of mental health professionals to maintain abstinence while healing. Mental health professionals can help you develop coping mechanisms and explore options that allow you to maintain your identity while abstaining from bottoming.

In worst case scenarios where a fissurectomy or a sphincterotomy result in physical changes that stop you from bottoming, a counselor is often needed to process anxiety and help develop new identities (as a top, for example).

Session Communication

Begin your session with an explanation of your hole. Inform your top of any weak spots or of any fisting practices that should be avoided to prevent re-opening old wounds. When you feel drag, request more lube. If you feel pinching, ask the top to ease off and reposition. Do not push through for his sake.

Conversations with Healthcare Providers

Fisters with fissures can report the fissure to their general practitioner, but they must include that they participate in fisting. Without full knowledge of your hole activities, the practitioner may provide a treatment option that may result in future fissures.

Topics that should be discussed regarding fisting—specifically related to fissures include:

Include Medical Rationale Down Arrow
  • General proclivities including type of and intensity of play, such as:
    • Punch Play | Including details about pace, style (open or closed), and duration
    • Width/Girth Play | Including activities such as double fisting and jack-in-the-box
    • Toy Play | Including firmness, width, depth, and pace
  • Frequency of play
  • Value and importance of fisting in your life
Doctor Office Communication
Figure 3-1 Doctor-Patient Privilege

Open communication with your healthcare providers allows them to customize care for your specific needs.[1, 2]

QUICK REFERENCE

Your fisting revelations to your healthcare providers are important. Without covering the information above, they may not diagnose you correctly, they may prescribe unnecessary medications and testing, and they may not offer sound medical advice for you. Their focus may be on abstinence only—especially with providers who aren't familiar with fisting culture.

You can help improve your providers' knowledge by supplying them with the following data sheet:

PDF Icon   050404222-01 Fissures and Fisting - Data Sheet

Content Development

The following material is under consideration in the development of this topic:

Objectives

Upon completing this course, the student will be able to:

  • Articulate verbally the differences between superficial and deep fissures as well as acute and chronic fissures.
  • Identify at least three modifiable risk factors that can reduce the development of fissures.
  • Conduct an educated conversation about fisting and fissures with your healthcare provider.
  • Identify changes to lubrication and clean-out routines that can decrease risk of fissures.

Note: Objectives should follow instructional design standards and be easily measurable with little ambiguity.

Supplemental Content

Blog Articles

  • Opinionated Fister: Who's at Fault? Let's talk about fissures.

F2 Promotional Materials

  • Thursday Erotica/Neurotica: None
  • Skills:
  • Protocols: None
  • FWOTD:
    • Fissure
    • Sentinel Tag

Outline (Proposed)

  • Disease Overview
  • Pathology
  • Symptoms
  • Risk Factors
  • Treatment
  • Address the Cause
  • Non-medical Interventions
  • Medical Interventions
  • Physical and Physiological Considerations
  • Risk Mitigation
  • Diet
  • Clean-out
  • Lubrication
  • Play Modifications
  • Restricted Activities
  • Modified Techniques
  • Toy Considerations
  • Psychological and Social Considerations
  • Mental Health
  • Session Communication
  • Conversations with Healthcare Provider

F2 Resources

These individuals have indicated they continue fisting with this condition:

  • None

Brain Dump - Staging Area

        

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