Other People

I found it helpful to acknowledge that fissures have a social side. Other people will influence your repair, so some social plans might factor into your protocol.

First, if you’re suffering from GI trouble, you’re far from alone. Statistics from the U.S. National Institute of Diabetes & Digestive & Kidney Diseases say that around 70 million U.S. residents are affected by a digestive disease: 63 million by chronic constipation, and 75% of people 45 years of age or older by hemorrhoidal inflammation disease. Publications available through the U.S. National Library of Medicine state that an estimated 342,000 cases of fissure are reported in the U.S. annually, that 40% of chronic fissures last for months to years, and that up to one-third of women develop anal fissures or external hemorrhoids during pregnancy. The startup medical reference Symcat reports that fissures are evenly distributed by gender, and that persons 15–44 years old are at heightened risk.

Despite the numbers, sympathy can be an uncommon response to digestive problems, and fissures in particular have a hard time facing the public (a New York Times article called them “A Pain That’s Hard to Discuss”). It’s no secret that social concerns can sway our most private thoughts and actions: high distress can lead to anismus (or “dyssynergia”, a lack of pelvic floor relaxation during defecation) or parcopresis (“shy bowel”, the inability to defecate without sufficient privacy), but even a general self-consciousness can delay timely relief, and this delay can cause real problems. How so?

Medical texts point out that deliberate delay can cause fecal matter already in the rectum to return to the descending colon, whereupon the colon removes moisture, the matter gets drier, its eventual passage gets harder, pain increases, sphincters spasm (tighten), and the fissure gets worse, or at least doesn’t improve. Similarly, to prevent or delay unwanted escape of intestinal gas, muscles in and around the pelvic floor are often squeezed together, which increases muscle tone (tightness) and reduces the blood flow needed for healing. Repeat either behavior enough times and a vicious cycle can set in.

In other words, if your body could take its natural course free from embarrassment, healing might be quite quick. But modern culture levies its level of polite restraint. So while medical texts encourage prompt response to natural needs, social concerns might obstruct quick action. How can this be overcome?

One way is to do what designers do—reduce ambiguity. For example, using a scale from “Definite Influence” to “Not at All”, estimate how deeply social concerns affect you. Then craft a response strategy to keep biological and social factors properly balanced. For instance:

1. Stop the problem before it starts by identifying foods or beverages that might significantly increase GI tract pressure, and then reduce or eliminate intake. (I isolated non-dairy creamer as a suspected culprit and was much happier after removing it from my diet.)
2. Become aware of GI transit times (how long liquids or solids take to move through your digestive system). Knowing your body’s approximate timetable can help you calibrate your personal and social schedules.
3. If you typically prioritize social over natural demands, try some friendlier self-treatment for a while. This might be as simple as excusing yourself more quickly to answer nature’s call. If it’s not clear how to do a gentle reset, popular sources can provide some ideas (such as Fast Company magazine’s “How The Most Successful People Poop at Work”).

Second, for those who prefer to keep personal issues low-key, I found it helpful to clarify that suffering in silence is not the same as suffering in secret. As I’m using the terms, suffering in silence means involving others you trust, sharing necessary information, and requesting or accepting help, but also means minimizing commentary so that your situation doesn’t extend past reasonable boundaries or overtax the compassion of those offering care.

Suffering in secret means expending time and energy to produce a private cover-up, masking reality with a sense of normalcy when things are anything but. As I learned, this is a difficult strategy, even if done with good motive. Like hunger or fatigue, the body signals repair needs in ways that are hard to ignore, and if the obvious path gets blocked by attempts to keep personal matters too private, a need may express itself in ways that are just as strong but harder to spot.

If you’re using a suffer-in-secret strategy, you may want to weigh why. A chronic fissure can become extremely difficult to heal on its own or won’t heal at all without help (reasons why coming up). Even if you prefer a wait-and-see approach, a medically informed baseline can assist future decision-making. If a simple self-analysis doesn’t clearly prove that secrecy yields greater value than involving others, my suggestion is to reconsider your approach, quickly.

Why the urgency? I found that it’s powerful to confront the uncomfortable, especially in a situation like this. Doing so can produce a more relaxed and flexible protocol, which can help you be more positive, purposeful, and proactive. In what ways?

Being positive can improve your signal-to-noise ratio, which is a Silicon Valley way of saying that you don’t let fears or frustrations degrade the quality of your interactions with other people. I received a high level of care, compassion, and dedication from several excellent medical providers, and since I had taken steps to reduce internal “noise”, it was easier and more enjoyable to express respect and gratitude for those whose career includes fissure repair. In my case, boosting appreciation amplified the signal.

A better signal, in turn, made conversations with physicians and family more purposeful. Goals were clearer, concerns quieter, questions more direct. As a result, options and opportunities were more forthcoming, answers more accessible, advice more actionable, and explanations easier to relate. Staying flexible helped me envision more possibilities. For little effort I gained big returns.

And there’s more: a clearer signal helped me be more proactive. Good next steps became evident, even obvious. Planning, experimenting, and repeating things that worked got simpler. The path wasn’t always smooth, but it was smoother.

You see the point. Since other people are inevitably involved in your repair, think ahead and do a little planning. Some friendly forethought, along with some kind self-treatment—the way you act toward yourself—can help you achieve positive outcomes. As the time-honored Silicon Valley quote says, “The best way to predict the future is to invent it.”

Next, the essential role of Information & Communication.

Last updated: June 2019