Hi guys,

It's been awhile since Ive been on this board. Honestly I think coming on here was making my anxiety much worse about my fissure. It's been over a year and I am so much better than I was but I'm still suffering and in pain at times. It seems like I will feel good for a month then I will irritate (or maybe even re-tear, I'm not sure.). Then, back to suffering a month. I am really trying not to let it make me sad or start feeling sorry for myself. Because honestly where is the good in that? What's bothering me the most is the uncertainty in my future. I really want to have another baby within the next year but I'm very afraid of what this may do to my fissure. I don't know if I shoulddo LIS before trying to get pregnant? The pain can be bad but it's nowhere as awful as it was. It may even be healed for all I know and I'm just getting spasms which is from it turning chronic. IF I do LIS now and get pregnant, what does that mean for me later on? Is risk of incontinence higher? Does it make more sense to do it after a 2nd pregnancy? Can I even survive a pregnancy with a fissure? You other moms know what pregnancy and post partum does to you- the dehydration, the constant drinking of water, the exhaustion. The sitz baths. Do we really have time for all that? I am so uncertain about the future and I feel like this is preventing me from moving forward with a baby. And every doctor I have talked to doesn't have any advice other than "get a c section". Can anyone relate??

Hi Newmommy, wow, it's really disturbing that the doctors seem to have no idea whether you can "do" another pregnancy with a fissure. Are you asking a CRS or an ob/gyn, or both?

One thing I would fear is that the pressure on your pelvic region during pregnancy would be too much for a fragile anal sphincter.

I wonder if a midwife or doula would be more useful to talk to. I know a couple of midwives.........I'll see if they know anything.

How long since your first baby's birth, Newmommy?

Hi there,
Yes, I relate. Although fissures are not life threatening, it has been the most painful and debilitating thing I have ever faced. Far worse than labor in my opinion. Just to give you some background, I have a 2 year old and was actually trying to have another baby last May when I got the fissure. Thank God I wasn't pregnant as I do not know how I would have went through a pregnancy with everything I have been through since May. Anyway, the short version is this: I got a fissure, used nitro and diltzazam ointments which didn't work. My CRS had to put me under to even find the fissure because I was in so much pain. When she did, she told both my partner and my mom that I had a deep and significant fissure. She said that she could do botox or LIS. They opted for the botox, which is less invasive. I had the injections in her office a few days later. That should have been the end of my story but unfortunately, I got an abscess and then a fistula which needed surgery to fix. Basically, part of the fissure didn't heal form the inside out as it should so the doctor basically cut it back open. So this put my healing back a little. I had this in October. I'm still in some pain but it's nerve pain, not fissure pain and this is being fixed with physical therapy. I hope! But the fissure is healed so the botox did it's job. Have you considered botox? It creates the same effect as LIS but is not permanent. In my case, I believe that during my pregnancy things shifted a bit, which is common, and then they didn't quite shift back right. this may have created an environment conducive for a fissure. That's what my physical therapist said. Since you had a baby recently, I would definitely recommend doing pelvic floor exercises, maybe pilates/yoga to gain strength in that area.
In terms of the baby, I really do understand. I am hoping that I heal by the summer so that I can try in the fall/winter. And time is a concern for me as I am 38 and can't just say I will wait a few years. But I do need to have a few pain free months before I even think about putting pressure in that area from a pregnancy. I can't imagine carrying a baby right now. But I do believe that the body wants to heal. I had a c section with my first and after this fissure ordeal, there is no way I will even try to push a baby out. No thank you, LOL!! I have been through enough. And it's really not the end of the world if I have another section. Though it is not what I wanted originally. They say, We plan and God laughs.
Hang in there! Give yourself more time to heal. Maybe explore botox? Definitely heal your fissure before getting pregnant would be my advice. And hey if you, or I, get another one down the road at least we will know how to deal with it.
Keep us posted and know that you are not alone :)
Hang in there

I just saw your old post and realize that you had botox already. Sorry, I didn't remember that. Why not try the LIS then, if your doctor says that it won't heal without surgery. Maybe get another opinion? I do not believe that this will prevent you from having more children so please stay positive!!! It will work out

Hi, my midwife friend says she has delivered a baby from a woman who had an active fissure at the time. So with a well-managed delivery, a fissure doesn't automatically mean you have to have a C section. She didn't say anything about the effect of pregnancy on a fissure. Probably doesn't know - midwives don't see their patients until time for the birth.
She also didn't say anything about the outcome for the mother after the birth - again, she probably doesn't know. The ob-gyn would do any follow-ups, I guess.
That's the trouble with our health system. It's so fragmented, everyone has their own speciality, and only the patient experiences the whole picture. There's nobody who takes care of you throughout the whole pregnancy/birth/recovery.

My other midwife friend hasn't responded yet. I'll let you know if she does.

Thanks to both of you for your responses. Scientist2516: I had my son in September of 2013. I was diagnosed with the fissure that November, but I know I had the fissure shortly after I gave birth. I really do appreciate you taking the time to talk to your midwife friends. That's send to be the problem with this whole LIS/fissure thing: doctors don't know how their patients are doing 1 year, 5 years, or even 10 years down the road. So they cant give you any definite answers when it comes to long term. That is what scares me. To be honest I had a very difficult birth that I can blame partially on the hospital I went to. Now I'm left with urinary incontinence during my period, I had to go throughpelvic floor physical therapy and had so many doctors office follow ups I can't even keep track. I'm very frightened to do LIS and then go through pregnancy again with more weakened muscles-- And I can't get a clear answer from a doctor that things will be ok.
Jlm: thanks for the encouragement. Yes, I did have botox and it didn't help. I feel like it's either do the surgery or keep waiting to see if I heal but at this point I think this is the best it's going to get. It's all very depressing. I'm glad your physical therapist seems to know what they're talking about and I'm happy to hear your fissure has healed!

Hang in there! I would really consider getting the surgery or if it's possible, seeing that Dr Feingold in NYC? I keep reading great things about him

Sorry to hear things haven't healed for you. If it makes you feel any better I'm in the exact same boat. 6 months after LIS and I'm in far less pain but still re-tear every 2-4 weeks. It lasts a few days and then I'm pain free until the next tear. I still take miralax, colace, and magnesium. I feel like I can't get pregnant until this is resolved which likely means a second LIS... So I'm debating if we are just a one child family or if I want to keep waiting. Right now my pain just doesn't justify surgery but if I will have to do it eventually then maybe I should just get it over with now. I did some googling about miralax while pregnant and it seems that doctors think it's fine and many people do it so that's good. No advice really, just commiserating.

I've had four children (my youngest is 20 months) and my CSR said that because I had them all vaginally and also had episiotomies with them that I was not a good candidate for LIS (because the risk of fecal incontinence would be high) Her suggestion for me was to try Botox. I think I'd discuss with both your GYN and your CSR to see what their opinions are.