Hello all,
I've posted my story in the New Members forum, but I decided to start another thread since I just went to the CRS... The summary is: I've been having bleeding off and on for 3 weeks. Pain has been from minimal to medium (like difficulty walking, but not disabling). Out of the last 20 days, 5 had no bleeding or pain and 15 had some bleeding or pain. Bleeding has been reducing, but it's still there.
The CRS examined me (it hurt!!) said that I had hemorrhoids AND a fissure. The called the fissure "borderline surgery" and injected the hemorrhoids with phenol 5% (I think), which he said should shrink the hemorrhoids and help heal the fissure itself.
Also, he gave me a Diltiazem 2% cream to apply on the fissure. He was quite cold and said that if my fissure doesn't heal in 3 weeks with the cream, than the next option is surgery, in which he would remove hemorrhoids AND do a LIS.
My mood isn't too great - it sounds like an ultimatum with slim chances :(. Folks, do I have a chance to get over this without all these surgeries? Was anyone here HEALED in 3 weeks by this medicine?
Again - thank you for all your help!

I assume most people are on the forum partly because they're well past three weeks of treatment. But don't let that discourage you. The best you can do is treat the hell out of that area. Use the ointments as directed, take as many sitz baths per day as you can and stay in them for as long as you can. And I cannot stress this enough: diet is IMPORTANT. Fiber, fiber, and more fiber with, at the very least, a gallon of water per day.
Basically, it's best to shape your life around the treatment and do as much as you can right in the beginning. If you're one of the lucky ones you'll heal and never have to worry about it again as long as you eat right.
I'm about three months in with no surgery... yet. My CRS says it's healing but the pain is still excrutiating on bad days. If it doesn't subside within another month, I'm going to seek info on other treatments... Botox etc.
Good luck.

Dcasp82, thank you for the advice! I'm eating a lot of fiber and water already, but this is really a good point to emphasize. Since I started on the Diltiazem, I've actually felt much better - no bleedings which is either beginner's luck or amazing for this medicine.
The diltiazem, however, causes significant constipation. My stools went from normal-soft to hard, which made it even more amazing that I was able at all to go 3 times to the bathroom without bleeding even with very hard stools. I'm now trying to manage it with even more water and Colace, which the doctor also recommended. Miralax didn't go veyr well with me (too "strong" w/ side effects even in small amounts), so let's see if Colace helps.
About you, I think that it's really encouraging that the CRS said it's healing. My CRS was really cold and said "3 weeks or surgery", which, given papers I've read, is really too radical of a time frame. I think your CRS is great and you should really try other treatments if it doesn't heal in 1 months (knock on wood!).
I will keep reporting on the Diltiazem, but I've read papers saying that cure rates for CHRONIC patients were from 45 to 80%, depending on the study - and generally above Botox. Even if doesn't work for me, it might work for you!

3 weeks or surgery seems very radical to me as well. I'm three months in and I'm still trying to avoid surgery. I luckily found a CRS who is very reluctant to resort to surgery before all treatment options are exhausted.
My CRS perscribed nitroglycerine .4% ointment and I'm not going to say it worked wonders, but according to my him it's definitely aiding in the healing process. Basically, it draws blood to the area by dilating the blood vessels allowing more nutrients into the affected area to speed up healing.
The only downside is that it gives you a headache because once it enters the blood stream it dilates all your blood vessels, including the ones in your brain. So you feel some pressure for 20-30 minutes after application. My heart beat very hard as well. But all in all, he says it did the trick. And no constipation.
I'm definitely going to look into diltiazem should my AF persist. Though I'm very wary of constipation. I made the mistake of taking vicodin for the pain in the beginning when I didn't really understand what was happening. Yeesh... Talk about constipation! No more opiate based pain killers for me!

Hi Dan,
I'm really shocked at the response of your CRS.
3 weeks is still an acute stage for a fissure and to give you an ultimatum of 3 weeks or surgery is terrible! Are you able to get a second opinion on this from another CRS? I would not be happy with that either...and would definately be looking for another opinion on this all.
I was using the Dilitizem too but it didn't cause me issues with constipation...Could it be the fact you have probably simply increased your fibre intake and your body is adjusting to the increase?? (In which case, drink LOADS of water...) It will settle down and I'm pretty sure that Constipation is not generally a side effect of the cream. I'm sure things will regulate there....I have a couple of spoons of olive oil, fish oils and endless water to keep things flowing smoothly!....
I was advised to use the cream for 6-8 weeks, some people up to 3 months, so I really don't agree with the 3 week period you've been advised. I'm sure you need to use the cream for longer than this!! It's similar to the BOTOX procedure, the effects of which last 2 - 3 months. Rectogesic and Dilitizam are the "chemical" version of the treatment and tend to be used for as long as a Botox treatment.
Personally, I think if you've had your fissure for just a few weeks than you have every chance of trying to overcome this with the cream, a healthy fibrous diet, lots of water, hot baths/ sitz baths, a positive attitude and all the stuff you know you need to do. I'm six months with my AF and the Dilitizam really helped.
I'm not yet healed but still continuing with all the necessary things I know I need to do and it's not getting worse and I've (touch wood) not had a retear, so thinking that things can only get better!...
Good luck with this all and try to get a second opinion if you can. Also go with your gut at this stage and do what you feel right. If you want to give yourself longer rather than feeling you are being "rushed" into the surgery option, then do it....Keep us updated & really hope you are feeling better soon xx One of the B Vitamins (forget which) is supposed to be really helpful in dealing with the bleeding...so see if you can read up a bit more on that too?

dcasp, Ever,
Thanks again for the responses. I think we are all on the same page here, I would never go for this "trigger happy" CRS view of "3 weeks or surgery". Like I said, there are many published papers detailing *complete healing* of chronic fissures from patients having them for 2 months to 3 years through pharmacological treatments alone, so if this CRS pushes me to a surgery after 3 weeks, I'll just say NO. The experience you guys had only reinforces this feeling, so it's awesome that you were able to share.
Regarding the constipation... I actually just read online that constipation is a documented side effect of Diltiazem. I just have no idea how prevalent. I'm already taking a ton of fiber and water, and apparently things are getting softer after the Colace, so let's see. I'll have what you said in mind and will keep the water intake very high. I'm still having a hard time stabilizing a good BM schedule, right now it's 3-5 times a day (of small, relatively hard BMs), and I'd prefer 2 (with soft, longish stools) to let the area "rest". Let's see how this goes...
By the way, has anyone tried sitting on a cold compress after the warm bath *with clothes on* (instead of putting the cold compress directly on the area, which would be OUCH)? Seems to be helping the relief after BMs, but I don't know if this is recommended.

Hi Dan,
That was interesting what you read on Constipation being a side effect of using the cream. I was advised the opposite...! (if any side effects aside from itchiness/ irritation)
I'm sure your bowels will calm down and regulate with an established eating pattern (at set times when poss) with high fibre & fluid intake & I think it takes anything like colace, miracol, lactulose etc. a day or two to start working properly, so you should be soon fine. I know it sounds disgusting but try the olive oil too?....
I've never used a cold compress only ever heat (A lot of people on this site use heat mats/ bottles etc.) or I apply an aloe vera compress on the area and that is heaven! I apply it from the plant directly if I'm particularly sore after a bath and honestly, NO ouch! - just coolness and soothing, which lasts a fair while. Can't see sitting on a cold compress with clothes on would do much harm?...but I really couldn't say..... :)

Here is the information on side effects:
http://www.drugs.com/sfx/diltiazem-side-effects.html
Of course, these vary from person to person... It's good and bad that we're all different. It would be great if this ailment had a silver bullet that worked for everybody :-/
Here you can find some research outcome results on diltiazem. If you change the search string, you will be able to see for other medicines. Most research is not accessible but the abstracts are - and you can see the actual conclusions on many of them.
http://www.ncbi.nlm.nih.gov/pubmed?term=diltiazem%20AND%20fissure
And thanks for the kind words... I hope it improves, it has been a bit all over the place in the past weeks. It's hard to change habits and see what works since it usually takes a few days for any change to actually work (days of pain :( ).
I'll do olive oil if the Colace fails... But yes, I made such drastic changes in my diet that my body is still trying to figure it out after ~15 days of fibers and water.

Hi, I don't have too much time to respond right now, but I agree with the other forum members that 3 weeks doesn't seem like a long time to give the fissure to heal!!! So please don't listen to your CRS if you don't quite trust him.
Also, I've had hemorrhoid problems too with the fissure and my hemorrhoids have taken MONTHS to shrink. At the moment i use a witch hazel cream for them that have shrunk them from being outside to well and truly inside my butt and at this stage my fissure has healed and I can poop a lot bigger and harder poops than I could before. So I just wanted to say that 3 weeks is not always enough time for hemorrhoids to shrink naturally with creams either...depending on how much pain you're in you might want to give it more time to see if they do shrink on their own...it's plenty of creams and herbs to try. I am at least glad I didn't listen to my CRS and managed to shrink them this much myself!Oh...and the more the hemmies shrunk the better my bum and fissure felt so maybe it might help you too to get onto those hemmies...?
All the best!!!! I'm crossing fingers and toes that you'll come up with a sensible plan of attack :D

NewMummy, thanks for the support and information!
Regarding the hemmies, although I didn't mention the CRS performed Injection Sclerotherapy on them (without my consent or informing me prior!) and it was a HUGE help. They hurt still, but they got much better.
In the last 2 days, I hardly saw blood from my fissure. A drop on the stools here and there, but although I'm passing super hard and dry stools, the bleeding and pain are significantly better (especially the bleeding).
So maybe it's starting to heal? I hope so. I just went to the bathroom and the stools were a bit softer. I also started with the olive oil as suggested above, let's see how that goes. I'm taking Colace with breakfast and dinner and drinking a ton of water (+fibers). Let's hope the softening continues! :)