Hi all.
3 yrs ago fissure first appeared after bad bout of gastroentiritis,eating shit n stress over early pregnany which ended in miscarriage. Morning of d&c was suffering worst spasms ever so was relieved to be knocked out for op. Fasted few days n the fissure healed. After having my daughter 2 yrs ago it came back but I managed thru fasting again. WELL a month or so ago it's back with a vengeance and I'm desperate this time. I'm lying in the bath as I write as only way to make pain subside. Chronic fissure that doesn't respond to conservative remedies. I'm in Italy and the GTN cream costs 74 euros plus am terrified of side effects. Will call proctologist tomorrow but I know he'll advise surgery. I'm vegetarian, v fit but have thyroid disease that I feel can cause harder stools at times plus am a total stress head.

I suppose I'm looking for support as am depressed. Have had hardly any food over Xmas period as am terrified of pooing. The pain is akin to shards of glass being stuck up my anus. I also have huge sentinel pile and hems. My whole arse looks like a car crash. The fissure looks v deep and sub muscular. I know if I fast 3 days it could heal but am soo hungry in the evenings when the spasms subside after 8 hrs of agony. Plus am still breastfeeding. Any advice? Shall I just go for the surgery or try GTN cream first? I'm prone to migraines tho and have low blood pressure.

Thanks and you people are my brothers n sisters in suffering as this is worse than child birth which I've done twice with no pain relief whatsoever.

Hi Mojo,
Really sorry to hear you are suffering. I can relate totally that the spasms are the worse pain ever...worse than childbirth like you I've done 2 with no pain relief, kidney stones and broken bones...nothing even comes close. At the worst times my spasms lasted 24 hours and I have often fasted for 5/6 days at a time just to be free of the pain. I have lost over 8 stone in 16 months due to this (I was really overweight though lol)
If you know that fasting for 3 days will heal you I would say do that as GTN lowers blood pressure...I have normal but after GTN it goes down to 50/70, but the plus side it does really help with the spasms. I wouldn't be without my GTN
If you are offered surgery I would go for it as this is something that seems to keep coming back and surgery is much more of a permanent fix than fasting or creams.
It works really well and really quickly for most people and they are pain free after a couple of weeks...some are pain free straight after surgery.
No one should have to suffer this amount of pain the spasms are beyond human endurance.
You have all my sympathy and I truly hope you get this sorted.

Thanks so much.
Just reading your reply has gladdened me but I'm still in the bath!! I tried getting out but the spasms floored me almost immediately and I was whinnying like a horse due to the pain. It's more like a drill up my bum now that I cn feel in my toes! I feel god forsaken and yesterday I was even welling up while running(yes I insist on poo free days hence no spams on running)thinking killing myself is only option. I have 2 kids to stop me doing that.

I can't even go to accident and emergency as the spasms are so bad. I'm thinking I'll fast today so no bm tomorrow then go to a&e in order to get treated sooner. This is Italy and I'd have wait too long to see a proctologist. What treatment do they give at a&e for AFs?

Hi,
Oh yes I spent hours in the bath on bad days...and lime you as soon as you step out of the bath..bang the spasms start again.
I agree I try and go to the gym or swimming when not having the spasms otherwise I would have no life.
There were many times I thought of ending it as my brain just couldn't cope with the unending hours of agony. But I too have 2 children and couldn't do that to them.
In the UK the A&E just give us stronger pain killers and occasionally Valium or morphine nothing to actually help long term. I only went once...never again, I waited 4 hours for two Valium that didn't do much lol. Hopefully it will be better in Italy.
How long would you have to wait if you called your original surgeon up ?
The diliatzem may really help you...I would advise you to start with a pea sized amount and work up as my CRS said my allergic reaction was probably caused by using too much at once.

I'm from the UK too but not there unfortunately. I'm hoping a visit to a&e will speed up referral to specialist procedure otherwise there's bureaucratic hoops to jump through. Tmi possibly but I've been massaging my anus opposite to where the fissure is and it's helped in stopping the spasms but as soon as I stop they start up again. I've also inserted aloe Vera suppositories as I'm desperate for anything to work.

Thank god my partner has a week off work and can look after the kids as last week I was dealing with this hell and a 2yo and hyper 6yo.

All I know is if I emerge from this I'll never sweat the small stuff again.

How many times a day do you go to the toilet, and are your BMs ok?
Sometimes very rarely they dont make the cut long enough on the LIS many surgeons are conservative due to the worry of incontinence and lots of them say the length of the cut doesnt matter, but some people do neec a second LIS.
Im sure you wont and that the cream will help but there is always something else to try, we cant give up hope. Dilation will probably help quite a bit too i try and massage like you do every night. Im thinking of getting the dilators but they are hard to get in the UK and look a bit brutal lol.
I dont know how your doing it with young children, thankfully mine are teenagers so dont need as much attention and looking after.
Oh yes...my hips can dislocate...i always used to think that was agony, but it happened the other week and i was like oh okk actually this isnt really painful when compared to a fissure...certainly toughens you up and is the best weight loss i have ever had lol.

2 bms today which triggered the horrendous agony. No blood n nt too painful. That comes after. I had no bms yesterday hence double dose today.

Re weight loss. I was basically anorexic before having kids so these enforced fasts are dredging up bad memories n I'm scared of getting stuck back in that negative pattern. Plus I've no excess weight now to lose n feel weak. I'm still in bath btw bt literally cnt take the pain when I get out. Luckily kids at mates' house.

Have u had the LIS or are u planning on having it? I'd be lying if I said I wasn't scared at the prospect.

Sorry I just realised you haven't had LIS yet but it is always an option if the creams don't work. Also there is diltiazem if the GTN has too many side effects for you.
I'm sure this will all be over soon as our bodies know how to heal themselves they just need a bit of help sometimes.
My pain kicks in about 20 mins to an hour after BM and could last ages.
I had the botox in June which stopped the spasms from day one but my fissure is long and deep so although botox helped a lot with the pain it didn't heal me. I had LIS in November and due to my IBS flaring up the first 4 weeks were very rough spasms at level 10 and literally rolling the floor screaming but I was going 3/6 times a day. I am now on new meds and my BMs are under control so I'm not having spasms now just burning and stinging. I am healing just slowly but most people who have LIS are back to normal after 2 weeks.
Try the creams give them a chance if you can but if the pain is as bad as it sounds then maybe surgery is the best option. You will be given a pressure test to see if your sphincter has a high tone...if it does then there is very little risk of incontinence. Mine was very high and I have had no incontinence at all not even gas. 97% of people who have LIS are back to how they were pre fissure after a few weeks
Surely with your history they don't want to risk you getting into the habit of being scared to eat...I love my food even IBS n crohns never stopped me but this fissure scared even me, so with you I would think they will offer the surgery, you have to do what you feel is the best...but the pain can't go until the fissure goes.

I started with the nitroglycerine cream yesterday morning. No headaches but also had a bm 3 hrs ago(yesterday I didn't)and already having spasms. How long does the cream take to start working? Yes there's desperation here.

Also, after an examination by the proctologist day before yesterday (where she inserted her finger all the way up anal canal and touched AF 3 times!) had 9 hrs of worst spasms ever! Was gutted as had fasted 2 days to stop pooing but had horrendous pain anyway thanks to doc.

She said if cream hasn't worked by next Tues to have the op. So: how long til it has an effect? And best way to apply it? Thanx in advance to anyone who can help. I'm in the bath again. Dreading partner going back to work Mon as dunno how I'll cope with kids and this AF.

Hi,
Goodness that examination sounded traumatic...some CRS can be less than gentle...I like my current one as he says internal examinations are not necessary unless there is confusion as to what is going on. No wonder you were having spasms
My CRS says to put the GTN on 4x a day always after a BM as that is when the spasms will be at their worst and at bed time...I worked up from a pea sized amount to 2cm...I was also advised to apply it internally as my fissure is long and went quite far inside. I couldn't do this at first but did notice it helped more once I could...started with my pinky finger can now do index finger. I use disposable gloves. It should help a bit pretty much straight away but the advice is to stay on it 8 weeks, I have been on it 18 months and am now down to just once a day at bedtime if I don't have a bad BM day.
It's good your being offered the op so quickly as lots of doctors prefer to wait a while.
Hope you find some relief soon...have you tried gabapentin it's a nerve blocking pain killer and is the only thing that helps when I'm having spasms