Continuing on.....
I used diltiazem and some doctors prescribe lidocaine too to numb the area. It doesn't do a heck of a lot for me but I know for others it can help. You can get it OTC but at a lower percentage I think. I am suprised that the CRS hasn't mentioned that as an option.
I put A&D ointment and KY jelly on before I have a bm to coat the area and help it slip out better. I also use wipes and am careful to kind of pat rather than rub the area.
You might want to consider botox and of course perhaps surgery at some point. I can't believe how you have been able to work this last year like you have in so much pain. It is dreadful. I am fortunate that I get to work from home but I seriously would have to be on disability not being able to sit for very long.
I think that is it. Feel free to look around-we have some great posts and threads and everyone here are real dears.
God bless,
Lecia

Oops, one last thing.
I think for sure activity can affect the fissure. My CRS said to be careful about squatting, picking up heavy things etc because it can retear. I do think you have to live your life and not worry about every single movement but I am careful about not sliding my bottom across things-like getting out of bed or the car I don't scoot-I just put my feet down and get up.

Thanks buttgirl and Lecia for the quick and comprehensive replies! I've just come through nine straight days of a lot of pain, so I know this is a definite setback. Amazing how one slightly lumpy stool can set you back 12 months in time. And it didn't hurt at all to pass it, that's the thing. I'm not sure if I've lost everything gained the past 12 months, and that's the discouraging part. I worry about being able to hold this job down, but, by the grace of God, I functioned the past year in a lot of pain for several months. After that, the bad pain was on and off, and more bearable. I've told my bosses about the problem, and that I might have to be in and out, so that's taken some of the pressure off. Unfortunately, it doesn't help the pain at all! And I certainly can't go on like this 4-ever, and in my mind, I'm always afraid I'll end up on disability or having to find some alternative.
Buttgirl, I hope I didn't give the impression that I had a lot of pain-free days. Every day there is some measure of pain, at some point, with a lot of back and forth. Things always feel very wounded and fragile, but the number of terribly painful days decreased significantly by February, five months into the fissure. Whenever the pain recurred, I thought of surgery, but things would relent after a week or so, and that gave me hope to stick it out more. That is why the past nine days are so discouraging. I haven't had these many pain days since my early days. So, you don't think a heating pad or water bottle would cause bacteria to multipy in the area because of the heat? I'm just concerned about causing any more problems. Thanks for all the great advice. I will read up on the creams, and dicuss them with the CRS. I just want to find out how they can affect the tissue (cause itching, thinning, or heart palpitations (like nitro can)).
Lecia - thanks for all your great advice, too. I will discuss Ultram and taking more Advil with my CRS, as well as the surgical and non-surgical options. It can be discouraging to read about folks who have had to deal with fissures for years. You would think a tear would heal like any other cut in the body, and we wouldn't have to go through such prolonged pain. If surgery were a guarantee, I might just get it over. I have read on other sites of individuals who had the tear sewn up with a laser. I'm not sure why we don't hear about that option more. I understand what's behind LAS (making a lateral incision in the sphincter muscle, so that it relaxes, and the ends of the tear can come together to heal), but I'm wondering why a simple repairing of the tear wouldn't do the same.
Well, my first step is to make another appointment with the CRS that I haven't seen since December, and maybe try to find another one for a second opinion. I want to try to find out how many surgeries they have performed (my aunt's friend, who is a nurse, said make sure they have done hundreds) because I don't want to waste my time or money on someone who doesn't have enough expertise.
Thank you both for your time, and thorough and helpful advice.
God Bless,
QueenofPain (AgonyAnn)
He cares for you. I Peter 5:7

It sounds like you have a gameplan which for me always made me feel better psychologically about things.
I have not heard of the laser treatment but it sounds very interesting. I have asked before why they don't put stitches in to close it and my CRS said it would easily get infected because matter could get in stuck in there.
I did ask about hyperbaric treatment as it is used for festering wounds and burns but no one seemed to know anything about it being used for fissures. I know there are some pretty uncomfortable side effects with the treatment.
I really think aloe vera is what has helped me the most after the diltiazem cream. I would try one of those for a few months and then discuss the surgery.
This pain can be so consuming it is hard to lead a normal life.
I am glad your bosses are understanding. Hang in there.
Lecia
ps. I like that bible verse. It has brought comfort to me through many seasons in my life.

Thanks for the encouragement and additional information, Lecia. I'm sure you've been asked this many times before, but do you put the aloe vera outside or inside the anus? What about the diliatzem cream? I wasn't able to get a hydrocortisone suppository (I wouldn't want to now - I read they can dry the tissue out) up me, and my doctor wasn't able to perform the digital exam on a later visit, which led him to send me to the CRS in the first place. So, I am afraid I won't be able to get a cream too far inside of me. I have a few other questions:
1) How do I find out how many LASs a surgeon has performed, or his success rate?
2) If the doctor wants to do a flexible sigmoidoscopy, how can they perform this procedure if you are too tight? Will they put you under? Will you be at risk for a retear or worse tear?
3) I don't even know where my fissure is located. How do you know whether it's a tear in the muscle wall, or at the rim of the anus?
I think I will increase my flax oil. I read that mineral oil wasn't good, so I am glad you are recommending flax, as well. Thanks for your responses, as I am sure you are very busy, and I've taken up a lot of time.
God Bless,
QueenofPain (AgonyAnn)
Behold, I am the Lord, the God of all flesh: Is there anything too hard for me? Jeremiah 32:27

The aloe vera can go directly on the fissure if you know where it is. Mine was right at the entrance so I didn't have to go far in putting the aloe on. Some people use finger cots and KY jelly to help.
The diltiazem I just put on the outside like you were using lipbalm. I know some doctors say to put it inside but mine just had me do it on the outside. You keep in in refrigerator and it actually feels kind of good when you apply it because you get a cooling sensation. I think this might be a good therapy for you to try because it sounds like you are very tight. Can you do warm baths?
After I had my last baby I had a really bad muscle spasm in my anus and was given nitro and told to take hot baths 3 times a day to get it to relax. I have also been givien very low doses of valium to help it relax.
I am afraid I will have to defer to the others for the other questions. Your doctor should be able to tell you where your fissure is and how deep it is.
Thank you for the new verse-that is encouraging.
I don't mind at all answering your questions if I can!

Hya! I've been dealing with mine for nearly 4 months, and some of the questions you ask about the sigmoidoscopy, I've been wondering about myself!
Before I go to the loo now, I put on wheatgerm oil, and a couple of times during the day too. I also have the diltiazem cream and it has made an enormous difference- I was feeling almost suicidal at one point, before using that cream.
I find that taking paracetamol at the same time as ibruprofen mostly helps, sometimes no medication helps, I even had pethidine and was still in agony!I'm on valium too, which has also really helped, but most of all, it's this forum that's helped me the most!
Val

Thank you Val and Lecia for the replies. Lecia, I am encouraged about the fact that diltiazem is applied outside. I just fear that I will never be able to get anything inside until this heals. I used a suppository before the fissure occurred (I once had a lower GI exam because of constant watery bowel movements - they found nothing aberrant. What a blessing my pre-fissure watery bowel was - wish I had it back!!), and really didn't have a problem inserting it. Now, I can't even get creams very far inside because of the tightness. So, Val, I worry that I will never get a sigmoidoscopy at any point in life, even when warranted, in order not to suffer another tear. By the way, Lecia, it is 8:20 a.m. Chicago time, and I'm on 4 Advil at once for the first time in a year. I took three before I left for work, and another before work started. It has taken me that long to have the confidence to take that much medication at a time. Not sure if it is going to work, but we will see. Unfortunately, because I work outside the home (single - never married), I can't take baths except once a day. The sitz bath that I carried seemed to put me into pain (not sure if it stretched the area too much, or what), so I stopped after several months. At any rate, I scheduled an appointment with my CRS that I haven't seen since December for next week, Thursday. I'll ask about Ultram for pain and diltiazem cream at that point. Thank you, Val, for your input about diltiazem, as well. I'll also ask him about how they would proceed if we ever needed a sigmoidoscopy.
Val - you poor thing. Pain can really drive you into despair because it becomes your focus, and can erode hope. I will pray for you both. Did we ever think one tear would cause such upheaval? I know that when I was trying to lose 5 lbs. fast before the holidays last year, and fasted 2 meals and drank Diet Coke for a few days, I never, ever thought I would be sitting here trying to heal a painful fissure a year later! I never even heard of a fissure! I really paid to lose that 5 lbs., and I sure am quite careful to not put it back on!
Blessings and Prayer,
QueenofPain (AgonyAnn)
God is our refuge and strength, a very present help in trouble. Psalm 46:1

I've actually lost 28lbs since this AF! They do say that there's always a positive to come out of a negative! It's the only thing I'm actually happy about since this all started. With this diet hopefully I'll lose even more!
Have you tried sitting in the actual bath as opposed to a sitz bath? I have at least 2 or 3 baths a day(our heating bill is going to be scary!)
All the best Val

Wow, Val, 28 lbs! Yeah, something good has got to come out of all this pain. I've read some of your posts, as well as some of the others, and I think you guys deserve the title "Queenofpain". I think I'll abdicate the throne!
I have been having an actual bath every day since the fissure, but because I have to work, I can't have more than one a day. Otherwise, I'd have about three. Today I read someone's post that said the sitz bath seemed to stretch them too much, as well, so I'm glad I'm not the only one with that experience. Sometimes I think it might be the warm water that is putting me into pain - I don't know. I mean, water opens cuts on hands, and then they hurt, so why doesn't it do the same with a fissure? It's all nearly so impossible to figure out! I've prayed for you to heal quickly, and will continue to do so.
QueenofPain (AgonyAnn)
I will praise Thee: for I am fearfully and wonderfully made. Psalm 139:14