Hi, I’m needing some advice! I’ve had my AF for about 2.5 years - it developed after I had my first baby. It took about 6 months before it was correctly diagnosed, and by that time it had become chronic. I’ve managed it with diltiazem for the past 2 years (and even had another baby during that time - went just fine). But for the past 4 months, the diltiazem has just not been working anymore!! It takes the edge off the pain & maybe begins to heal it, but then it just tears again so easily. I used to only use the diltiazem for 2 weeks every other month or so, but now I’m using it every single day & still in pain. My fissure never bleeds, just causes pain.

I take miralax daily & watch my diet, so my stool stays pretty soft. But that doesn’t seem to matter. Sometimes it seems to tear when I’m not even in the process of pooping.

I had been using a diltiazem/hydrocortisone combo (now on just diltiazem) - so I wonder if I could have overdone the hydrocortisone & weakened my tissues (my GI says that can happen)?

I don’t think I’m ready for surgery yet - my GI has recommended I wait for surgery until I’m done having kids (and I’m hoping to have a couple more). So any tips?? Has anyone else experienced this? What else can I try? Are there other creams besides diltiazem? More natural methods of healing that have worked? Is it possible that I just need to keep using diltiazem straight for a few more months & I can get back to a more solid situation? Is botox a good option…?

I’m meeting with my GI again in a few weeks, hopefully I will learn some things there. But would love some help from you guys too.

So thankful for this community & a place where I can talk about my pain in the butt. <3

Unfortunately, creams and ointments don't have the best reputation as a treatment for anal fissure. Also, you need to see a colorectal surgeon (CRS), not a gastroenterologist (GI). A CRS may recommend Botox treatment, or a lateral internal sphincterotomy (LIS), but each case is different, and there is no universal cure that will work for everyone. We can't give you medical advice here, but welcome to the forum, and please keep us posted on your progress.

I can relate that even soft stools tear me back open. Curious what you are going to do? My doctor said it’s obviously not normal if you keep your stools soft and tear so worries me that I have stenosis or something. Curious what your doctor said for you to do.

Thanks!

Update: I have found a good CRS! She actually understands what’s going on and how to help me and it’s awesome. We tried Botox and it did not work. May try another round at some point. But for now, I’m using nifedipine ointment daily. It keeps the pain down & I’m able to not worry about the fissure too much. I’m pregnant again with my 3rd now. Planning to eventually try LIS.

Fissures are finicky, they just tear again so easily. Work on relaxing your muscles when you poop - and try to find the sweet spot with consistency. You don’t want your poop to be runny - just like soft serve ice cream texture. But be patient with yourself when it’s not - I think it’s pretty impossible to have perfect consistency poop every day. It helps me to remember that the pain doesn’t last forever!! Flare ups happen, but they resolve. Hang in there ❤️