at like 230,this will be the 1st visit since the nitro cream,which seemes to have lost its magic,it does work,just not as much as i want.i seem to be bad in the morning after i get up and start walking around.like the fissure heals itself a little overnight,then i reaggravate it in the morn causing spasms..guess well see what stage 2 is...

Good luck with that! I know how you feel. I would wake up thinking I was doing so much better but once I got up, went to the bathroom, etc it was down hill from that.
I am wondering if trying one of the beta blocker creams will be another option. Also some doctors will prescribe small doses of valium as a muscle relaxer. Are you taking baths? How is your diet/food/fiber system working for you?
Let us know what the doctor thinks!

What you describe sounds typical for what I went through most of the time...a constant re-injury of some type every morning. The AF pain routine.
Like Lecia, I would ask about the creams. Keep in mind, Dano, the longer you suffer from the fissure, the more chronic it is likely to become and harder to heal on it's own. Tell your doctor you feel like now is the time to be aggressively treating this thing and the botox may not be doing it's job...

well,it came and went.he said the fissure is better than the inital visit,also noticable improvement in the muscle pressure also.mentioned that its not as far along as he would have hoped but maybe im a slow healer?i told him the muscle spasms comes and goes,maybe he picked a good time to exam me as the muscle wasnt as tense.maybe the fissure getting a tad smaller helps this? we went over the different creams and he ended up giving me a stronger nitro cream as i told him it rarly gives me a headache,and it does seem to help.he didnt want to give me the dilitizem[?] cause its not "medically"proven to work,some people it may,some might not,he goes on to tell me hes been doing this forever and if something is proven to work they WILL use it...he laughed at the botox dicussion,swearing once again it the might/might not work deal and isnt proved to work,plus it expensive..all in all guess it could have been worse,he said at the rate im improving,though its slow,surgery may be avoided.he swears on not cutting people up right away,yhe says if i have any sudden or sever pain we can do the surgery if needed,but just keep using the ointment...oh yea,i have a new friend called a sentinal pile,small one but there,hes not related to gomer pyle is he??

Fissures in and of themselves are slow healers so I don't think that it is necessarily you! It seemed like at first when I would go in for recheck the improvement was very minor but it was an improvement. After about 3 months the amount of healing increased enough that I could tell a difference between one week and the next.
Yes, I have the senitel pile thing-(no relation to Gomer). It does get better and is your skin trying to pull back together from the tear. My doctor said to put aloe vera or vitamin E on it and the aloe seems to help me.
When is your next recheck?

a few months,unless i get real terrible in the mean time.im willing to go all the way with the creams,like i say..mines not that bad where i cant move or work,though sometimes i would like to take off cause of it! usually after 10am im pretty good.by then the spasms stop from my morning reinjure,then im left with the stinging ache of the fissure itself,which i can deal with.i have to get my new cream tomarrow.he never mentioned stool softeners again,just keep taking the metamucil.

Dano, are you currently taking stool softeners at all?

I was going to ask the same thing

no,just the metamucil,i have had no problems since day one with hard stools,he asked me if i had any trouble "passing" i said not that i can remember,so he told me to keep takin metamucil and i should be fine..i know one thing ,i havent hurt like this in awhile,guess all the "examinations" are taking there toll!

You might consider giving them a try for a week or so, see if you have any lessening of the pain. They are so inexpensive and safe, that you really have nothing to lose -- unless you think they might somehow cause loose stools, though they never did with me.
Are your stools consistently soft all the time?If they are, man are you fortunate! I never knew from day to day what my BMs were going to be like...funny how that changed for the most part and I had more consistent stools on a daily basis.