I'm a 52 yr old woman living in WA state USA.
First had the pain Nov 2019 after excess meat consumption following a week or vegetarianism. I thought it was a hemorrhoid and tried prep H and Anusol suppositories but they didn't help.

Dec 2, 2019 went to a Dr who diagnosed fissure on the posterior right side and he said it was already healing.

The pain and bleeding went on for months, I wasn't really doing any treatment for it because I thought it was maybe healing like the Dr said. Plus I was just busy with life and my "sedentary" desk job.

Feb 2020 I complained to the Dr about the fact that I still had this problem and he sent me to a colorectal surgeon.

The surgeon prescribed lidocaine-nifedipine ointment and sitz baths. The instructions say to put the lidocaine-nifedipine ointment "inside" the anus but the surgeon says just putting it on the outside is ok so that's what I do. He also started me on taking psyllium fiber every morning. He told me there was no need to quit caffiene or adjust my diet, just eat enough fiber and try my best to not get constipated.

I normally poop 3-4 times a day and this has been true for decades, even adding the fiber supplement didn't change this.

At some point I got one of those over the toilet sitz baths, which helped me more than sitting in a storage basin in the bathtub.

After 2.5 months I thought it was healed and stopped the ointment and sitz baths. But a few weeks later the pain and bleeding returned.

I have noticed that because of the pain it takes effort to relax through the bowel movement and that difficulty with relaxing is bad news, seems to be more likely to cause an issue. The warm water really helps.

I am nearly out of lidocaine-nifedipine ointment and since it has been 9 months the surgeon thinks I should return to see him again. I want to go just to get another Rx for that or another ointment, but I feel a little disappointed in him because he only can ever seem to recommend either Botox or surgery as solutions, but never orders any tests that would give more insight as to what's going on, says that doing any kind of anal probe would be too painful.

I now take colace every morning in addition to fiber. I still occasionally "feel" constipated even though I poop 3-4 times a day.

Here are my questions:
Should I trying putting the lidocaine-nifedipine inside and what is the best way to do that if it is (I imagine) painful? Q-tip?

Should I be quitting coffee and tea?

Any other thoughts or advice?

Thanks in advance!

Hi summerseason, sorry you are going through this. I think if you still feel constipated, it may be too much fibre. Sounds like you don’t have trouble going to the toilet. Miralax will soften everything but start with a small dose as it can cause diarrhoea. Don’t take it with Colace.
I don’t think it’s necessary to quit coffee or tea. Caffeine is a bowel stimulant.
As for the ointment/cream, try to use a cotton tip to apply but don’t stress too much. I’ve been told that close enough is good enough as it will be absorbed anyway. I have read here that it needs to go inside though. There doesn’t seem to be consistent advice.
Also don’t be afraid to see the specialist again. You may end up battling on your own for a long time only to end up needing to see them anyway, like most people here.
Botox works for some and definitely not too difficult. I felt great 8 days after Botox. The effect didn’t last though. Even surgery doesn’t sound that bad but maybe that’s because I’ve had a chronic fissure for over 4 years.