I’ve been dealing with a recurring anal fissure for about a year and a half. I’ve gone to a colorectal surgeon twice to talk about it. He has prescribed lidocaine-nifidipine ointment and sitz baths. Which helps as long as I’m consistent with it and also remember to take a stool softener and be careful with my diet. However I will still have bleeding and pain every few weeks or months suddenly, but never as bad as it was initially.

But I am wondering about is how I can have a better conversation the surgeon if I go in a third time to discuss this issue, as I am inclined to do because this is a chronic problem I would like to solve. It seems like all he ever recommends for next steps are Botox or surgery. Isn’t there some sort of testing that needs to be done regarding the spasticity of the muscle before you jump into something like surgery? How can I tell if I’m a good candidate for botox or surgery What kinds of questions should I be asking? What should I be cautious of?

By the way I am a 52 year old woman, still pre-menopause.

Thanks in advance.

Hi Summerseason. I also wondered about the pressure test but failed to ask my CRS about it when I was with him last week. Dumb! Someone just told me on another thread they aren't doing that anymore. I don't know if that's widespread or just an isolated answer. I had LIS already, not healed, no incontinence so that's a plus, but no solution either. Botox is pretty much risk free long term because it only lasts 90 days. My new CRS (#2) prescribed something different from Diltiazem but I haven't picked it up yet. Gonna try that for a bit, and then if that doesn't work, Botox is next. Diltiazem has been a life saver for me though, although not healed, it keeps me out of pain. Anyone on here who is just living with the pain: take note Diltiazem works for making it livable, although it sucks to rely on it.

Hi Suxsomuch2,
Thanks for your response. Is the Diltiazem a pill or ointment, or...? (I don't have high blood pressure so I don't know if they would Rx that for me as a pill.)

I have found sitz baths to be the best thing so far. Helps with relaxing the muscle, I guess, and softening things up. The sitz that fits over the toilet is my new BFF. (eyeroll)

Summerseason, I don't have high blood pressure either - the prescription is an ointment. Apparently, someone figured out somehow that putting high blood pressure medication (calcium blockers or nitroglycerin) in ointment with lidocaine and applying it rectally (yes with a finger up the butt) helps. And man, it really does! The new ointment i received was nifedipine which is same family as diltiazem, so trying that now. I also have the toilet buddy which is fun to have to hide from visitors ... :)

Oh, I just read your first post again. You already tried nifedipine. Sorry. Anyone who's reading this who hasn't though really should because the ointments (diltiazem or nifedipine or nitroglycerin) really do help with pain. But they aren't an answer for total healing for everyone, regrettably. Including me. My second CRS says to keep trying though. He thinks I have a more than 50% chance of healing even though i haven't 9 weeks after surgery.

My CRS basically said Botox is a temporary fix (as we know) and you'll be right back where you are now. I did everything over the years. I did niphedipine, niphedipine and lidocaine, diltiazem, rectiv, Botox - all failed. LIS was the way to end to my 6 years of misery. But I did do a pressure test or anal manometry as they call it. The test showed I was off the charts tight/strong so an LIS was pretty much a risk free surgery in terms of incontinence for me. The LIS worked to perfection. It's been over 6 months since the LIS. 6 glorious pain free, normal BM months. Even a BM where my stool is hard to pass is not that bad. I have a "squatty potty" or step stool to help align my rectum and I feel it really works when things might be a little slower in the evacuation process. But I never strain anymore which is so wonderful I can't even tell you. Never feel any shame or hesitation to tell your CRS you need help. If they are indifferent, find another one. My CRS was so nonchalant about it. "Get the LIS and get on with your life." He's a top CRS in the area and to him this is not a big deal surgery. I went back after only 3 weeks and the fissure was 100% healed. I thought he had to have done some magic thing to the fissure itself but no, just an LIS. So you can play with ointments, pain killers, Botox for years or you can get it taken care of. I do understand it's not always a success for many patients and many CRS or general surgeons are total hacks so make sure you find a great one. My CRS is in the Chicago area and he's my hero!!!