macymae wrote:Wow sounds like you have been busy. I think its best to wait a bit too, as if you can avoid surgery, why not? Some people cannot wait pain wise but like I said, my friend is mostly healed and it took her about three months.

Let me know what she says!

Can you see yours at all?

Haha yeah, "busy" is one way to put it, "panicked and burning through time and money looking for a cure" is another way that comes to mind :)
Do you mean if I can see my fissure? If so, nope, I don't think so. I haven't looked all that hard for it, but from the exploration that I have done, I can't seem to see or feel it. It kind of makes me wonder if it's really a fissure I'm suffering from at all. The pattern of pain surrounding BMs, and how it almost completely fades away after a night's sleep, seems to fit though. Maybe it's just higher up in the anal canal and that's why I can't see it? At the risk of TMI, I do have external and internal hemorrhoids too which might obscure my ability to visualize or feel the fissure.

Don't worry about TMI! I don't have hemmies blocking anything, but myself have tried to look and never seen anything....fissures can be really small but feel really big!!!!

Yeah if someone had told me that a little tiny cut could cause so much agony, I wouldn't have believed it. So I guess I can't really blame others too much for not understanding the pain when they've never had one themselves.
The only way I can sort of tell there's a cut down there is when I apply the nitro ointment. It depends on how much I put in and how good my aim happens to be, but sometimes I can feel one little spot that burns and stings when the ointment hits it, which I presume is probably the open fissure.

Yes. I used that stuff too and hated it. It really burned! Are you taking baths too?

Sort of -- I do the sitz bath thing with a bit of epsom salt every once in a while, but it's not part of my daily routine. I guess I only do it when the fissure hurts real bad. The sitz bath (I have the kind that fits over the toilet) doesn't fit my butt real good and kind of hurts my back when I sit in it. It's weird because I'm a pretty small dude. Maybe a small dude with some kind of back problem, I suppose.
I'm largely okay with the nitro side effects, the only time I got kind of scared was early on when I put in waaaaay too much and got a severe headache, pounding heart, and feeling like I was gonna faint. That was pretty scary. But I've been more judicious with the amounts since then and am pretty used to the weird throbbing headaches now. Actually doesn't feel like my day is quite complete without them. I'm going to ask this doctor today after efficacy of nitro versus nifedipine or diltiazem, though. The nitro side effects haven't been as bad as I'd feared so far but I kind of wonder if it's really doing anything other than providing temporary relief.

Sounds like she will know. It didn't do much for me but my CRS was pretty insistent upon LIS being best for me....but not for everyone and I hope you are one of the lucky ones!

Yeah I hope so, if I get one more generic "eat more fiber and drink lots of water and it'll just go away on its own" answer from a physician I'm just going to scream.
Well I'm off to see the wizard (of anal fissures), I'll let ya know how it goes. Cheers and may we all be blessed by friendly soft stools for the rest of the day :)

you too! Let us know!!

I didn't realize you had an appointment today, NG! Here's hoping it turns out well, buddy! I'm with Macy...let us know what you find out!

Ok so that was an interesting visit...
The doctor didn't want to do a full rectal exam because she (rightfully) figured it would be supremely painful. So instead she did a limited exam using just her finger. She poked around a bit and found the spot that hurt real bad. She indicated that the spot is indeed consistent with where nearly all anal fissures occur in males. So now we at least know that it's likely a normal fissure.
She also said that my sphincter is in a pretty severe spasm -- the diameter is apparently very small and tight, making it tough for fingers to get in or stool to get out.
That was all pretty much expected. Now here's the interesting part. The nitro ointment I've been using is just 0.2% nitroglycerin mixed with aloe vera. What this doctor prescribed me is a compound consisting of 0.2% nitroglycerin, 2% hydrocortisone, and lidocaine. I've read a lot about nitroglycerin and lidocaine being used to treat fissures, but thought hydrocortisone wasn't supposed to be used because it thins the skin around the anus... So I'm not quite sure what to make of this. I'm going to give it a try, but I don't fully understand the hydrocortisone part of the equation.
Also, she prescribed me Valium and indicated that it would help with the sphincter spasm. Conceptually it makes some sense, and I found a few isolated bits of literature online indicating that Valium is used for "several anal sphincter spasms." But the literature to this effect definitely wasn't abundant by any means.
Finally, the doctor asked me to follow up in 3 weeks, and said that since my spasm was pretty bad, she'd get on the horn with my insurance and get them to authorize a botox injection between now and my follow-up visit. According to her, nitroglycerin is more effective than nifedipine or diltiazem, and has a cure rate around 60%. She says botox is a bit higher at around 75%.
What do you guys think? It wasn't the prescription I expected to walk away with, but this doctor does seem to know her stuff, so I'm inclined to give it a chance. I'll create a short abbreviated thread on just the medications to see what others think too.