FireCracker, oops sorry I knew it was one of those "eastern-ish P" places I'm a Republic of California hippy, that's my excuse and I'm sticking to it...
Anyhow yeah I know what you mean about being suspicious of surgery. I've seen a hell of a lot of doctors over the last two years and sometimes I do think "hey maybe this dude is just ordering this because he's got a boat to pay for." I'm sure that doesn't apply the majority of the time, but doctors are human just like the rest of us. I just refuse to buy into the belief that they -- or any other profession really -- necessarily walk on water any more so than the population at large
Anyway if you do indeed have a fissure, I'd personally still think Botox could help. Like with any other treatment, there's no guarantee. But it's pretty well tolerated and I haven't personally heard of any real complications from it. The main complaint seems to be failure to heal the fissure. Then again I heard the same things about LIS, and here I am with complications from it that won't go away...
Here's the way I see it: if you're not in major pain, then you're probably not going to take the leap into surgery, and understandably so. But then again, the creams aren't working. So Botox is kind of a middle ground -- more aggressive than the creams, but not as aggressive or invasive as surgery.
I don't recall which ointments you've tried already (sorry), but it might also be worth trying either nifedipine or nitroglycerin instead of diltiazem. I personally thought nitroglycerin did the most for me.
BTW I personally gave the creams a lot of time before I did anything else. Once I realized that I was just in limbo with the creams, I went for Botox, and was in butt heaven for several months afterward, no joke! After I re-tore the fissure, the discomfort was still very manageable, but I wanted to go all in (all or nothing basically), so I went for LIS. But it took me over a year before I got to that point, and I only did it because I was greedy and wanted to be back to 100%. So it's entirely normal to not want to do something more aggressive, but truthfully the longer things don't heal with the ointments, the less likely they are to heal with more aggressive measures.
That having been said, I'd say that one episode of mild bleeding is hardly reason to go and try something that you aren't keen on. When my fissure would pinch and bleed, it would do so for a couple of days before it stopped. But as long as I was diligent with the ointment, diet, stool softeners, and water intake, it never did return to the insane crippling pain of its "young" days. So I'm guessing that the pain you got today will be the worst of it.
Also, a lot of people describe the pain as feeling like the tip of the stool is hard while everything else is soft. I felt the same thing. But personally I think it's just perception. When that first bit of stool comes out, I think it has to force its way out of the spasming muscle, which is why the first bit feels harder than the rest.
Oh yeah, you can't always feels the muscle spasms either. Sometimes you just get used to it, or it's spasming enough to irritate the fissure but not to cause you pain. A doc should be able to feel it with a finger exam though. I'd think Pittsburgh would have a good number of CRS and GI docs to choose from, but then again there's that California thing :)
Hope things feel better tomorrow!

Fire,
If you are willing to share--what do you do in the medical field?? My son is currently in his fourth year of pharmacy school and is doing an medicine internship at a hospital in Springfield, Illinois, right now. I hope you are feeling better today (and less anxious)!!

over the course of the last 13 years i've mostly heard "there is no surgery" available (from regular family practice people)...it wasn't until i came to this board that i even realized there was something more permanent i could do about it...
i probably would have tried botox years ago had i known about it...
and i agree with cheryl's assessment of ng--thanks for the advice and sharing--as well as the all around friendliness...
cheryl: i'm going to springfield, il this saturday--that's where my brother's family lives and my brother is performing in a muni performance of the musical seussical :) we were there last fall for a concert and took our friend from LA (he's in the band) to lincoln's house while we were there...my husband and i like springfield a lot--it's a really great town...

Dee,
I'm looking forward to going to Springfield this weekend. I've heard the Lincolm Museum is terrific, but my son isn't interested. My mom and I might go to see it, however. And the 3 of us hope to play a round of golf!

cheryl,
my husband and i want to go to the museum at some point...we've never had the time (we don't want to just go and rush through it)...my brother said his whole family liked it (his kids are teenagers)...
we took our friend to the house because it wasn't going to take a lot of time--plus it's free...i took a picture of my husband and our friend by abe's outhouse...and there are lots of other lincoln sites that are free to see...

Neuro....I have been using diltiazem since 4/17/10, which I truely feel that it has helped me alot, but I did have 2 minor set-backs since that time...once from diarrhea and the 2nd time (yesterday), which I feel was from too many solid foods on Sunday .
I did go to see my PCP today. I think that he has been doing some reading up on fissures and treatments. He seemed more knowledgeable about fissures and treatment compared to the 1st time that I saw him. I explained to him about not having anymore Rx's for dilt. so he did write me up a new Rx for 12 weeks. He asked me if I felt that it was helping me, and I told him that Yes...I feel it is helping and told him about the 2 set-backs. I think that if I don't feel that it is helping me anymore then I could call him and ask him for something else. I also explained to him about not going anywhere in the past 3 months due to being too nervous of what could happen, except for work, and I explained how this condition makes a person very scared to have a BM and eat....at least for me.....so he recommended an anti-anxiety med. He gave me Lexapro to try for 1 month. I was a little apprehensive about taking something like that, but if it helps me to deal with this situation a little better then I guess it's worth it.
I know what you mean about the tip being harder may be a preception. I just wasn't sure how to explain it, but it seemed that I was having a hard time having the BM (not constipated, but I could tell that I had to go) and it felt as if the muscles were not pushing it along...so I had to push a bit, but the tip was definately not as soft as what followed.
I don't know that number of CRS's in the Pittsburgh area, but from the reviews that I have read about some that are available...not too many nice things said about them (too rough, does not care about the patients pain, and so on.) I don't know anyone who has ever had to see a CRS, other than my sister and I used her CRS, so I can't even get a recommendation from anyone that I know.
As for the Botox...I don't feel that I am in that much pain to do that. Every now and then I might have a slight bit of discomfort (a pinch), but nothing that Aleve doesn't take care of.
cherlyk...Thanks sooooooooooo much for the prayers. I really need them and greatly appreciate them.
I work in a physical therapy office. No, I am not a therapist, but I do everything else in the office, which by the way I love my job. I just have seen how some patients regret having surgery done...saying that they felt better before the surgery. And some have also commented on how they were sorta pushed into surgery. Alot of the patients are older so they pretty much do what the doctor recommends without questioning it.
I worked in a hospital for 2 yrs. and have seen/heard how some of the patients have tests done that aren't neccessary for their condition.
My FIL, who 87, recently was placed in a personal care home. All the sudden the MD's are saying that he needs hearing aids....the man hears everything. I know those types of things don't happen all the time, but like I said before, I am just not a trusting person when it comes to the medical field. Believe me...I have had some things happen to me personally that has made me lose some respect for the medical field. I know they are not all bad, but I just can't seem to find anyone that is good or that I trust.
dee....OMG 13 yrs. How in the world did you deal with it for 13 yrs?????
(Fingers crossed) So far today...the BM's have been ok. Thanks soooooooooooo much everyone for your help, input and recommendations!!!!! :D

Hi Fire
I completely empathise with you as this happened to me quite a bit with my fissure. Neuro's advice and thoughts are pretty much spot on and reflect my experience. I had a fissure for 5 years and I agree with Neuro in that if the creams don't work to try botox. However you seem just fine with the creams for the moment. At times my fissure settled into a pattern where I would get blood on toliet paper, a bit of pain for a couple of days and then as long as I used the my ointment (Rectogesic for me) it would go away for a month or so and then do the same. So I was not in terrible pain but I'd get a couple of sore days every now and then. So hopefully what you have experienced is similar. It doesn't seem you are back to square one just a minor blip (fingers crossed).
Just like Neuro botox gave me 6 months fissure free and then probably a year after with more minor fissure problems. It does completely cure some people tho. It's a very difficult call when to escalate your treatment to the next level (if ever). I don't know if it scientifically proven but it seems from people on here the earlier you have the non-surgical treatments the more chance they have of working. I didn't get on to rectogesic quick enough I wasted 6 months or more because I self diagnosed my fissure as piles and used H/C. I then waited too long to get botox probably 18 months or so of trying creams.
After 5 years I had surgery 3 weeks or so ago. Time will tell if that was the right decision I guess, it is early days this seems to be ok at the moment.

Fire,
Sounds like you are feeling better today. Lexapro is what I took for 1 1/2 years. I feel it helped me a great deal and can explain how I approached using the med to get the most benefit of it (I think) if you are interested!

cherylk wrote:Fire,
Sounds like you are feeling better today. Lexapro is what I took for 1 1/2 years. I feel it helped me a great deal and can explain how I approached using the med to get the most benefit of it (I think) if you are interested!

Of course I am interested!!!! You can PM me if you want. Yep...feeling a little better....Not as good as 2 days ago, but a little better. My stomach is a little queasy today...so I am not eating much this evening just out of fear of getting diarrhea

Hey FireCracker,
I've taken antidepressants in the past well. I didn't like them at the time but have been thinking about giving them another go recently, especially since when I took them in 90's, SSRIs were still pretty new. I have a Rx for citalopram (Celexa) from my previous doctor and every day it gets more and more tempting to start on it. I actually know a bunch of people that take them. People just don't talk about it. I think part of it is the fact that they're called "antidepressants" when in fact they're used for all sorts of things from social anxiety to obsessive compulsive disorder to general anxiety.
Anyhow if you don't feel you're ready for Botox then it's definitely the right call not to do it. If it's one thing I've learned from my unfortunate adventure with surgery, it's that you have to be fully mentally committed to it, otherwise you're going to have major regrets if something goes wrong. Learned that one the hard way.
Regarding the CRS, I wouldn't let one or two negative reviews scare me away, and I wouldn't let the fact that someone has no reviews scare me away either. Sometimes you find real good docs that aren't mentioned in any reviews. And sometimes you end up having a crap experience with well-reputed docs. To be honest it's a roll of the dice either way, as I'm sure you know. I'm sure you can find a CRS in the area that you like if you try.
That having been said, conventional treatments for fissures are limited to the three ointments, Botox, and surgery, so regardless of which doc you see, the course of things to try likely won't vary too much. Some will give Valium or hydrocortisone as adjunct therapy, others might suggest specific stool softeners or specific diet regimens that they personally believe in, etc., etc., but the core treatment will still be the ointments, Botox, or surgery. So if you're pretty sure on the ointments, the best thing is probably to give it more time or try a different ointment. If you get to the point where you don't feel like they're working, then you can always consider Botox as a next step. For me personally, I had zero reservations about getting Botox (I actually wasn't happy I had to wait so long to get it), but it was the surgery step that took me a lot of time to take.
Dealing with these things definitely has a lot of ups and downs, even when you're doing all the right things. Hope things are on an upswing now, and let us know how it goes with the Lexapro. I'm keenly interested myself -- for selfish reasons, of course since I'm considering take the "SSRI leap" myself :)