So it took me a while to realize it but whenever I get an erection I am greeted with fissure pain. If I ejaculate the pain comes later but it comes on strong and long. I have tried just doing it every now and then but have decided that if I ever want to heal I need to stop for good.
The trouble is I'm 22 years old and being sexually active is something that I want to be, I am worried that I will never heal and will never be able to meet someone that will want to stay with me. I'm crazy for one girl in particular and I'm starting to realize there is no chance she would want to stay with me because I honestly can't have sex. I am willing to endure the pain but I don't know how long I could keep that up.
I'm just really depressed, can't live the life I want to live and I'm having an extremely hard time coping.
Anyways, does anyone else have this problem or a similar one? It can't be that unique, though it seems that my particular condition is in a few aspects. F this fissure.

Hey bro, my fissure certainly made sexual activity more uncomfortable, but it sounds like it's causing you substantially more pain than it caused me. One thing that did happen when my fissure was real bad was I would get bad spasms while urinating. The same muscles are involved in both cases, so maybe it's that kind of discomfort.
Anyway, I think the real question is how you plan on treating the fissure. You've been on diltiazem for a while now. If it's not improving, have you thought about what you'll try next? Honestly if diltiazem hasn't helped for this long, it doesn't seem likely that it'll cure the fissure.
I know you're reluctant to get LIS (which is completely understandable) but what about Botox? Botox is really no big deal and it's temporary. It certainly beats doing nothing and continuing to suffer. I held off on LIS for a long time only because my fissure wasn't causing me that much pain. If it were really interfering with my life like it's doing to you, I definitely would've done something more aggressive a long time ago.

The thing is, it's really not THAT bad, I don't suffer when I have bm's and the dilitiazem makes everything manageable, granted I have to use it twice a day. I am worried about botox/lis because of all the horror stories I read, I feel like it could be much worse for me and I am so scared that they would hurt me more than help me.
While the pain isn't 24/7 it is certainly affecting my quality of life. I can do most things still, however I can't drink and party with my friends, I can't work out like I became so used to doing, and I can't have sex. To some these would be a non-issue but for me they are very troubling. I have friends but my social life is lacking because I stay in trying to heal this fissure. I want a relationship but can't have one. I don't want to weigh 150 lbs when I'm normally around 175 or so when I'm in shape. I hate it when people telling me I'm looking skinny, as whiny as I'm sounding right now.
And in reality I don't even know for sure if I have a fissure. Each doctor I've seen has never been able to diagnose me with an anal fissure but I have all the classic symptoms aside from painful bowel movements. My sphincter tightens up throughout the day, and if I don't use diltiazem I will get horrible pressure/pinching that is unbearable. Sorry about the lengthy post, I'm sitting at home depressed, trying to talk to a girl who I can't stop thinking about but know will never want to be with me, feeling like shit.

The pain being manageable which makes you reluctant to have more aggressive treatment, the reluctance to have Botox or LIS, and the being bummed about not being able to party with your friends (let's just say I personally partied pretty hard -- ok maybe TOO hard -- in college :)), I can understand all of that... The working out, well ok, I was never big on working out, so that part I don't get, but for the rest I think I can relate And it's 100% understandable.
But here's the deal: you mentioned that you don't know for sure that you actually have a fissure. Has anyone ever actually seen it? Or is it just a presumptive diagnosis at this point?
Fissures can cause rectal pain and spasms, and blood with BMs (not sure if you have this as a symptom but I sure did), but they're not the only thing that can. I'd say the first thing to do is to make sure you're truly dealing with a fissure. I'd see at least two docs and have them both take a look to see if they can visualize the fissure as well as where it's located. If you can tolerate it, they can use an anuscope, but many colorectal docs won't need an anuscope to see a fissure. They can do it by gently spreading the buttocks apart to look, and they can detect sphincter spasms using a finger.
I mean, based on the symptoms you've talked about so far, I'd guess it's likely a fissure too, but I think it's important for someone to see it and be certain. Once you know for sure that's what it is, then you can decide what you want to do next. I personally tried nitroglycerin first, then nifedipine, then Botox, then diltiazem, and finally LIS.
I won't say anything one way or the other about LIS, because I'm still recovering from mine and have had a rather ummm "interesting" (not in the way that I'd like) experience with it so far, so the jury's still out for me when it comes to that. But I haven't heard of many horror stories with Botox. The main disappointment with Botox that I'm aware of is that it didn't work or wasn't permanent (in fact my own weird experience aside this is the main complaint that I'm aware of with LIS too). I had absolutely zero problems with Botox, I drove to the doctor's office 60 miles away, had it done, and drove right home (through rush hour traffic with a stick shift -- that's how easy the procedure was!). It allowed my fissure to heal for months before I re-tore it by being careless.
You'll get different opinions when it comes to Botox and LIS, but I don't think anyone will disagree that you should get a definitive diagnosis and then consider more aggressive treatment.

I appreciate the responses man, I really do. I have had two colonoscopies, an anoscopy, an endoscopy, multiple manual examinations and no one has ever seen a fissure. I don't have any other rectal disease either, and since I am responding to fissure treatments I have been given a presumptious diagnosis. That's why I'm so worried about botox/LIS, I feel it could make things worse.
I'm near tears at some point everyday, I'm definitely depressed, and I'm not even as bad as some of you. I feel like the longer I have the pain the worse it will get. I guess I'm just using this board as a place to vent, I don't know where else or who else to turn to.

Wow ok and here I thought you'd never been scoped :) Do you ever have bleeding with hard BMs? And do BMs make the pain worse or better?
If you've been scoped and examined as many times as you'd said, and no one's found a fissure, then the definitely sounds bizarre. Have any of your docs considered other possible diagnoses? There are other disorders that can cause rectal spasms like proctalgia fugax or levator ani syndrome. I would think that somebody would've seen the fissure through the course of all your previous exams... There are other meds that can be tried if one of those conditions is suspected. I would be reluctant to do Botox or LIS too if no fissure had ever actually been visualized.

If your fissure was not seen during colonoscopy , I really wonder if you really have it ! Mine second fissure could not be seen during anoscopy , but was clearly seen during colonoscopy - my CRS even made a photo of it during that procedure to show me my "illusive fissure"!
Could you go to some major teaching hospital and have some really good CRS examine your sphincter with manometry and ultrasound ? Also , I would visit an urologist for opinion since sometimes those pelvic muscles can constrict and cause allllll kind of pains in the pelvic area and burning sensation also !
I recently read a ton of material about Pelvic Floor Dysfunction Disorder and it can cause pain in the anus, tailbone , vagina, penis , vulvodynia and all sorts of trouble
:( . Did you ever try to take a Valium for your spasms ??? If such muscle relaxant takes away the pain - than it definitely could be coming from your muscles going berserk :roll:
I really hope you will find a doctor who would look into those disorders and find a correct treatment for you
Just NEVER give up - there is always something that will work at the end - you just need to be persistent and search for it until you find it !!!!

wow thank you Fiss! I have been reading about pelvic floor dysfunction and I am clueless as to why none of my docs have ever mentioned this being the culprit. No fissure has ever been seen and I don't have painful (uncomfortable, yes) bowel movements, but I have multiple symptoms for PFD. Painful erections/orgasms, urinary "leakage" (though this has subsided somewhat), pain that can be felt between my penis and butt, in my bladder region, or just about anywhere in the groin region. I REALLY hope there is something to this, I just want to get my life back on track. Thank you soo much, I am going into the the KUMed center in June and I'm to meet with someone at the Mayo Clinic sometime in June/July, so I will definitely be mentioning this to them.
I am kind of confused as to why the Nitro and Diltizaem were/are so effective in my pain relief? I know they help to relax the area but I just hope they aren't making things worse in the long run. Thanks again, I facking love this board!

Jman,
I took the Pelvic Floor Retraining class at Mayos. There is another thread about it on our forum. Where in the Midwest do you live? Most people in our area (Central Illinois) go to Mayos when they have thrown up their hands after seeing local docs for conditions that could not be rectified. Good luck!!

during orgasm the muscles at the base of the penis and around the anus contract rhythmically, which could contribute to fissure pain..