I have had a fissure twice before, but they both healed on their own. This is my first experience with a chronic fissure.

My journey is as follows:

I had a really bad bout of gastroentitis back at the end of August... 8 days of diarrhea ended with a course of antibiotics. I think I got the fissure because the antibiotics made my stool so hard/dry, because I got it at the very end of all that. Saw an urgent care doc in early October who diagnosed the fissure and gave me some steroid cream which did not help at all. (I now know I should have gone sooner because I would have had a better chance at healing, but I was so embarrassed!) Also started at that point with stool softeners and lidocaine based on what I read online. Saw my regular doc in mid-October who told me to stop the steroid cream immediately and gave a script for diltiazem. After about a month, I noticed some improvement, in that I stopped having the really tiny "pencil poops" and was able to pass gas again to some degree.

Up until mid/late-December, I was still having the worst pain of my life on a daily basis, with the razorblade BMs and spasming for hours. I was also still having more diarrhea than usual, though not every day... it's just like some foods I can't really handle anymore. I was completely miserable and scheduled my surgery in mid-December but we couldn't do it until late January because of my and my doc's holiday travel schedules.

However, I've been learning, and am eating really well these days. I also started with the magnesium supplements a couple weeks ago and this has been making things WAY easier for me... the stool softeners are basically useless in comparison. Things are not so bad since the new year... mainly because BMs now never take more than a couple minutes. I still have a sharp pain right when I get the urge to go and when I pass the stool, but if I'm good about soaking right afterwards, I don't have the spasming. (I'll get occasional twinges of pain throughout the day but only for a second.) I also have my sentinel piles, and they are still irritated after BMs (always in the morning for me), but are not so bad at night. I can't tell if I'm healing or if I'm just managing the symptoms a lot better.

The main reasons I'm still considering are the surgery are: 1) I'm so tired of this (as are we all). It's really dominating my lifestyle, my schedule... I have no social life and the only romance I have is not because I feel in the mood, but because I feel guilty for neglecting my partner. (Sad for so many reasons, I know.) I even turned down an awesome internship offer because it would require me to move to a foreign country and I was too afraid to have to deal with this in a healthcare system abroad. 2) I have to travel for work/school and it's REALLY hard to deal with this on the road and in airports. 3) I will be moving out of state this summer. I live in a great place now with a fantastic hospital; I trust the doctors here and have no idea what it will be like where I'll end up. (I don't even know for sure yet where I'll be, just that it won't be here. And I don't have much choice in the matter.) On top of that, I have a support system here (which I won't have in a new place); I don't have the money to afford movers, so I will want to be healed before time to move; and I don't think I'll be able to take time off from a new job for surgery.

I agree that in normal circumstances, I'd cancel the surgery and see how it goes, but I don't have all that long before all of these major life changes and I want to go into this new phase of my life being the best me I can be - if that makes sense. (And if you made it this far, thanks for reading!)

Thanks for all the info Zipp. Glad to hear things are going much better for you. Sure sounds like you have given this a lot of thought. I agree that it is difficult to know if you are healing or just managing symptoms better but I would think it means things actually are healing. Would be best to get assessed to determine that of course. When have you scheduled surgery? Would you have the chance to be assessed first? I think you have all the right reasons to go for it except for if something doesn't work out really well it doesn't sound like you have much extra time for recovery. How much time have you factored in for recovery? I am almost 9 weeks in and am still having a very rough time but I also have IBS and a spastic pelvic floor to manage. The pelvic floor problems are a real challenge not just to healing but the LIS seems to have upset my muscle balance back there and am having a lot of pain that is probably not directly due to the incision or fissure. I also had an infection and have now been on 3 rounds of antibiotics. CRS thinks I may have formed a sinus (pocket) where BM gets caught and then keeps getting reinfected. He may have to go back in. I am hoping not as it has taken me so long to heal this much and the incision site is still not closed as it still seeps! Anyway, I digress. You have to go into something like this with the best hopes but also have to be prepared just in case things don't work out great. There are a lot of stories of negative things happening to people on here post LIS (including neuropathic pain and leakage) that scared me a lot when waffling over my decision. I hope I didn't just scare you. I really want you to have your quality of life back ASAP.

I would lean toward not having surgery as well, because I am old enough to really know that any surgical procedure has risks, and to never minimize them, or take even a "simple" procedure lightly. I understand your situation though, zippety, so can relate to the fact that you don't want the fissure to return while you have so much going on in your life. The support and a surgeon you trust are also very strong reasons to go through with the procedure this month, but again, if you have been able to heal the fissure again, and believe that you have also changed your dietary habits to make a re-tear less likely, you may be better off cancelling now and seeing how things go.

msimon asks a very good question though - can you get in for a quick exam to see if the fissure has healed?

Hi ladies, thanks for your advice. I also should add, I haven't bled in the last 10 days or so, either.
My surgery is scheduled for 1/26 (in 12 days!), so I just wrote the clinic asking if I could have another physical exam prior to that date. If not, I'll go ahead and postpone until I can get another exam, just because I'm really hoping that this will go away on its own. Before I didn't feel like I could survive another day, but now I think I could make it a few more weeks (especially if things keep getting better rather than worse), barring some sort of new trauma. I still have some days that are worse than others, but none are as bad as a normal day from a few months ago. And even if I waited until mid-late February, that would still give me time to recover before graduation.

I took two weeks off for recovery (luckily I can do a lot of work from home, anyway, both during and after recovery), but you're right - there's always the possibility of complications and that can take much longer. I'm sorry to hear that was true in your case, msimon. =( I hope the doctor has good news for you next time that does not involve another round of surgery!

If you still have some wiggle room, I think that postponing it for a couple of weeks might be a good solution.

Wow... the doc was not very helpful. I described to her exactly what was going on (almost the same as what I said to you a few posts ago), and ended with 'I cannot tell if I'm healing or just managing my symptoms better, but obviously if there is a chance that I will move past this on my own, I do not want to take on the extra risk associated with the surgery. Would it be possible to have another physical exam before the procedure?' And she just wrote back 'Yes, it's possible that you could be healing, but evidence shows a high rate of recurrence.'

ARGH! (My frustration is at her, not you!) Because that's not what I'm asking. If I get a retear and am back to where I was a few months ago, I'll be on the operating table lickety-split! No doubt about that. But I'm asking if I need the surgery NOW... not whether there is a possibility that I will need it in the future.

I wonder if she just wants me to go through with it anyway because procedures are how they make their money? Perhaps that's cynical but I feel irritated because she didn't even really listen to me. Guess I'll postpone. Seems like the best solution for the time being.

I have to admit that I'm not too surprised by the response. I have found that surgeons are generally only interested in their own specialty and not about your other issues, whether it's another physical ailment (unless it affects their work), or your personal situation (school, moving, etc.), and you may be better off discussing that with your family doctor. I don't think that your surgeon is specifically wanting to do the surgery for monetary reasons either, but has just told you what matters to her. She doesn't really care if you are healing now or not, or whether you need the surgery now or not, just that once you've had three episodes, the statistics say that it will recur again and you will eventually need to have it dealt with surgically.

chachacha wrote:..., just that once you've had three episodes, the statistics say that it will recur again and you will eventually need to have it dealt with surgically.

This is likely the reason you got this response. Doctors really look to the data for these things and they have the best intentions of trying to fix things for people long-term. Of course there is a chance you can heal this one and move on and never have another problem but I think they have seen a lot of people where it is an ongoing cycle of healing and tearing for them and they look to solve the cause (or what they think the cause is anyway). Everybody is different though and nobody knows your own body like you. Go with your gut.

Well, I cancelled the procedure... only to have a setback the very next day! The bleeding is back but still not as bad as it had been previously. I just feel like this is the universe's way of saying "don't get your hopes up"... *sigh* Now I'm trying to remind myself that this is only temporary, and I'm developing such good eating habits that my health will benefit in the long run. It's a struggle to see the bright side sometimes, though (as you all know)!

chachacha, what ended up happening with you? Did you get to talk to your doc and find out if you'll be able to move forward?

how are our healers doing? I haven't been on in a few days since school's starting back up... getting busier (boo for more stress, yay for more distractions). Hope everyone's had a good week.

i had it and will post when i can sit