Just a little update from my side:
I have a chronic fissure since March 2016. My current situation is that I'm mostly pain free but with occasional flares of pain (often after gym or other strenuous movements or long sitting). BM is completely pain-free and there's days where I have no pain at all - but - also days where I have pain all day long.

So I just had my appointment with another specialist after feeling I wasn't examined properly at the other hospital I've been to. At the hospital I've been several times I always just had contact with assistant doctors. I've never seen an actual experiences doc there. Usually the assistants had to consult the senior docs after examining me. They literally just told me what the senior doc told them (without them having examining my fissure first hands). So I thought it's best to change the doctor and see an actual experienced specialist directly.

So that other experienced doc checked my fissure and he actually told me that my fissure isn't active anymore and it's already healed. There's already skin grown over the fissure he said. He said the occasional pain I have is because my sphincter resting pressure is really high and this in combination with cramping when sitting for a long time or doing certain exercises will actually cause the occasional pain I feel. He said I have a true body builder sphincter muscle ha-ha I guess.


He told me to try to keep the sphincter pressure low (a.k.a. relax it) as much as possible. Continue using the Nifedipine cream.
I asked about the coconut oil. He said it can keep the skin smooth and may aid a bit with the healing.

Then I asked again what about that scar/tear I have, if it will ever heal completely. He said he didn't see a tear or scar. Then I said I can clearly feel it with the finger whenever I apply the coconut oil. He said what I feel is just irregular skin from the fissure healing but is no scar or tear.

About the full healing he told me it will eventually fully heal and I will be completely pain free and will be able to do any exercise again I used to go in gym. I just have to give it some more time.

He said under no circumstances he wants to do any surgery or cut anything on my sphincter. They know now for a fact that this kind of surgery comes with high chances of getting incontinent. Especially women. But also for men the risk is as high as 10%. That's why he strongly discourages LIS or any cuts around the sphincter.

So I kept on asking what options I have if the pain doesn't go away soon (because I’m dealing with it for 1.5 years now). So he said he would recommend doing a Botox injection as a next step. Short anesthesia and then he would inject Botox into the fissure area. This way the sphincter will relax for around 3 months which gives the surrounding area enough time to fully heal.

Also I asked about whether I shall douche out my bum regularly to keep it clean and empty. He said NOT to do that because every time I douche the bum I will damage the mucosa and the rectal skin which makes it more susceptible for tearing or damaging. He said not to wash it out anymore. He said when he has rectal surgery with a patient they leave the wound open and don't douche it out.

So he said to just continue what I’m doing now (apply Nifedipine and coconut oil regularly, try to relax the sphincter as much as possible and avoid exercises that put too much strain on the sphincter) and if I feel like nothing changes anymore until August to contact him again for an appointment to get a Botox injection.

So that’s what I’m going to do now….

I was actually really surprised (and relieved!) to hear that my fissure is already inactive and that the pains I have are not coming from the fissure itself. At least one thing less I have to deal with. Just hope the pain will finally fully go away within the next 4-6 weeks.

Hey, im a week post Botox, and so far im pleased with it - now getting zero pain and bleeding. Hang on in there, you can get through this :)

Hey Lsfb1989. Thanks for that info! I was wondering, do you feel anything from the botox? like having a numb feeling or is there nothing different than normally?

Its really numb, i hope this isnt tmi, but when I go to the toilet, I barely feel anything coming out. The same with wind, its a very odd sensation. I promise I am not incontinent, I know when i am going to fart, but I dont feel anything!

I have had a slightly different experience from Lsfb1989. It felt like my sphincter opened A LOT the first two to three weeks after my Botox injections. It's been six weeks today and what I feel now is similar to Lsfb1989, I.e. Not much.

I have no trouble controlling my stool either. I've had one close call but that's because I wanted to finish eating dinner when I felt a BM coming on. Waiting ten minutes after you feel that you need a BM is a little dangerous. I made it to the toilet. Just!

I had a setback close to two weeks ago when on holiday and then another one last Thursday. The fissure is still there but it doesn't hurt. It seems like you bounce back quicker after set backs when you've had Botox. I'm completely painfree now. It doesn't hurt during or after BMs and I can sit on pretty much any surface I want for as long as I want. Rock hard or too soft where there's no support for the bum isn't great but I can still sit on them without being particularly uncomfortable for say half an hour to an hour.

I recommend getting Botox if you've tried the creams and the fissure didn't heal.

Thanks for your valuable infos!
Thing is, my fissure doesn't hurt anymore. Doc said it's healed. I just get pains occasionally. Days at a time and I dont know why it comes. Just some days I wake up and I have pain all day. Other days I have exactly zero pain. It's like the fissure is trying to hide from me and just show up every now and then and then go back into hiding.
I can sit on more or less everything. Just some particular chairs or sofas are really putting a strain on my ass and I can literally feel the pain crawling up on me minute by minute sitting on it. Office chairs etc. is no problem anymore.

When I apply coconut oil I can still feel a tear/wound or so. Even though the doc said that's nothing. I dont know if he just says this to not make me want to "rush" into using the botox or whatever.

So anways, today after 7 months I tried to have anal sex again. It didn't hurt at all so that's good. But afterwards I was bleeding again! Damn! I'm really discouraged now about the healing. I just hope I don't get any paind and bleeding tomorrow.

Doc said to wait 4-6 more weeks and observe it and if I'm not happy with the healing process I can get some botox. I think I will do exactly this. Wait until August and then make an appointment for botox. I really hope this will make the fissure heal COMPLETELY after those 3 months. I'm really so done with this...

Are you sore today after trying anal sex again? It's good if you aren't sore. It might just have agitated things a bit and you'll hopefully recover from it quickly.

It seems like a good idea to wait 4-6 more weeks and see how things are before you go for Botox. There's always a chance you'll fully healed by then. It took me almost two weeks to really feel the effects of the Botox. I had no pain at all for four weeks before the surgery but wanted to have a skin tag removed. I did regret having the surgery the first few weeks when things were uncomfortable and I'm still at 75-25 happy I had it/regret it. I hope my private insurance (I'm in the UK but try to avoid the NHS when I can) pays for another round of Botox if the fissure hasn't healed when I have my followup visit with the CRS.

Can't really tell (yet) if I'm sore since sex was today. so far it just feels... fragile... but not particularly sore. I think I will know more tomorrow when I wake up.
Maybe I should have used more lube and relax more etc. Applying coconut oil here like a crazy person to prevent the worst.

yeah I will do like the doc told me. Wait those 4-6 weeks he said and then will call him in mid-August to get a botox appointment. In Switzerland insurance doesn't pay it so I gotta pay that shot myself. But as far as I know it's only around 100.-- so that's well invested money I'd say.

Just a little update. I've had a good night sleep and it's about 16 hours after my "incident" yesterday.
I'm mostly pain free this morning but I can feel a tiny bit of soreness. Really just a tiny bit. What's more is that I feel cramped again at some part of the butt (inside) which seems to cause the slight pain now.
I guess I was lucky but it just showed me that it's still NOT healed (not like the doc said). I hope by tomorrow that little pain is gone, too.
Waiting for August to get my botox.

Thanks for the update! It sounds like it's not agitated the area too much. The cramps will hopefully subside later. Did they start after a BM?
I hope you feel a lot better in a day or two.