Hi everyone, I am new to this forum. I'm actually new to online support in general, and the amount of information is a bit overwhelming. I am a 43 year old female. i have had issues with hemorrhoids since my mid 20s but always minor, and resolved with at-home remedies. In December 2021 i had the classic hemorrhoid symptoms, so I self-treated as I always do, but the pain and bleeding did not subside in a few days as per usual. Fast forward a few months, when the pain became excruciating- I saw my PCP then colorectal surgery (appointments that took months to make- and i am in the USA, and on the nursing staff of the hospital). Via visual and finger exam I was diagnosed with an anal fissure (anterior). I have many skin tags, one I know is old. I already had suspicions about the diagnosis (my best friend also has anal fissure/fistula) so had already been doing the home remedies that did not help much. I was prescribed diltiazem/lidocaine ointment and instructed to use it for 12 weeks, and follow up if it doesn't heal.
It has been 4 weeks. Overall, I feel better than i did a couple of months ago (meaning that i can actually sleep through the night, but my quality of life is nowhere near back to normal). My pain is not excruciating anymore, but it bothers me enough that I don't socially engage (particularly if I have to sit for long periods of time). Every day is hit or miss, and this is not acceptable to me. I have NO IDEA what caused the anal fissure, or the previous hemorrhoids. My BMs are super normal and consistent. I have never been pregnant. I am a cardiac nurse and am very familiar with the types of medications prescribed for anal fissure and the side effects. I am not sure why I was prescribed diltiazem over nifedipine or nitro ( I suspect because of the lower side effect profile). I have hypertension and can tolerate nifedipine and nitro from a blood pressure perspective, but I suspect that my provider chose diltiazem as it doesn't cause headaches as much.
My questions for the group- has anyone had experience with diltiazem and should I be frustrated with the slow/stagnant healing that I am experiencing? I really don't feel better or worse since starting it. As I mentioned, my provider said to give it 12 weeks total, but this is another 8 weeks of my life.
My provider mentioned botox vs. LIS if needed, but seemed very "gloom and doom" about LIS. I also inquired about skin tag removal as a separate issue ( I cannot seem to ever get myself clean after a BM). She suggested that I install a bidet- but I would rather get rid of these skin tags surgically and be done with it. Is skin tag removal really that horrible?

Thanks for listening, everyone. Any advice would be appreciated.

Cassie

Hi Cassie, I’m so sorry for your struggles! We have a lot in common except I have a 2 small children.
I will tell you that a bidet is very helpful! Please get one- get one that puts out warm water and cold. I have tags- same deal as you, I had them in my 20s and never have been constipated. My fissure came on about 5 wks after I had my daughter but it was in 2020 (Covid time) and I thought it was hemorrhoids and tried treating them myself for 5 months! When I went to the doctor I was diagnosed with a posterior fissure and given dilitziam with expectation that I’d return if it didn’t work. I did have find some help with dilitziam but not much. Perhaps I needed to use it longer than 4 wks. I may try it again though as I had a set back this week. Ugh.
I am seriously considering LIS at this point bc I want my life back, it’s been 2 years, though I’m scared.
Perhaps you just need more time to heal before things become normal again? Sometimes the muscles in the interior sphincter become too tight and it’s hard to relax it. Have you tried deep breathing and pelvic floor stretches?

Best, Michelle

I'm in the same boat. I don't socially engage for past 3 months. I've been on nefedepine for over 2 weeks with no improvement and I'm already ready to throw in the towel and get surgery.