I found this site while doing research for my anal fissure surgery and it is so helpful. I am 28 years old and have been dealing with a very painful AF for over a year now. Before that I had slight discomfort with BM's and had some experience with hemorrhoids for about 5 years (just light cases, with anusol being prescribed). The change happened last February after I had a trip where I had no access to a bathroom for a few hours and had to "hold it" and once I did I had a very painful movement (and was in pain all day afterwards) and since then have been dealing with an AF. It has been awful pain for pretty much the last year.
I have gone through all the conservative treatments- sticking to a very heavy fiber diet, lots of water, exercise, sitz baths, etc. I also do a psyllium supplement. When I saw my specialist about a year ago, she put me on 0.2% diltiazem ointment 2X per day to relax the muscle. I felt better after 2 weeks and after 8 weeks my fissure healed, so it was such a relief! Unfortunately about a month later my fissure came back (or I got a new one--not clear) and since then I have been on diltiazem about 3 different times (6+ weeks per time) and each time it feels better, looks better at the Dr's, and then about a month after it has "healed" a fissure comes back. On my visit this week, the dr talked me into surgery- he thinks since I have tried the conservative treatment for over a year and am still in bad pain, with the fissure returning after the diltiazem treatment, that it means I should go for surgery.
Whew, that was a mouthful! My real point is I have a number of questions for those who have been through this:
1) My main fear is slight incontinence. My dr. said incontinence is rare with this surgery because they don't do anything with the external muscle, and I understand that and am not worried about losing total control. What I am worried about is having gas incontinence or leakage. I'm young and would hate to have to deal with that for the rest of my life. My dr. said none of his patients have had this, which makes me feel better (and I am young, fit and healthy, so that is good for recovery), but I'm still scared of gas leakage and slight incontinence. To others who have had the surgery, what has been your experience? Do you have small accidents ever, have slight leakage, times where you can't hold in your gas? Notice a difference in your control of the area? I'm also worried about not being able to differentiate between gas and stool-- are these realistic concerns?
2)I am trying to get pregnant and actually I suffered a miscarriage which I think lead to my latest round with the AF (bad diet for a few days after the miscarriage surgery, stress of it). Anyone know anything about this surgery and pregnancy? I am wondering how having the surgery could affect me if I get pregnant a month or two after surgery? I think I should have surgery before I get pregnant as pregnancy affects the bowels in its own way- my dr. feels I should take care of this now as well. I know a number of women experience tears during childbirth and I have to wonder about if I do have problems if the surgery now will weaken my muscle or cause problems while pregnant. The nurse said that even if I get pregnant shortly after the surgery, i would have 9 months until delivery and should be healed fine by then. Just worried about how this could affect a pregnancy/ my ability to get pregnant. I know there might not be anyone on the board who delt with an AF and pregnancy, but I figured it was worth asking!
3)I'm really curious about the recoup time, but I know it varies per person. How long until I can exercise again? Also, for women who have had the surgery, how long before you were able to have intercourse after the surgery--I'm just wondering how long it will take until I am able to start trying for a baby again. I'm worried I will be inactive for a while.
Thank you for all your wonderful posts, it really is good to hear other people's experiences. Right now my surgery, if I go through with it, is scheduled for April 4. I'm basically trying to decide if this surgery is worth the risks, but thinking about having pain free BM's makes me lean towards the surgery. It is just a scary thought to have someone cut that muscle! I thank you in advance for your advice on my issues!

Hi Suzy, welcome to the board!
Glad you found the site and I hope you can get some good information here!

I felt better after 2 weeks and after 8 weeks my fissure healed, so it was such a relief! Unfortunately about a month later my fissure came back (or I got a new one--not clear) and since then I have been on diltiazem about 3 different times (6+ weeks per time) and each time it feels better, looks better at the Dr's, and then about a month after it has "healed" a fissure comes back.

Sounds very similar to my case, except my fissure never completely healed, though it did get very manageable. The difference was I was using Nefedipine rather than diltiazem. I finally decided after seven months that enough was enough! After I had my surgery, I never looked back! My recovery was tough, but my CRS warned me it would be.
But you're almost twenty years younger than me, chances are you will bounce right back. My CRS told me it would take 2-3 weeks recovery; I was back at work in 1.5 weeks.
Yes, I did have a single incident of not recognizing stool from gas, but it was a very loose stool just days after my surgery -- I was still in complete recovery at that time! I haven't had anything remotely like that happen since. But as I eat a lot of fiber, and I'm less than 3 months out from my surgery last December, I do have the occasional unexpected passing of wind. More like a little poot than a full fledged fart; this is not often.
Does that make me want to go back to the days before my surgery? No way. I am so *thankful* for it and also thankful to those on this board, who not only showed me surgery could be my cure, but supported me through the process....which wasn't bad at all. The recovery was far worse (but not horrible) than the actual surgery. Some Dr.s even do it as out-patient day-surgery -- but watch out for that! I was kept overnight and closely watched. I feel it is best to be kept overnight and monitored. I know of one case on the board where a member was, apparently, rushed through the procedure and sent home the same day. She is still having trouble. The rest of us veteran surgery members are doing quite well, as far as I know...
As for your feminine-type questions, I'll leave them for the feminine types on the forum...
Good luck,
Kim

Hey Susyq,
So glad you could join us here! I am sorry to hear you have been having such a long battle with your fissure though!
I am doing the same routine that you are since I am not a good surgical candidate but I can understand why people turn to the surgery. I think after having gone through all the conservative treatments and you are still having trouble it makes sense to look into the surgery. I know many of the posters here have successfully had the surgery and they have healed very well and are happy with the results and would do it again.
I may not be the best person to answer your questions since I have not had the surgery. I may at some point if the fissure doesn't heal on its own but the doctor wants to hold out unless there isn't any improvement since I have preexisting nerve damage that increases the chance of incontinence later in life. Women who have had previous obstetrical trauma (like me)are at greater risk of this than the normal population.
I think it makes sense to get your bottom in good shape before pregnancy. There are so many physiological changes in the body and the bowels and treatment during pregnancy is very limited. I think doing what you are doing with the fiber, water, supplements and exercise are important pre-conception and during pregnancy to help reduce trauma to the anal canal.
I got really horrid hemorrhoids during pregnancy-I was actually in bed the last month because they were so thrombosed they wouldn't go back in and I was in some major pain. They were actually going to induce me I was so miserable. Constipation and the slowing down of the bowels can be problematic so do your best not to get constipated and don't strain!
They have prenatal vitamins with stool softeners in them now since the iron and calcium can be constipating. You might want to get a presciption for those now since you want to start trying soon.
I have heard that people can have flatulence incontinence but most of the time it is just temporary. I know that "most of the time" isn't as reassuring as most of us want to hear though.
I am not thrilled with cutting things down there but I think after you've tried everything else and it is seriously impacting your life it makes sense to look into surgery. I think they try to make the incision just as long as the fissure is itself and that reduces the amount of incontinence and gas incontinence too.
The other thing that is mentioned in the literature is botox. I don't have any personal experience with it and it is not widely practiced but you may ask your doctor about it and see what he/she has to say about it.
As far as IC after the surgery I will have to defer to the other posters on that one since I don't really know the answer!
I know others who have had the surgery will be along shortly. I just wanted to welcome you and give you a run down of what I know. Definitely get your bottom healthy and keep it healthy during pregnancy!
BTW, I didn't have any problems with my first baby. I think there is a higher probability of pelvic floor dysfunctions the more babies you have but generally one normal size baby, with a normal uncomplicated, unassisted delivery (no forceps, normal presentation) shouldn't aggrevate or cause further rectal trauma but you probably don't want to go into a pregnancy with this going on.
This time in your life is so special-good luck with everything and let us know how we can help!
Lecia

Kim and Lecia, thank you so much for your words of support and advice! I really appreciate it!
Lecia, thank you for the pregnancy tips. I have a fiber-tastic diet so I will keep that up for sure, mainly just so I won't get fissures in the future. My fiber filled life is here to stay, which overall is a healthy way to live so I can't complain about that change, but it is good to remember that during pregnancy. I'm on a prenatal now and have heard about constipation from the iron.
Funny enough, throughout this whole process I have never been constipated===what made me get my fissure was straining and rushing my whole life in the bathroom. Wish I had known not to do that in my late teen years/early twenties. :roll:
Kim, my surgeon says the procedure will be outpatient, so I won't be spending the night. I wouldn't mind if I did, but I don't think that is what the hospital does for this surgery and my insurance won't cover it-bummer.
I'm excited to hear from others who have gone through this as well , but wanted to jump online quickly to thank you two!!