Hi all,
I've been reading posts here since last year and finally decided to join.
I've had rectal bleeding on and off for many years. Usually doctors attributed it to hemorrhoids, prescription hyrdocortisone suppositories seemed to help, and the pain/ bleeding went away completely for weeks at a time. Still for four years every day I've had to take Metamucil twice a day and 200mg docusate every night to try to manage the situation. If I would fall off that regimen too much, I'd bleed. I think there might have been a fissure there all along.
Last September (2012) I had bleeding from a hard stool, and nothing I tried seemed to work anymore, including changing my diet and twice daily sitz baths, and I bled a lot with going #2 every day for a couple weeks, but usually without much pain.
In November I saw a surgeon who saw an anal fissure and prescribed Nifedipine. It reduced the bleeding to just a little bit once every 5-8 days, but it never really healed. I got a botox shot March 14 and after two weeks of waiting for it to fully take effect, I had two weeks at the end of March and early April with no bleeding and no pain, and I was even off of Nifedipine. This despite my surgeon noticing that the fissure seemed to be getting fibrotic.
As it turned out I eventually had a hard stool in mid-April, or maybe strained too much, or ate too many pretzels without enough water, or all of the above, and I'm back to bleeding every 5-8 days, and I'm rarely completely pain free now. The pain rarely gets to anything more than what I'd consider a 3 or 3.5 on a 10 point scale, and is usually around 1 or 2, but I'm quite tired of living like this, as I'm sure you can imagine. I had to cancel a meditation retreat, and my wife is feeling driven up a wall by all the confusion about what I can and can't eat.
I'm back to using Nifedipine several times a day, and have been having small amounts of blood once or twice a week, with pain between 1 and 3 on a 10 point scale.
The symptoms seem relatively mild to moderate, so it's still seeming hard to risk a bad LIS, yet at the other time I have little hope of ever fully healing from this if I don't have surgery. Perhaps another botox shot might work, but the last one seemed to have caused a hemorrhoid and some other strange phenomena down there (the blood vessels meant to cushion the outgoing poop seem more swollen in general, though hard to say since I've obviously been noticing all kinds of things down there I'd never thought about much before).
Anyway, it'll be interesting to hear what the CRS has to say on 5/29.
Best to everyone here.

hoping to heal sorry to hear that you are having problems, that is how we have found this forum, looking for advise and to read what others have gone through and how they have cope with this problem.
Many have taken the road to recovery with surgery because nothing else works.
I also bleed whenever my fissure was active.
I have not opted for surgery yet, I have manage with proper care, trial and error and a routine that work for me, to make life more comfortable.
Surgery works for some but is always a small group of people that will not.
You still will have to keep your diet, watch what you eat for the rest of your life after healing to avoid retears.
Is many threads of people that have opted for surgery and their experiences that should help you with any final decisions you may take.
I still get set backs, but because I know and understand my body I take care of the problems faster before it gets out of hand.
I have app in june 10 for a follow up, so far I am managing fine on my own.
I hope you make the right choice and I wish you the best.

thanks very much for your reply, Marg6043. I've definitely felt like I've been managing ok at times, and then of course the setbacks happen.
anyway, best wishes to you, too, with everything leading up to your next appointment!

Well just got back from the CRS with good news. He could see that scar tissue formed over the fissure and that any bleeding I may have had recently may have been due to some small hemorrhoids or the scar sort of consolidating.
It's very encouraging, and I think what did the trick over the last month was using Nifedipine several times a day while the Botox shot I had 2.5 months ago was still in effect. I'm going to keep my current routine at least until my follow-up on July 1, and probably a lot of it for the rest of my life. Things still don't feel as good as they did before this big flare up started 9 months ago, but I'm thinking that may be due to eating chicken yesterday and wiping more than usual today, probably as a result.
Current routine=Nifedipine 4x/daily, 95% veg diet, plenty of beverages all day, taking all showers sitting down in the tub with the water filling up, avoiding cheese, white rice and white flour. I've also been drinking Metamucil 2x daily and 200 mg Docusate Sodium each night for the past few years.

hoping to heal I am so happy for you, is nice to have your CRS to reassure that things look good.
I know how it feels when is never the same in your bum after you experience a fissure, changes are for life because is always a chance that you will get a flare up anytime.
But life can get better and more comfortable without surgery.
And is always surgery is things do not get any better.

HopingToHeal,
That's great news! :D
Your body is healing!
"Things still don't feel as good as they did before this big flare up started 9 months ago"...........
Unfortunately, they won't (at this stage) because as we all know, it takes a LONG time to feel completely normal again after having these issues and for that scar tissue to settle down too and for you to mentally adjust, but with a bit more time & patience, you'll get there. Just keep up all the good work & keep updating!!
Wiping too much really doesn't help - I know it aggravates my hems too

thanks for the kind comments to marg6043 and Ever the Opimist. being here at this board has been helpful, too. one of the links in the resource section encouraged me about using nifedipine in tandem with the Botox shot, and reading through a lot of folks' stories was supportive about sticking to a high beverage intake, vegetarian oriented diet. as well as the fact that everyone's symptoms can have a very unique quality to them, so I needed to stick to some of my own conclusions about what works for me.
also appreciate the messages that this situation requires some long term changes (like minimal wiping, for example!)
anyway, will check back in as things progress. currently at 18 days of little pain and no blood, the longest i've gone without blood in nine months. i know a retear could happen but at least i have some ideas what to do if it happens.

hoping to heal I am glad you are doing a bit better, but when fissures are chronic you can not let your guard down, you have to take what you have learned about fissures along with diet and life changes and find a routine that you can work with for life.
Only like that you can progress in your healing and keep the fissure from set backs, yes they happen but you can still heal.
Blood is always a sign that the fissures is been aggravated and irritated.
Always, always, lubricate before you BM, something that help me greatly with my fissure and the discomfort was using Carlson suppositories first thing in morning and before bed.
Then vaseline with BMs.
Sitz baths and using wet wipes no toilet paper.
excessive diarrhea and constipation, a balance is the best.
I hope you road to recovery be a fast one this time, that you know what works for you.

Hi Marg--thanks for the encouragement!
I'm up to 36 days of no bleeding, and at this point, there really is very little  to no pain.  It's been about 3 months and two weeks since my Botox shot so I realize that may still be helping me out some.  I remain cautious about what I eat, too, but I really appreciate the encouragement not to push my luck!

That's great news. I had Botox last week and hope to be just like you very soon!