Hello,
I am 27, have got surgery 4 months ago.
I have got two unhealed places after external hemmie excision. It seems they have similar symptoms like here described chronic fissures. Most of the day I can live more or less ok. Feeling discomfort, but bearable. Though,, moving of ass sitting on the chair is still painful.
During BM I feel how poo is passing my wounds/ulcers.
After 45-1h of BM, it starts to burn, inch, spasm, and lasts for 4-5 hours. Close to chronic fissure behavior.
So I wounder what is difference and approach to heal chronic fissure and those unhealed wounds I have got.
Is 4 months mark meaning something is doing wrong here? Doctors say keep it time. But if it is chronic fissure it will not heal on it own right?
I am using nifedipine for 5 weeks now. Just can't believe this outpatient surgery spoiled my life so much.
Please help! What do you say?

Igrik,
Can you go back for a second opinion on this?
The pain you describe is SO symptomatic of a fissure and you wouldn't be the first person to develop fissures after having hem excisions - It happens a lot.
Chronic fissures CAN heal naturally on their own for some of us - Trust me, I am living proof but it took a LONG time (1 year & 5 months to be precise) and I needed to use Diltiziam cream for 7 weeks to kick that healing process in.
5 weeks is still relatively short time on the cream (some people use it for months) but I would probably expect to feel a little improvement by this stage but it could take longer. If you do have fissures, it could be that this process isn't helping.
On the other hand, I don't know enough about the recovery from hem surgery to know exactly long how that process might take and hoping someone else will pop by to answer that question for you....
Good luck and don't be afraid to go back if you are not happy and need more detailed answers. Alternatively, perhaps seek an alternative opinion from another CRS??

Hi igrik1986
My story is exactly like yours. I don't know for sure if this fissure is the same wound that I got after one of my hemorrhoids (the bigger one) was removed, all I know is that the fissure pain is in the same spot where I was feeling the pain of a trombosed hemmie when I was pregnant. So one of two things happened.
1. The wound has not healed
2. Or we got a fissure because that area was weak.
The best thing you can do is go to your doctor and ask, but if you are using Nifedipine already, your doctor might be treating it like a fissure already, in the end is a cut in the rectal area so it is the same.
5 weeks is still a very short period in my experience. I have been using it like for 3 months now, and right now I have pain free BMs and no bleeding most of the time. I believe is healing.
Please be patient because this thing takes time to heal. I honestly don't know if my will heal, I'm hopeful because now I have more good days and less bad days, but it takes time. Watch your diet, you need to maintain your stools very soft, many people here use Miralax, I manage with diet, because if I take any medication I start to have cramps and to many BMs, but whatever method you choose, try to make sure your stools are soft. And relaxxxx, if you relax you are already half way.

Hello,
Thanks you for responses.
Regarding second opinions. I have been with three more doctors. One actually did examination on spasmed muscle and caused the blood and worsen this unhealed place/wound/fissure.
Second one, was very unpleasant, asking why didn't I perform surgery at his office. And didn't say much, told I need rectoscopy after two weeks, seems that he just wanted to get money from me. I was not ready to allow something to be inserted in my rectum again.
Third one, also asked why didn't I perform surgery at this office also. Prescribed some antibiotics and told to do dilation. Was very unpleasant too.
My original doctor says give it time.
Regarding surgery I had hemmie surgery to cut externals only, he did quite massive cut, and I was recovering slowly, and painfully..
Also I had suspicion of stenosis myself as my BM became narrow, though doctor says it is because of spasm and myself trying to protect wound during BM. Yesterday I had a bit bigger BM and initial poop had 2.5 cm (one inch) in diameter. Next ones were more painful and squeezed in less diameter.
So probably doctor is true and I have no stenosis. During BM I fell one place tearing everyday.

Regarding nefedipine, my doctor didn't know about this med, and I insisted him to prescribe me the one. Though I am not sure if it works, as I don't feel any direct effect applying it. I am just continue to apply morning, evening every day :)
galamat
Have you tried to inspect yourself in mirror? That is quite easily to be done and you can see where is what.
Do you have post BM inching?
When did you get your surgery?
Ever the Optimist
I am about to visit last CRS in my area, which may be helpful, however I will restrict finger examination. Only outside. If I see my wounds outside I think normal doctor may see also.
I would be able to cope with this fissure, my previous in 2010 became less symptomatic after 2 months, and I forgot about it. It eventually was healed when I came for hemm surgery this year, and doctor told he does not see any fissure.
So I will get less symptoms, I think I will forget about this wound/fissure also, and it will be better with time.

Hi igrik1986
When did you get your surgery? I didn't have traditional surgery, my hemorrhoids were removed by applying a Chinese herbs in a hemorrhoid clinic in Vancouver, although they don't call it surgery, in my experience it feels like one, because they leave the wound open.
I had then removed last August, almost a year ago. At the beginning like you I was in a lot of pain specially after the BMs I was bleeding in every BM. I remember myself rushing to get into the siztbath after because I couldn't stand the pain. After like one or two months the pain was better but I started to have an intense itching, and that itching lasted several months. I went to Italy last December, and I remember having intense itching while I was walking in Venice, it was crazy, I was always carrying wipes and ointment, because that helped it a bit.
After December the intense itching started to decreased, and it was a lot better, but then I became constipated and I started to have pain and horrible spasms, and again strings of blood in stools and toilet paper, I went back to the Chinese doctors and they told me I had a fissure, they told me to drink a glass of hot water with one tablespoon of lemon and one tablespoon of honey first thing in the morning, and before going to bed. And advice me that I should avoid the foods that make me constipated, they said everybody is different, so I had to discover the food that affect me. Now I don't eat pizza, rice and try not to eat anything with white flour, because that doesn't help me. Amount the food that you consume, try to find a food that make your stools hard and avoid them.
Do you have post BM inching?
Yes I had a period of crazy itching, but thank god now I don't have itching. I believe this is because the wounds are open and the area is not clean.
I couldn't agree more with your original doctor give it time, you will see it will get better, and about stenosis I thought of that too, but then also your doctor has a good point, that it could be the spasms, in my case I believe is the spasm and fear. For this what I do is relax when having a bowel movement and breathe with my stomach, that helps a bit.
Patience, hope, diet and exercise are the things that has helped me, you will see it will get better, don't strain while having a BM and drink water. I really hope you get some relief soon and I'm here if you have any other question. :)

Thank you for your support.
Definitely it is sort of better after 4 months. First two were hell. Originally I was told will be normal after 1 week. If he would tell truth, I would not have this op, as my hemm was not so bad actually. Just wanted to get rid of it before my kid birth, to take care of him.
But even after 4 months I am not nearly myself, and completely different person and habits.
I see I can do nothing, just to cope with what I have at the moment. Botox or LIS might be an options, but not sure If I want more surgery at the moment on my rear :).
I should be better, all your posts Ever the Optimist and galamat proves this. Just matter of patience.
My wife always says you will forget pain after all this be over, but you will not forget moments of life you did over the pain. So try to get out, see places enjoy something. That is true. We went to see some fancy castle last month, I was so depressed and in pain. Now after month, I don't remember pain, but I do remember beautiful castle we visited.
Next week my kid will appear and I will participate with my wife in process. Ehh, I would wish I would in best shape for this, but I can do nothing, will try to enjoy and do my best with pain in ass.
Somewhere I was reading that fissure and their occurrence is just a matter of bloodflow down there. I had fissure in 2010, but it was gone quite quickly so I didn't put attention. My external hemmie was not so nice and bothered me 2-3 times per year, due to alcohol and bad eating habits, sitting job. With the changes I had done last 4 months, it would never appear again, I bet. So apparently I had bad flow of blood there, even when I was in shape. So this is pathology, I was not recovering quickly from my external hemmie I will not recover quickly from my injuries.
I have to increase bloodflow there. But how? Before I could do some training, now it is nearly impossible, cuz ass in constant pain/discomfort. And additional walking moving around make it worse. I wish only to lay in my bad all the day, and never wake up.
Sorry, my post is quite messy, as my mind is also.

I'm responding to your dilemma/bad experience with doctors and rectal exams. I've had four exams thus far. Not counting the GP who I nearly slugged because her clumsy exam was so painful!! I called the best specialist in the area to see if I could get advice without an exam and it was a 'no-go'. The naturopath I went to initially said he'd do anything to help (I had to pay out of pocket) but got testy when I wanted prescriptions refilled after I declined a third check-up/exam when I was having a really good day and didn't want to ruin it. I got a second rectal exam with the PA through my managed health care plan and it was worthless (you still have an AF--which I knew from the pain, idiot, and he couldn't tell me if it was improving or not). He did put in a referral to the CRS surgeon, which I cancelled because I am improving AND changing insurance companies. So, I'm becoming more and more cynical about the help available--I wasn't born cynical. In the meantime, I've been tracking my very, very slow progress and listening only to my body. And ideas from you fellow sufferers. I'm not anti-surgery or anti-anything. Just want to heal and feel better. The most helpful things thus far for me have been: sitz baths, ointments, ideas from this forum!!

I forgot to add, as I have gotten a little better, I really enjoy lying on a heating pad before I go to sleep. That helps blood flow, too!

Today my son was born. The best day of my life, though, I would like to meet him in another shape. Just had a BM, and it was terrible.
First of all I had urge to go, and first part caused me as usually spasm and pain, the rest was squeezing very narrow, (1.5cm in diameter). And as BM was huge and wish to empty also, I was straining so many feces. A lot in mass, but narrow, therefore so much effort to get it out. Due to straining my external hemmie is again very swollen, I hope it will not get thrombosed. Pity to say, I was going to remove it only, but got fissure, 4 months of misery + my hemmie back. Was this op reasonable? I say no. Doctor could also inform me about misery he is about to put me in.
After 1h spasm/burning started. And I am suffering so much. I want my life pain free life back! I think it will last at least 4-5 hours from now..
On Tuesday I will have one more appointment with CSR, and ask what he can help with, however will restrict any digital exam.
By this moment I am ready for additional surgery: Botox or LIS. Whatever to get healed.
My wife sitting near to me, and was hearing how I had BM. She is saying I did so much "ugghh", so she though I have constipation, but now, I have toothpaste to get sqeeezed via 1.5 cm diameter. This is something killing me also.
Could you say if it going to be loosen with Botox or LIS? I mean will I get bigger diameter, since spasm will be removed?
I am tired of such kind of BMs, before operation it was 4-5 sec job. Now it is 5 mins!

Hello everyone,
Yesterday visited another CRS, seems like old school guy.
He did examination with finger and spasmed anus, and caused some blood again.
I looked at the mirror and he created small new fissure (acute) in the health anus side. IT seems that due to long term 4 months spasms, all skin is very sensitive and easy to break around, not only in wound area.
So hopefully it will heal by its own, otherwise I will have plus one problem as fissure.
Otherwise he told, they never perform LIS as it is too risky. Botox he never heard, nefedipine and nitro also.
Just prescribed some anti-inflammatory drugs against pain like Diclofenac.
Seems, I don't have competent CRS in my country, whom at least doing Botox, and understands reason-cause of the fissures. Where the main reason is lack of blood flow due to spasms.
Well, another theory, why should be heal spasm by Botox or nitro? Why we should not stop pain, which causes the spasm? Seems to be logical also.