Does anyone have any experience dealing with a fissure that heals and tears every few weeks? Had mine for over a year.

I've seen 3 CRS's.

- proctology to confirm fissure
- anorectal manometry and anal ultrasound found normal resting pressures and squeeze.
- used GTN and diltiazem but neither worked.

CRS's don't know what to do with me. Can't do LIS because I have normal and not high pressures. Also CRS said I am having acute fissures not chronic fissure which I find strange because I am in agony for hours after BMs. Don't recommend advancement flap because there isn't enough skin to pull over.

Anyone been in a similar position and know what to Suggest? The pain and anxiety is ruining my life and I'm only a 27 year old guy

Hi Nick,
Sorry to hear you are having a tough time of it.
I take it you're using a stool softener? This is quite key to avoiding retears. Is botox an option for you? This is usually the next step if the creams don't work.
Best, LemonMan

Hi lemonman, thanks for your reply.
I'm scheduled for Botox in a month but my CRS doesn't think it will work. Botox essentially mimics LIS in that it reduces your pressure to allow fissure to heal. But my pressure is already in the lower end of normal range. I've been using stool softeners for the last 9 months. But I still tear every few weeks. My bowel movements aren't even particularly hard when I tear, just not completely soft.

Hi Nick,
If you are getting pain you may be having spasms which will cause your sphincter to tighten and reduce blood flow....reducing the healing ability. Even if your resting and holding pressure isnt high, spasming will stop blood flow.
Botox stops the spincters ability to spasm thus stopping the pain/spasm cycle, so it may help you. In a way you are lucky to get it as lots of docs wont even let you have botox if your pressure is low.
Are your BMs acidic as this can thin the skin causing it to tear much easier than normal, just a thought if your BMs arent hard.
Im sure the botox will at the very least stop your pain for a while.

Hi mypoorbutt,

Thank you very much for your comments! That was really informative. I didn't think of the Botox that way. Hopefully it won't also give me temporary incontinence due to non high pressures. Also I think I do actually have acidic BMs. Do you have any advice to alter that? I eat very well (no processed foods, meat or dairy and I rarely drink alcohol)

Hi Nick,
I dont think your existing pressure makes that much difference to the effect of the botox as like with the lines in your forehead it doesnt matter if you have lots or just a few, after botox you cant move those muscles.
I had no incontinence after botox...although i did find it easier to pass wind (i have high resting pressure) i just felt my whole sphincter relax, it could not spasm, again like your forehead cant frown. My pain went after a few weeks (although i didnt heal)
I can have very acidic BMs mainly when my crohns is flaring up, a low residue diet can help...but if the acidity is coming from your gallbladder then im not sure what diet would help...alcohol def makes things acidic. If you do have acidic BMs then you could look at an alkalising diet...they are quite popular at the moment as they are meant to help prevent cancer.
This may sound gross and i apologise....but you can always buy some litmus paper off amazon very cheaply to test the actual acidity. When my crohns is bad it can be as high as 11/12.

Wow, so much great advice. I am learning more from you than my CRS's. I will buy some litmus paper now. Thanks for that.
Out of curiosity, what did you do when the Botox didn't work? I'm guessing you went down the LIS route since you have a high pressure fissure? I already have a little urgency in the mornings when I wake up so im not sure what that will mean for my continence (or lack of). But from what I've read, if you do experience incontinence, it will be temporary and you regain continence after the Botox wears off.
So sorry to hear you have crohns as well. That's a tough card you have been dealt. My CRS is checking for underlying causes when he does my Botox injection and I'm hoping I don't have anything like that. Having a fissure is bad enough with having to manage something else. I feel for you!

Your welcome,
Most of the help i got was from fellow sufferers but i now have a great CRS hes my 4th lol who specialises in IBDs and he has been really informative.
Yes i had LIS and it was quite rough in the begining as i had a flare up of my IBS...my colon hates me lol...but its slowly getting better.
My resting pressure was very high so i have had no issues with incontinence. My CRS said that the most from LIS he has seen is slight soiling of underwear not literal incontinence and that the longest it has lasted was around 3/6 months. From botox he said hes never seen actual incontinence only gas incontinence, and i must say i found it so much easier to pass wind after botox than after my LIS. If you have a low pressure i doubt a surgeon would be willing to risk LIS with you until they were certain that its your only option.
You can have peri anal crohns where the only symptoms are fissures and fistulas but from what i remember....i dont have it so didnt take much notice.....the fissures are usually deep and occur all around the anus as opposed to the 12 and 6 position. Usually a good crs can tell a crohns fissure but the test is simple they just send a miniscule piece of your fissure to the lab.
Yes i got super lucky getting IBS as a young teenager then crohns in my early 20's....but this fissure has been the worst thing ever lol.

You did get very unlucky, I'm so sorry you had to go through all that. I have IBS too but nothing like what you have.
My poor butt, I was hoping you could help with the most important question I have. I spent hours looking through the forums yesterday and couldn't find it in the LIS thread or elsewhere.
My CRS in London who is supposed to be one of the best which is why I asked for a referral to him, is willing to do the LIS surgery on me. I was scheduled to have it done about 2 months ago and was in the operating room, post anaesthetist talk and in my gown when my CRS walked in and said I needed to sign a consent form acknowledging that he had never done the LIS surgery on someone with normal pressures and who is suffering from recurrent fissures rather than one, non-stop chronic fissure. He said he didn't know what would happen if he did the surgery on me. So I declined the surgery at the last minute and walked out.
Has anyone else in my position done this surgery as far as you know? Normal pressures and recurrent acute fissures but no ulcer or exposed sphincter fibres. I do have a skin tag though. I'm in bloody agony with this condition (as in 27 yo guy crying and squirming on the floor pain and I've got a decent tolerance for pain in other circumstances) so I assumed it was chronic due to pain and over a year of suffering every 2 weeks but apparently it's not chronic. I want the surgery but as far as I'm aware after speaking to 3 CRS's and my current CRS speaking to 3 of his colleagues, no one else has presented like me before. Ever heard of this? Thank you again for all your help

Gosh, i dont think i have heard of anyone who has had LIS when their sphincter tone is normal as to be honest if a fissure doesnt heal its usually because of tight sphincter tone. But like you say yours isnt one fissure that will not heal but new ones that keep happenig.
In a way i dont blame your surgeon for doing that as it is a very unusual case. Heres the thing and im guessing but if your in serious pain then your obviously spasming so theoretically that could be causing the fissures and obviously the pain. Both LIS and botox are meant to stop the spasming, maybe this is why your doc was happy to try the LIS, but needed the security that you knew this is rarely if ever carried out on people with a normal resting tone.
All i can say is if you are in the pain i was in when the spasms are at their worst...like you literally rollong around on the floor screaming...then i would try anything to stop the pain, but you need to know the risks and i guess at least with botox nothing is permanent.
Are they planning on testing you for peri anal crohns...do you know the position of your fissures?
I guess right now your docs are being very honest and thats a good thing. I hope you find positive answers