Hello all!
I am so glad I found this forum, thank you to everyone who posts and shares, it is really hard to find someone who understands our pain and sufferings!
I am 35 years old female with 18 years of history of bum problems. It started back in college, pain and blood would come and go, the doctor said hems. OK. I dealt with it. First child comes, it gets worse, but I can still manage, its not ALL the time that I am in pain, it subsides sometimes. I am terrified of second pregnancy, but the second child comes 5 years ago, I still manage with stool softeners, etc.
About one year ago it becomes unbearable. And I mean UNBEARABLE. While my pain used to come with BMs and subside during the day, now it never ever goes away. I see GP, she sends me to gastro, who diagnoses fissure + skin tags (which I think I've had misdiagnosed as hems before, or may be in addition to hems that I too have).
So I am given nifedipine, stool softeners, fiber, etc.. you know the drill. One month I feel ok, one semi-soft BM and all hell breaks loose again, I am nursing my bottom back to health for a month. Went to see CRS, and the best one at that! Top hospital in Boston, one of the best in the country, the world, the universe!
He looks and says " i will not operate on you, it doesn't look THAT bad"!
Oh really? Want to know how it feels? I won't describe it here, people here know how it feels.
For the past 3 months I have had the itching that drives me up the wall, constant, burning, worse after BM! This itching turns into burning and pain, pain, pain. Did I say CONSTANT? For 3 months now.
I have gone to CRS again, he looked and said "fiber" and that he won't operate for the fear of incontinence. I paid $400 for a visit to the surgeon who tells me about fiber, as if I am not already only having foods that have fiber. And I take stool softeners religiously. Only one thing I still have in reserve: I have not tried Miralax.
I am regular, every day like a clockwork, but if ONCE I have stool which is not toothpaste consistency, I am back in hell.
I used to be ok for months and then the fissure comes back, how long does it need to heal?
I am so miserable right now, depressed and barely functioning. My family suffers, I am short tempered, not interested in anything (including husband), I snap at kids, I lost weight because I am afraid to eat, because of this constant nagging, nagging, nagging itch/pain.
Questions I have for you guys:
1. What do you do if CRS refuses surgery?
2. For those that have their fissure under control, how long is the longest time you've had pain/blood/itch free?
3. I live in sitz bath, but if you had the itch, any other suggestions?
4. I tried every possible cream: wheatgrass, diaper rash cream, am healing oil, anything else out there?
The doctor told me NOT to put anything on the bottom, just the bath. He also never mentioned botox.
Thank you for listening!

Welcome Hope, but sorry you have to be here. I know your pain! So well! Until 6 days ago that was me...only I had tried it all. Started with fiber, then nifedipine, which I've used since last April only got slight relief for maybe a month, after that, Botox, big mistake for me! It made everything worse for 6 solid weeks and at that point I thought it couldn't get any worse! Then I had to fight for surgery. Finally got it last Thursday and hope, it's like night and day...I am still amazed! So I'll answer your questions best I can.
1. Find another CRS if he flat out refused! That is ridiculous! I wish these guys had to have a fissure for just a week before they get their diploma! Then surgery wouldn't be so difficult to get! Of all the stories I've read, I've never heard of anyone who has incontinence, but I would happily sit in a diaper til the day I die if that takes the BURN away! Seriously!
2. Personally, I was never able to completely eliminate my pain, but I got thru each day by almost constantly sitting on a heating pad, taking a combo of ibuprofen and generic robaxacet ( calms the spasms) and near the end I got something like Valium, which stopped the spasms therefore the burn was almost nonexitent but I was pretty buzzed taking care of my kids, cooking etc, but at least I was then able to do something without heating padunder my ass! I also had a heated pad for thecar cuz driving with AF can be hell!
3. For the itching I sometimes used baby powder or gold bond soothing powder but watch the gold bond, it has menthol in it which can be cooling but if it works it's way in, it can sting. I've heard that dr wheatgrass cream is great for that but I never tried it.
4. If you know anyone going to Mexico or Belize get them to grab you a tube of sufrexal. It's key ingredient is ketanserin, I was having some success with it but the spasming worked against it. It is apparently very good at healing fissures it's worth a try. My mom lives in Mexico so I was lucky cost $50 cdn and is supposed to b really helpful after surgery as well... I'll let you know I'm gonna try it again in another few days.
I hope this helps you, I think you definitely need to find a different doc, I know this can b difficult but even if you have to travel to find one( I drive for an hour for mine) it will be worth it to find someone who will help you. I needed surgery a year ago and only got it last week. But I have my life back, and my kids have their real mommy back too! I'm still healing but this is manageable pain... Not like the fissure.... Good luck! This forum will help immensly! O and pull out that miralax... It changed everything for me too bad I only found it a month before surgery on this forum. These ppl really know what they're talking about but u will need to find your own perfect formula.

welcome hope - I'm so sorry that you are suffering! It also really sucks that your doc refuses surgery. I agree with Elphie that you should find a new surgeon - at the very least to get a second opinion. I'm very surprised that s/he flatly refuses surgery - was there any reason given for this other than the 'no pain' nonsense?
Right now I've been on diltiazem for about 3 weeks, which has helps a bit, but the pain/burning and bleeding is still there. I'm going back to my surgeon on the 10th to see what to do next. Mine did mention surgery as an option if the dilt doesn't work. As for botox, I do believe that it has worked for a few people here, but the problem is that, like the ointments, the fissure can come back after a while.
I hope you are able to get to see a different CRS very soon -
I really think that is the best thing to do at this point.

Hi hope,
Welcome to one of the only places where we all know and feel your pain. Really. I keep thinking I'm a wimp but I was stung by a wasp the other day and hardly noticed it compared to the AF.
At my worst - a while back - I was transformed from a 75kg fairly logical, stable, calm and happy person to a 60kg grump with dark thoughts and just one aim in life (and not the usual one for men) - to ease the pain. However for me things are now better - and as you'll see the same goes for many people here - things will improve.

Unfortunately it doesn't always appear to be exactly the same answer - we've all got AF but the fine detail is often different - often the strategy seems to be to start with what the medical world recommends and then try varying or adding things and ask them to change things and see what eases your AF.
There have been a couple of posts on how to explain to family, friends and at work how uncomfortable it can be - if only they knew. One suggestion was to send them to this site to read a few accounts. I really wouldn't wish an AF on anyone, but just sometimes I wish they knew - I wanted a 'genuine pain' meter for xmas. If anyone wants to come on this site and call us a bunch of over-sensitive wimps it would make my day to reply to them!
So like everyone my two penn'orth is only my own experience and thoughts, but in addition to the wise replies you've already had I'd add:
1. I'm not really sure because it didn't happen to me, but if there are other CRSs it's surely worth a second opinion, so do consider trying another. I had a sort of deal with mine: try 6 weeeks of new treatment, if that doesn't work the CRS said he'd Botox (IF there's incontinence it's usually temporary) and we'd wait and see after Botox; and if that didn't work he'd do an LIS.
2. I've certainly gone 2 years without significant problems. It comes and goes (over about 8 years) and I think my recent mistake was not piling into all the conservative methods at the very first sign of trouble.
3. I've been trying a bit of crotamiton cream to ease the itching - around the anus only (which is where I've had the itching) and that seems pretty good. It's OTC and not expensive. My own itching seems to correspond to using diltiazem (similar to nifedipine).
4. For promoting healing I tried GTN and two brands of diltiazem (the first didn't seem to help, the second seems to be good). For easing the pain I'd certainly recommend the hot pads to sit on. Standard analgesics (ibuprofen and paracetamol) didn't seem to help a lot. Once previously I was prescribed proctofoam which I seem to remember was a minor help, and then more recently some lidocaine - which seems the best of the pain relief agents for me - but the effect doesn't last that long.
My recent improvement has corresponded to both changing the diltiazem from one manufacturer to another and to changing from a lactulose stool softener to a macrogol based one ('the shit-shifter of choice') - like Miralax (in the UK Laxido is exactly equivalent and available OTC). I'm now much more like toothpaste to yoghurt every time (rather than a bit more hit and miss). There seem to be quite a few macrogol (aka PEG) fans on this site so you might want to try the Miralax.
After, well, a bit of most gentle practical encouragement from my CRS I've also got a bit bolder in being able to get the diltiazem to where it should go. And that's a virtuous circle because the more I overcome my squeamishness and get it to the right place the more good it does, the less pain I have and the more confident I become about getting the gear up my anus.
So all the best of luck - do consider trying something new, and perhaps a new CRS and let us know how you get on.

Hi Hope,
I'm new to this forum but I've had problems with anal fissures for about 12 years now. I have found that the only quick cure that works the same day is an anal dilitation procedure.
In the past, I've had the procedure performed by Dr. Norman Sohn who created the procedure back in 1997. He claims an almost 95% success rate.
The great thing about the procedure is that there is no cutting of the sphincter muscle and therefore, the healing process is only a couple of days but the relief is instantaneous.
I would definitely advise you to ask your doctor about this procedure. I've had the procedure twice and it lasted for a good couple of years before I needed it again. I have also been told by Dr. Sohn that most people who get the procedure are completely healed and don't come back.
Good luck to you. I know how you are feeling when you can barely function because of the pain.

Hi Hope...glad you found us here. I think we can all relate to the way this takes over your life, ruining every enjoyment and making you grouchy and disinterested. I'm so sorry you're going through this! I had my fissures for five years and got the surgery 6 weeks ago. I've been fighting with some lingering depression, because it really did a number on my mental state.
I absolutely agree that you MUST see a different CRS. 'It doesn't look that bad' is NOT a valid assessment of the situation. No doctor should ever tell you how you're feeling, YOU know what it feels like to live in your body, THEY don't. I would definitely give the Miralax a try, it helped me to stop tearing before I got the surgery. In fact, when I went for my surgical consultation, the CRS couldn't see a tear at all. But he could tell how tight the muscle was, so he offered me the surgery anyway.
I went ahead and did it. He knew what he was doing...I am not incontinent in the least. You should question the skill of any CRS who brings up fear of incontinence; my surgeon never has had one case of it.
Poor you, you've been struggling with this for too, too long. There is no reason why you shouldn't be able to have the surgery; after this long, the surgery is the only thing likely to cure you.
I hope you can get a second opinion, and fast!

Hi Hope. Welcome! Just been to Boston myself, so will be interesting to compare notes, so to speak. Have the flu right now which has added to my woes - chest and bum!! I wrote a bit about my trip a few weeks back under 'general anal fissure discussion' headed "Wretched Fissure - so much pain". I am not feeling my best, so will come back tomorrow and write more. Sorry you are in pain. I can empathize as it is just all too much sometimes. Em

I am so grateful for all of your replies! Thank you, thank you, thank you!
Regarding finding a new CRS. I went to two different doctors, both were recommended, old (=experienced?) and practicing for years at excellent hospitals (Mass General, etc.). I keep thinking that if the doctor knows the nature of fissures and he knows that mine is chronic (years of presence, skin tag et al.) why did he say it will heal with fiber, diet, stool softeners? He must know it might heal, has it heal for ANYONE here with conservative treatments?
Because from what I have read, there is nobody on this board who can safely say " yes, my fissure is completely healed with diet, fiber, softeners, etc."
Elphie, yes, at this point I will be glad to sit in a diaper if it means no pain! Tell me if sufrexal is helping you!
Hopetoheal, the CRS told me that I have a "beautiful bottom" (literally. that's what he said. my husband was hoping he meant it in a medical sense). I think he was just trying to get rid of me. The fissure was healing at that point, he said he doesn't want to do digital exam for the fear of reopening it. He also said that I don't have a bad spasm, that my skin tags are not a big deal (but they ITCH and burn!) and I should continue to keep up with the toothpaste stool. Without ever having an occasional non-toothpaste consistency.
Spamfree, 2 years AF free!!!!!! This would be a dream come true for me. But then again, it is a bit discouraging that AF would come back after all this time!
Why or why? Isn't 2 years a long enough time to heal completely for this damn thing???
I am sure your spelling mishaps would be left unnoticed since all of us here are fixated on other PROBLEM. :(
Mikeymike, I was never informed about this procedure, I will be sure to ask when I see the CRS in 2 weeks.
I was also never told about Botox.
Alpinestrawberry, I saw two different doctors (both CRS), I am going to see another one. There are plenty of doctors in my area. What I think is happening: they all go by the same protocol and the insurance companies are involved. They offer every conservative method and send you home hoping you won't come back. Surgery is expensive, they can't offer it right away even if you tell them you've been suffering for a long time. They have to have a written record proofing that you just won't go away till they do something. So I am just going to make an appointment again.
Savaici, I found your other thread! So the doc also sent you away and didn't propose surgery? But then again, he didn't see the AF so he wouldn't know what to operate on.
I am sorry about your flu, I know how you feel, my AF however, always feels worse than the chest! Feel better soon!
Again, thank you all so much!

My second trip to the ER was in Hartford where the doc there recommended a CSR. Research on the net indicated that he was an acclaimed specialist in treating AF. He also proclaimed that surgery wont be necessary. And at first the creams etc did work. A few weeks ago, I had a bad episode, could not get to see the CSR but saw his PA instead. I told her I had made a decision that i wanted an LIS. She seem to be agreeing that having gone through the gauntlet of treatment, surgery was the next option. She wasn't very direct, so I wonder if she was wary of giving an opinion that differed from the CRS's. She added lidocaine 5% ointment to my regimen, but it was of little use. Its painkilling effects wore off after about one to two hours. Then I came across this forum and Elphie (may God bless her kind heart), and I begun to see that despite what my CRS thought, surgery was going to be my way out. I then read a lot of surgical research papers on the effectiveness of conservative vs. surgical treatment. One thing became very clear, surgery had a success rate of 90-95% while for conservative treatments it was 48-52% with signs of success starting to show within three to four weeks of treatment. While all this has happening, I was gradually being transformed from a strong assertive man to a cry baby (I am originally from Jamaica where men do not cry). When the AF acted up, I stayed in bed and cry and prayed and cry .... On my last visit to the ER (last Sunday), I was a total wreck, crying and screaming in agony. My earlier post listing a series of coincidences that allowed me to have surgery that same day. As Elphie pointed out to me, if you make the decision to do surgery you have to insist for the CSRs seem not inclined towards LIS. One thing is sure, in this forum you will get nothing but love, support and understanding. Good luck.

Hi Hope. It's not that uncommon to land up at the doc with a healed fissure - they have that little trick up their sleeves, so to speak, that they heal up and return when least expected. The CRS used a Q tip on the inside of my anus, and from my screams was able to agree with me that all is not well. Also, the internal spincter goes into spasm that even if the fissure improves on some days, is still there to haunt you! The spasm has improved a little for me since using Nifedipine but I am never confident that all is well, though I sometimes now let down my guard. Have a piece of cake or something. Sometimes I suffer for that, other times not.
This week of flu has been hell in that my Behcet's has flared up (painful ulcers) and today had a lot of trouble going to the loo and passed a lot of blood and was pretty much in agony all morning. But, this evening, things look brighter.
My hubby and I had a great time in Boston; we live in the wilds of Maine, so was different to visit the big city.