This has been a constant battle for me. I've had this right side lateral fissure since October. I've been on Nifediptine & Lidocaine creams since November. Some days, reduced pain, but then one or two episodes of constipation will re-tear it. The last few days I was constipated & now I guess I've retore it for like the hundreth time, because when I go it stings & bleeds just after wiping. Sick of it.

My Nifed says to apply on outside (external only) but what if I start putting it inside the anus? Maybe that will help me heal better? It hasn't worked up to now. So maybe I just need to start putting it inside. I just want to heal once & for all. I am doing all the right things, fiber, stool softeners, just trying to make sure I get enough water. But when will this cycle stop?

Today I went to the bathroom twice & both times it stung & I had blood on tissue. Like I'll go a few days with no blood and then have stinging pain & blood again. I'm so tired of it. My CRS said last month to give it another 3 months or so, guess I will, but I'm ready to just nip this in the bud.

Have any of you had success with applying the Lidocaine/Nifed inside the anus instead of just outside? My CRS told me to stop sitz baths, & to eat whatever I want just to temper it with lots of fiber, etc..

I'll try anything at this point just want to not have to constantly obsess/worry over this anymore. I can almost tell when I will see blood on tissue, because it seems to correspond with a more painful bowel movement.

My CRS has me put in just inside a little (fingertip length) to relax the inner muscle.

Alex, Nifedipine did nothing for me. Maybe I'm resistant to it. You could try diltiazem or nitroglycerine. Both of those were more effective, and I date the beginnings of recovery from when I switched away from nifedipine to diltiazem.
I don't think everyone responds in the same way to any given drug, and if one doesn't work, why not try another? Good luck!

These ointments have been shown to be more effective when applied internally. Some people don't find it possible to do because of the level of pain and spasm, but the more you can get it applied inside (about the distance of the first knuckle of your finger) the better it will work.

That being said, no matter what treatment you try, it's really the constipation that needs to be addressed, and not just short term, but from here on out. Identifying what foods and combinations of fiber amounts and stool softeners, etc., that will get you more consistent results with your bowel function is critical. Fissures are really tough to heal, and like any wound, heal in different stages, and even when you start feeling less pain you have to continue on over the long term with the same habits because the area will remain fragile and prone to re-tears, even after you're feeling better. . Actually, the area will always be vulnerable to tearing again, but it will gain a lot of its strength back over the course of months after healing.