I have an appointment with CRS soon and I wonder if I should be checked internally with camera.

I have fissure from July and have recurrent bleeding. Before I had 3 weeks or so free of bleeding with some discomfort , but now the bleeding happens every week and it is worrysome. Psychologically I am better, kind of adapted to the new lifestyle of steamed vegetables and spending more time in the washroom. I have been seen By GI , but he checked me internally and told me that it will heal by itself with nifedipine and fibre intake. But it is not and I want to be free of AF issue. I am considering botox, but saw on the website mixed opinions about procedure.

any comments are welcome

Hi Guest,
I'm sorry you are not healing.
About your appointment - one problem with being checked internally is that if they have to look inside, the sphincter can be stretched and torn again, so you need to be sure your CRS will be very very careful. My CRS said he will rarely use the anoscope because of the pain it can cause.

It sounds as though you've been using nifedipine and fibre for about 5 months with no effect - is that right?

Has your increase of fibre has helped you to have soft stools? The main objective is to get stools that are soft and come out easily without any straining whatsoever. If that's the case, and you are still not healing, maybe you will need to change your treatment. Botox and LIS are both options, but if you want to stay conservative, you could try a different drug. Nifedipine had no effect on my fissure, but nitroglycerine was effective. So consider changing to nitro or to diltiazem.

Good luck!

Thanks Scientist2516 for your suggestions and support!
My stool is soft, but sometimes it may be too thick and that what gives retearing. I found that if I go once a day it changes the form, but then going twice a day it traumatizes the area more often. I have tried nitro , but it gave bad headaches. May be I should try diltiazem..

Hi, I think part of the problem may be the fiber. It can bulk the stool up too much and if you're not drinking enough liquids with it that could cause dry thick stools. Have you tried miralax? It draws water into your colon to soften the stool without bulking it up. It's very safe to use. It's not a stimulant laxative. As far a nitro and diltiazem, they are very similar to nifedipine it just a matter of what works best for you. I tried them all and the only one that worked for me was nitro. I got a few headaches from it but not for long. Diltiazem caused bad itching and nifedipine had no side effects for me at all. Has your doctor told you if your fissure is healing at all? You had it for a while now and unfortunately it's now considered chronic. Those are a bit tougher to treat. Try to stay positive, I know it's hard, these painful butt monsters take a toll on our minds and bodies.
There is hope out there. I suffered with mine for over 5 years, I tried just about everything including LIS and nothing worked. This past April I had bilateral sliding flap anoplasty done. It made such a big difference in my life. I just wish I hadn't been so scared and put it off so long. If you have a good CRS you like and trust listen to his or her advice. Looking back I wish I would have. All the best Suzy

Hi Guest,
If your fissure has failed to respond to the Nifedipine, it is very likely that your CRS might want to get a better look anyway at everything and it is is possible they might want to do an examination under anaesthetic on you.
This will allow them to take a really good look at the fissure whilst you are asleep and they will just open you up a little more to have a really good examination. This is common prior to any form of Botox treatment. Alternatively, they may suggest Botox and will be able to to do the Botox as well as the examination at the same time......Please don't be put off by Botox as there are some very encouraging views on the procedure and side effects are pretty minimal. There are some great success stories on this site to read and if it does not help full healing, it has also acted as great pain relief for others. If you are in the UK, this is something most CRS' would want to try prior to LIS surgery.
Diltiazem was my own saviour and allowed me to heal to a stage where I progressed to continue to full healing with minimal pain, so I would also recommend you try this if possible.
Just a thought but is it possible you are slightly overdoing the fibre in your diet?? It might be really helpful for you to google Soluble V Insoluble fibres too as both produce differing effects on your BMs..........There has a been a lot of discussion about this on this site.
Wishing you all the very best in sorting this out and hoping you get some answers from your CRS very soon :)

Thanks Suzy and Ever the Optimist, for your suggestions. I will look into it! I use Metamucil and stool softeners as well

just to second suzy's suggestion. i would stay away from metamucil and use miralax/movicol/laxido instead.
my personal experience is that movicol plus a reasonable balance of soluble/insoluble fibre, plus time (12-18 months) plus patience, plus keeping a positive outlook = healing :)

For last week I have tried to reduce Metamucil a bit and saw big difference. Greatly thankful for this suggestion! BM became thinner , yet somewhat less soft. I have also tried to stay relax when I am passing BM and did not have bleeding for a week.. even thought that's it I got my balance, but today its again bleed.. I have my appointment with CRS in 2 days and will explore with him your suggestions. I afraid to go off Metamucil at all.Though I am taking 1 stool softener at night and prunes. Is Miralax considered to be a laxative? Is it too much to take it with stool softener? How long you are supposed to take Miralax?

Miralax is a mild laxative, it is not habit forming and will not be absorbed by the body. You can take Miralax for long periods without problem. I can not tell you if will be too much in combination with stool softener. I only took Miralax + diet+ tons of water and was enough for me. Miralax was my salvation . I was able to heal with it because gave my BMs the right consistence.

Hello again, I had appointment with CRS. He was very pleasant and respectful. I did not want to be checked internally that day and just wanted consult. He said that he could not see anything externally and for internal exam he suggested sigmoidoscopy. I have read about it and it is pretty deep insertion of the camera. There is also anoscopy. what is the difference? why he suggested sigmoidoscopy?
I have asked him about Botox. He said that there is no evidence that it is better than ointment like Nifedipine and he said that he anyway need to check me internally before Botox.
I have took prescription for Dialtiazem and want to try it today. I am not sure how much to put it, since I was 1.3% Nifedipine before for 4 months. CRS told me that I did not apply Nifedipine right way. I should not be putting it inside, because it absorbs through skin and it is enough to put it internally.
I still bleed every 3 days and feel very uncomfortable doing this internal exam.