Was diagnosed with anal fissure in 2008. Had a colonoscopy and all it showed was some internal hemorrhoids that my GI doc said were not significant. Since then, it would act up every few months with constipation (burning, spasm, felt like defecating glass), also noticed some swelling (sentinel pile?) and itching but otherwise bearable. Per GI doc used Miralax and increased fiber and water. Thought I was in the clear. Haven’t been constipated in 6 months.
Spontaneously (maybe I rubbed too hard during cleansing), for the past month though have had some fecal soiling of underwear daily (small amount of liquid in the afternoon and later part of the day). Went to PCP and he performed DRE – no blood, no stool, no problem he said, he recommended an increase in stool softener due to fecal retention.
Went to GI doc. He couldn’t visualize or palpate fissure upon DRE but thought it to be posterior due to my pain response (and that being the most common location). Repeated colonoscopy (same results in 2008), had barium small bowel x-ray series to rule out Crohn’s (results pending). GI doc recommended medical treatment (sitz bath and hydrocortisone suppositories twice daily for at least one month, continue high fiber diet, miralax, eliminate dairy) and then referral to CRS. He thinks chronic fissure has caused scarring causing incomplete closure of rectum.
My question is if 4% of chronic fissure patients have soiling and 4% of surgery patients have soiling, what is the benefit? I’ve started wearing men’s liners and its depressing, less than 30 years old and a healthy weight.
Is the soiling due to sentinel pile, abnormal closing of sphincter due to scarring, or pus from the fissure? I feel some irritation down there and the liquid irritated the surrounding skin. It is usually light brown liquid, but today after working out it was pink.

Welcome to the forum!!

My thoughts:

Sitz bath is good.
Hydrocortisone suppositories I would question, though maybe the doc has some good reason for prescribing them. I would look it up and research.
Make sure that you are not overdoing the amount of fibre that you are using. Just use enough for your body weight.
Make sure you're drinking enough water.
Definitely never ever ever rub. Just dab with damp soft TP. I use Cottonelle with vitamin E and aloe, and then Johnson and Johnson gauze sterile pads to dab again.

I can't really answer about the incontinence. But I would suggest seeing a CRS sooner rather than later.

Feel free to ask more questions!