Jax,
I don't think how wide your BM is matters if it doesn't hurt.
That's actually awesome news. But keep it up so you don't relapse.
My first CRS said that anterior for women was harder to heal, but the second guy I saw said he noticed no difference in healing rates as to where the AF is or if you are a male or female.
I suspect they all have their pet theories.
I am glad I got a second opinion, although I can't say as either of them seemed terribly interested in my problem.
Would be nice to be taken seriously.
Or do I take myself too seriously?? Only time will tell.
I hope it is the latter.
-Tanya

savaici wrote:Hi here Jax,
I had the problem with the 'gritty' Diltiazem, and actually posted about it one here and got some good responses.
http://anal-fissure.org/t2705-diltiazem-with-grit-in-it-please-help?highlight=Grit
I had a pharmacy compound the one I use now, in Boston, and it has no grit. I got the gel.
All The best
Sav

Thanks for the info. I will have to look into the gel if i can't take the current ointment. It seems to be helping but im not sure if it's the dilt, or the fact that just having the ointment there is keeping that area smooth and moisturized.

Jax,
I don't think how wide your BM is matters if it doesn't hurt.
That's actually awesome news. But keep it up so you don't relapse.
My first CRS said that anterior for women was harder to heal, but the second guy I saw said he noticed no difference in healing rates as to where the AF is or if you are a male or female.
I suspect they all have their pet theories.
I am glad I got a second opinion, although I can't say as either of them seemed terribly interested in my problem.
Would be nice to be taken seriously.
Or do I take myself too seriously?? Only time will tell.
I hope it is the latter.
-Tanya

Ahh thanks. Yea, I've seen two doctors and both are very knowledgeable and informative with their diagnosis. But after they reached a conclusion, they state it and then seem to rush out of the office. So i always feel rushed because it takes me a while sometimes to figure out what i want to ask in the moment.
The first doc kept saying its a fissure and int hemrroids. He used an infrared coagulator on the hemmies and gave me HC supp and antifungal cream and said I'll be fine with some metamucil in my diet. He never mentioned stool softener. I saw him on and off for 3 months with some bleeding in between. He claimed I was healed back in December.
Well there were still some bleeding here and there about once a month, so I went to see a new doctor for a second opinion earlier this week. He told me I most likely need LIS if its been around that long The first doctor never even mentioned surgery in the future. But this doctor said I could try the Diltiazem because I was never prescribed it or NG in the past so I obviously opted for the cream. He said worst comes to worst you postpone the surgery with the cream for a few months. I guess he was being honest but that didn't make me happy to hear. He did the exam and concluded all within 5-7 min. I wondered if he even considered the history of my fissure. I know it's considered chronic now that it's been on and off for 7 months, but it did "heal" at one point. And luckily I was never in alot of pain, it just hurt during the BM. Plus this time around, I actually have the help of the ointment and stool softener. Both which i wish I had the first time fighting it.

Jax,
I don't use stool softeners, except for prune juice.
It all depends on your body.
I've had my fissure since last June, didn't get the right diagnosis til December, and I am almost healed (touch wood and whistle). I was using the nifedipine, but had to stop a couple weeks ago as it was messing with my menstrual cycle. So all I rely on is a couple different moisturizing/barrier/lubricating creams and not straining when I go.
I have started self dilating the last couple days, but that is more to stop it from coming back in future.
So really the things that made the most difference for me were not straining at all and protecting the area with different creams/salves. I don't know that it matters much which ones. Something that is antimicrobial, anti fungal and anti-inflammatory is a good thing.
Right now I am liking the Dr. wheatgrass and virgin coconut oil, and sweet blessed bee magic.
I was using lanolin for a long time and still like it but it was more of a hassle because I had to warm it up a bit to use it. I've also used neosporin (don't know it that one would be good to use for more than a few days though). I have manuka honey too. Anything made for the nipples of breastfeeding mom's will work well for AFs too. And of course, Aloe vera gel.
Basically I have my own little drug store under the sink. And that doesn't even count all the remedies I bought when I thought it was hemorrhoids that I had!
So you had the hemmies coagulated? How was that?
I try to have all these questions ready when I see doctors, but it's hard if you don't know the right questions to ask in the first place.
I think some docs want to do surgery just to heal you quicker. But there's no guarantee that it will. There are people on the board here and another AF forum on yahoo who still took months to heal even after surgery.
What it does is loosen your sphincter. You can do this yourself with self dilation. It's kinda scary at first, but does work if you are patient and careful. IMO.
The cream you are using makes the sphincter muscle more relaxed and increases blood flow to the area.
So basically you want to loosen the muscle, increase blood flow to the area and not strain.
anyways, I will stop going on and on.
-Tanya

Hey,
Just some updates, I'm still using the Diltiazem ointment 3 times a day. I have had no signs of blood at all in the last 3-4 days. I'm now down to a 1/2 dose of Miralax a night and Im eating a high fiber diet. I will continue to keep this up until my follow up 2 weeks from now. I want to make sure to tell my CRS to be gentle as I find those anoscopes are so uncomfortable. Im afraid it might split the fissure again :/
I do want to note that my fissure, although chronic, does not seem as bad as some cases on here. This is what has been making the decision to have LIS so hard since I'm a mild case. There were no signs of my fissure acting up in the past unless I had some constipation. It would feel like the stools would scrape as they were passed and I would see a little blood on my TP. Although the first time I noticed there was an issue (July 2011), there was alot of blood in the toilet bowl and when I wiped (as much as a bloody nose). That was scary.
So I think this simple stool softener and ointment will allow it to heal. The real test is how strong the tissue will heal and how long it will stay healed. If the CRS does agree that it's healed, Im curious to see how long he feels I should stay on my half dose of Miralax. I feel like I could go down to a 1/4 dose at this point given how soft it already is with 1/2. I wonder how long do they recommend patients recovering from LIS to continue a strict diet with stool softeners.
I dont mind drinking a cup of Metamucil a day or to keep a 20g fiber diet for the rest of my life. But I dont feel comfortable doing the same with Miralax.

BTW Tanya, the infrared coagulator wasn't bad at all. It took less then a minute and I didn't feel any heat since my hemmies were internal. I couldn't tell you if it did anything. My doctor just treated them because they were apparent not because they contributed to anything (i think).

jax -
It's a tough thing, I know. I went through the same "do I or don't I?" with my fissure.
Finally, the third crs I saw told me that fissures don't heal on their own -- and even if they seem to, they usually come back. It's not what I wanted to hear, that's for sure. He said I could either live with it (and some people do opt to do that) or have surgery -- LIS and a fissurectomy.
I had the same question about fissurectomies -- how can a surgical cut be better than a tear? He said that fissures tend to scar up around the edges and can never really heal, for that reason -- but, if the fissure is excised, the fresh skin can grow together without scar tissue. THAT said, alot of people only have the LIS surgery, and their fissures heal up, just fine. I guess it all depends on what each, individual crs thinks about it.
Okay, so THAT said, the healing after both procedures seems to take more time and alot of patience. I'm 7 weeks post-op, with awhile to go before I feel healed.
Hope that helps.

jax,
thanks for the ifc info. Not sure if I have a hemmie or not. Will find out when i see my crs next thursday. I worry about him re-tearing things there when he looks too. Hoping I will be healed enough that it won't matter. He's pretty careful though. (touch wood and whistle)
Glad you are healing well!
I don't mind doing metamucil for life either. Heck I drink it in restaurants now. I'm too paranoid to mess up my schedule to wait til I get home. :)
Some CRSs say Miralax is safe for a long time. Some people take it for life, but I did read of one lady developing a reaction to it after a while (she got swollen ankles or something). Don't be in too much of a rush to get off it. But you know your body best.
I did buy some cookies a few months ago, that had an ingredient from the same chemical family as the stuff in Miralax in them (propylene glycol). They gave me the runs! lol.
-Tanya

Hi All,

Finally got to see the CRS yesterday at the Cromwell Hospital, he prescribed Diltiazem cream which was £125 a tube!!! hmmm don't know how often l could afford that one! and Normacol fibre granuels... these l have to take indefinitely. He did say that in women the muscles in that area are very weak and that's why they don't like to do surgery on women for this reason.... that would be a last resort. So lets see how l get on with this......!

Hi All..... just wanted you to know the Diltiazem cream prescribed was Anoheal and has to be kept in the fridge.

Frazzles,

Glad to hear that you sought treatment and the ointment works out... Good luck