Hi everyone,

It’s been quite a while since I’ve posted. Recently, I’ve gotten a re-tear of my chronic fissure and I’m miserable. I got sick with a really nasty cold and also a flu a few weeks ago. I developed constipation during that time and harder stools and must have pushed far too much to go, which was a huge mistake. I also had horrible coughing that I could not control very well with medicine. I think I really irritated the area and am now in pain again from a possible re-tear. To top it off, I have my period, which is definitely making everything worse. I was doing so well for a couple of years except for occasional flare-ups (I developed my fissure during Christmas of 2012). I still use Diltiazem ointment regularly, but I don’t think it’s as effective as it used to be. Sometimes it seems like it works and other times it doesn’t. I really want to try the other ointments like Nitro and Nifedipine to see if they would be more effective, but I know my CRS does not prescribe Nitro due to headaches and I don’t know about the other one. : ( In the meantime, I’m keeping my stools soft (I normally have no issues with constipation other than that time I got sick), taking the ointment twice a day, and taking ibuprofen when I need it.

I feel like I don’t have any options anymore except LIS and fissurectomy surgery. I also do not have any medical insurance since I don’t work, so paying for everything would be out-of-pocket. I am scared out of my mind of having surgery, but know it helps many people. I have an appointment with my CRS next Thursday to discuss things. I’m afraid he’ll say my only option left is surgery, which is basically what he told me last April. He says he doesn’t do botox (which I don’t believe would work in my case because I’m so tight), but does LIS and fissurectomy together. I’ve heard the recovery is brutal when fissurectomy is done as well as LIS since the surgeon is essentially cutting out the fissure and the surgery scares me enough as it is.

I just need some reassurance and comfort that this will get better. : ( I’ve been so hopeless lately. I suffer from depression and anxiety and this has only worsened all of that. I keep getting panic attacks each day that are difficult to control. I want to be hopeful that this will go away like it always has, but some days it seems awful and other days are tolerable. I’m so worried it’s just going to get worse and I’m scared. I want this to heal again and this pain to go away!

Thanks for listening and I hope for healing for everyone.

I'm so sorry to hear that you're suffering again. May I ask what you mean about the Diltiazem sometimes working? Diltiazem is not a drug to soothe the area, but instead is a drug to help heal the fissure by encouraging blood flow in the area and increasing the amount of blood vessels in the region for the same purpose. It's not an analgesic that relieves pain, but by making more blood available, it allows the fissure to use that to heal.

Do you think that your CRS would agree to just doing LIS, or did he say that he only does the two together no matter what? If he won't pass on the fissurectomy, perhaps you can get a second opinion? I know that can be hard when you're paying out of pocket, but if LIS alone will do the trick, why risk complications from doing both together if you don't really have to?

Good luck going forward and I hope that things work out well for you in the very near future. We all know how nasty fissures are/were.

Thanks for the reply, chachacha. The Diltiazem seems to not make the muscle as loose as it used to. Sometimes it seems to make it relax more, while other times it doesn't. Honestly, with this re-tear, it hurts to apply it (it stings), so I'm not sure if I should just apply it externally or do my best to get it on the fissure. I know it doesn't relieve pain and is supposed to help it heal. I just still get spasms so I'm not sure how much it's helping with the muscle relaxation part. I'm not sure if the efficacy of it can wear off over time (I've been using it for about two years now in an effort to avoid any kind of surgery and because it seemed to be helping to relax the area). Now with this greater pain, it seems to hurt sometimes to apply (although I did get that when I first started using it a couple of years ago).

My CRS told me that the chronic fissure will not heal unless a fissurectomy is done along with the LIS. He said he'd have to remove the old scar tissue and sentinel piles so the fissure can heal anew. I will have to ask him about this again when I see him next week. I've read varying opinions on it and some say LIS should be done with fissurectomy while others say it doesn't have to be. I'm honestly very confused about all that and would like some honest answers. My CRS has never gotten a good look at the fissure because I'm so tight (especially when I'm at the doctor's office and can't calm down). It's internal (although I can see it by parting the skin back a bit... he doesn't seem to want to hurt me by doing that and won't use an anoscope, which is probably for the best). So, until I'm put under and he has a good look at the fissure, he probably won't know what he has to do (just LIS or LIS and fissurectomy).

How was your experience with surgery, chachacha? Did you have LIS and fissurectomy or just LIS?

I used Diltiazem for about 2years and it also started to make my skin sore after a while.

Everyone's fissure is different, but if your CRS hasn't actually seen yours, he must just have very strong opinions about what must be done (I could see any CRS recommending both procedures if they had seen that it was of a type or stage that really needed a fissurectomy too, but since he hasn't, this must just be his standard practise). My surgeon, actually said that he would not remove my sentinel pile, because that would make the recovery process more difficult and painful and could lead to other complications. He said that I would just have to live with the sentinel pile, because to remove it was just not wise. May I ask how old your surgeon is? Sometimes the younger doctors just don't have enough clinical experience, so haven't seen what their patients actually go through, especially if they haven't done many to begin with. Years ago, my CRS actually told me that he has learned far more from his patients, than he ever did in med school. I think that this applies to all doctors, both surgeons and GP's, and I now value experience much more than I once did (and yes, the young'uns also have their own advantages like more recent knowledge and gaming skills for the surgeons who play).

My LIS was done on its own and I am really happy that I did the procedure. Each person will be different on that front too though, but for me, it was a really, really good thing. I have my life back and no pain with BM's now and no complications from the surgery either.

chachacha - My CRS is on the younger side. He has 16 years experience. I see him next week, so I will ask him more about the surgery and his experience and success rate. I'm just really scared about all this. There is an older CRS that works in the same office that has 37 years of experience, but he's very hard to get an appointment with. I'm wondering if I should see him as well since he has more experience.

I was under the impression that Diltiazem also helped spasms by relaxing the internal sphincter muscle to promote healing. I'm just afraid that I've been using it for so long that it isn't as effective.

His success rate is very important, and that seems to be what most on this board suggest you ask about. And how often he performs the procedure, because a rate of 100% cure, after having only performed the surgery 5 times, may not say much at all. This would clearly apply to the older surgeon in that office too, but if he is hard to get an appointment with, it may be because he has a very good reputation overall.

Yes, it can relax the sphincter to allow that new and increased blood flow to do its work. It may have stopped working for me for the same reason (used it too long), but I was also never convinced that it ever did. Before trying it, my fissures would heal on their own after about 4 - 6 weeks, and did the same while using Diltiazem. So was it the Diltiazem, or would they have healed on their own without it? I have no idea, but the fissure eventually stopped healing at all, so I had to give in to LIS at that point.

It is a VERY hard decision to make, but for me, my quality of life diminished to the point that I could no longer live as I was living. I was very scared to take the chance, but got to the point that I couldn't do much of anything anymore, and the pain was just too much! I bit the bullet and did it, and (again) for me, it was the right thing to do.

I wish you luck with your appointment and hope that you can get some good answers to your questions.

Thank you for the helpful advice, chachacha. I have a lot to think about and talk about with my CRS. I just hope and pray this can heal again without the surgery. I don't know how much more I can take of this, though. I just have to get the strength to get the surgery like you did. I think talking to my CRS about it is a good first step, though.

Hi Luka, I'm sorry to see you back here under sad circumstances. That is very disappointing news.

It's worth asking your CRS about changing your medication. Nifedipine works for a lot of people. Not everyone gets a headache with nitro (I didn't). It seems very inflexible of your CRS to refuse to prescribe it for you.
Also, heat is an excellent way to relax the sphincter, and increase blood flow. I tell everyone to use a not-too-hot hot water bottle! There is a scientific paper about a study that was done, applying warmth to the buttocks and measuring anal pressure, and heat does relax the anus. Also it feels wonderful. I sat on one nearly all day for several months. I would re-heat it in a microwave oven (only 2-3 minutes, you don't want the bottle to burst!).

If you go ahead with surgery, you have to have confidence in your CRS. Definitely ask him all the tough questions about success rate, infection rate, healing time, incontinence rate etc. And there is no reason not to see the other guy and see if you trust him more. It's going to be difficult to heal if you are scared. If the CRS doesn't understand your fears, and address them sympathetically, he's not the right one to do your op.

I have my fingers crossed for you, Luka. Best of luck. Let us know what you decide, and how you get on.

Thank you, Scientist. : ) I really appreciate the encouragement. I've just been so panicked lately and I'm desperately trying to calm down. I hate these anxiety attacks. I just feel at a loss right now about what to do next. I'm so tired of worrying about this all the time.

Thank you for the tips on the hot water bottle. I'm assuming a heating pad would be similar? I like to lie down in the sun during the afternoon (I have a large sliding glass door in my room that has a lot of warm sun coming in in the afternoon). It seems to help the pain and relaxes the area, like you said.

I will have to talk to my CRS in detail about the surgery. I have a lot of questions to ask. I wish he could examine me properly to see the extent of the fissure, but I'm too afraid the anoscope will cause more pain and he's hesitant to use it. I think the only way to examine it properly is under anesthesia and if I get that done, I might as well get the LIS (and possibly fissurectomy) done at the same time. I'm just so scared right now. : ( I'm a big wuss and don't do well with pain or anxiety.

Thank you for your help. *big hugs* I will try to keep positive.

Hi there,
MY CRS couldn't see my fissure until I was under anesthesia and she did nothing until speaking with my family first. While I was out, the CRS told my partner and mom that she saw a deep and significant fissure. (mind you, she couldn't see a thing in her office, thought it was ulcerated hemmies, I was in so much pain she couldn't get a good look)
In my case, becasue of all the pain I had already been through, they decided on botox, which I think I am happy with, LOL As long as I don't get another fissure and I am doing everything to prevent that.
This was in July. The fissure healed but I had some other unfortunate complications.
Anyway, maybe your CRS can take a look FIRST and discuss with you before you make a decision? It is such a delicate area that I don't think it's too much to ask.....
I don't do well with pain or anxiety either, so I relate. I think that I will always be super sensitive about this area for the rest of my life. But I try to think positive. The body wants to heal.
Hang in there! We are truly warriors for dealing with this crap!