How long do i try meds before surgery

Nitro and diltiazem healing time

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How long do i try meds before surgery

Postby Broncosgirl » 18 Mar 2015, 02:54

I am feeling a bit frustrated. 6 weeks ago I was prescribed nitro from a doctor. A few days later I went to a CRS because I was still in so much pain. I was told by that CRS to give it a month. Two weeks later I got a second opinion from another CRS who told me to give the meds two weeks to to work.

Well, after a month on the meds I went back to both docs. My fissure pain had decreased in the first few days of use from a 10 to about a 5, and then it stayed there for the rest of the month. I figured I would be told surgery was the next thing to do, but instead I was told to keep trying meds for another month.

I am wondering how long these meds are supposed to take to work... How long did you use nitro or diltiazem before you no longer experienced pain from your fissure? If the meds have made no impact other than the first week of use, is it really going to make a difference to keep trying for another month?
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Re: How long do i try meds before surgery

Postby chachacha » 18 Mar 2015, 09:22

When I was on diltiazem, I did a lot of research on google, and came across an article that said that some people needed to take it for 6 months before seeing results. I tried it that long, and had no success whatsoever. I had originally tried it for a couple of years when my fissure was not yet chronic, but don't know if it worked then either because my fissure used to heal itself within about 6 weeks and the diltiazem had the same result. By the time I tried for 6 months though, I think that it was just too late and the fissure was too far gone.

You may have better results though, and because surgery is such a major event, you might be better to keep going with the cream for a bit longer. I know that it is quite annoying to have to apply it twice a day, every day (and mine used to make my hemmorhoids come out too because the diltiazem was mixed in vaseline), but a few extra weeks vs surgery may be worth it.
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: How long do i try meds before surgery

Postby jlm1 » 18 Mar 2015, 09:56

I would never tell anyone what to do but this is my experience. I went to a gastro doctor in early June and was given nitro. I used it faithfully for 6 weeks. I called and saw the doctor several more times and dealt with a great deal of pain. It got a little better but my life was on hold and went around my BM's. Thankfully, I'm a teacher so I made it to the end of the school year. Finally I saw a CRS and my only regret is that I did not do it sooner. There was no reason for me to be in pain for so long. The CRS had to put me under to even find the fissure, which was deep and significant. She offered botox and it worked for me. I know there are mixed reviews about botox and it doesn't work for some. Botox simulates the LIS without surgery and relaxes the area so that it can have a chance to heal. I had other complications that were ust unfortunate and another story. But maybe botox is an option for you? You can always do surgery if botox doesn't work. I do not think anyone should have to go through needles pain. Again, not telling you what to do but I would be very vocal about the pain you are in and see what other options your CRS can offer, such as botox. And, although I haven't had the surgery, many have and it has been successful. Good luck to you!! Amazing that for all our advancements, we can't cure a cut in the a$$
fissure May 2014
nitro, diltiazem
botox July
fistula surgery, piece of skin tag removed Oct
fissure declared healed Dec
currently have burning/pain-told it is nerve pain
physical therapy, sitz baths, valium suppositories
hoping I am healing
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Re: How long do i try meds before surgery

Postby jlm1 » 18 Mar 2015, 10:02

I see on another thread that you were going to have surgery?
fissure May 2014
nitro, diltiazem
botox July
fistula surgery, piece of skin tag removed Oct
fissure declared healed Dec
currently have burning/pain-told it is nerve pain
physical therapy, sitz baths, valium suppositories
hoping I am healing
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Re: How long do i try meds before surgery

Postby Broncosgirl » 18 Mar 2015, 10:50

Thank you both. Yes, I was going to have surgery but chickened out because of my CRS encouraging me to wait.

Pain-wise I can handle doing meds for months, but from what I have read, they typically stop the pain in about 6 weeks and then the fissure can take another 6-8 weeks to completely heal. I still have pain and blood with each BM after 6 weeks of use.

The reason I don't want to drag this out is becuse I feel like my life is on hold. I have a new baby and I feel like I am missing out on being fully present for her. If there is only a small chance that meds will work if they haven't by now, I would rather do surgery and move forward than tack on months more to the healing process and just end up getting surgery anyway. Yet, I don't want to just do surgery if I have a good chance of healing without it.
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Re: How long do i try meds before surgery

Postby jlm1 » 18 Mar 2015, 14:37

Again, I will suggest you try botox. Especially since you are hesitant to do the LIS surgery. If you don't have any other issues, there is a good chance that the botox will work for you. I also suggest pelvic floor physical therapy. That has helped me a great deal.
fissure May 2014
nitro, diltiazem
botox July
fistula surgery, piece of skin tag removed Oct
fissure declared healed Dec
currently have burning/pain-told it is nerve pain
physical therapy, sitz baths, valium suppositories
hoping I am healing
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Re: How long do i try meds before surgery

Postby Bailey » 18 Mar 2015, 16:32

It's such a tough decision. I don't know that there is an answer.

I can tell you that I started with meds in October. Things seemed like they were getting better and Nov/Dec I had minimal pain (only during some BM's). Then, I retore in January. I didn't have an appreciation for the fact that I could not stop the cream/stool softeners and probably didn't pay as much attention to my diet and... Back to square 1. I tried the cream again but it didn't seem to be working. The last month and a half has been bad. Last week, I was done... Ready to have the surgery right then if I could. But, I've started Nitro and want to give it time. And, after months of watching my diet and taking the stool softener as prescribed by my Dr... And having difficulty achieving consistently soft BM's... I finally tired what many here on the board say to do - Miralax (or Restoralax as it is known in Canada). It's only been a week, but what a difference! No pain when sitting, I've had a few days of pain free bowel movements... I have hope again that this may heal without surgery. Wish I would have tried the Restoralax sooner!

So, as hard as it is... Give it some time. Most important thing - soft BM's - however you need to do it! I'm eating well, drink LOTS of water, walk everyday, drinking prune juice every night, taking a stool softener and Restoralax... Whatever works. Talk to your doctor and get their advice. But, don't rush to surgery... These things take time.

Best of luck to you.
Diagnosed anal fissure October 2014
Tried nifedipine - fissure seemed to be healing but reoccurred January 2015
Switched to Nitro and started Resoralax - Beginning of March 2015
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Re: How long do i try meds before surgery

Postby Broncosgirl » 18 Mar 2015, 20:35

Thank you for the wisdom! I am glad you are starting to heal.

It seems like the soft BMs are the number one biggest factor that I hear everyone talking about. I think that is also a reason I feel frustrated with my situation. I would say thay during the six weeks I've been using the meds, I have had perfect BMs every day. Despite this, it feels like I am tearing each time I go. I've had a day or two where I have had no pain and then bam, I feel it tear again. Strange thing about it is that my BMs when that happen are ideal. I think that is why I am losing hope. Even with the perfect BMs for weeks I feel no difference...
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Re: How long do i try meds before surgery

Postby Bailey » 18 Mar 2015, 22:14

What you are saying is exactly how I feel... Same story. I thought BM's were good but they need to be super soft! My problem is sometimes they tend to be a little more firm at the start (too much information, I know:). I was so frustrated. My suggestion is... If you haven't already, try a stool softener or Miralax just to see if it helps. Tons of water and meds to make BM's soft. I tried with diet alone and although BM's would be ideal for anyone else, it wasn't good enough to heal this fissure.

Fingers crossed the healing continues. Try not to be discouraged. Good luck.
Diagnosed anal fissure October 2014
Tried nifedipine - fissure seemed to be healing but reoccurred January 2015
Switched to Nitro and started Resoralax - Beginning of March 2015
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Re: How long do i try meds before surgery

Postby msimon » 19 Mar 2015, 10:54

I, personally, have to keep my BMs like soft serve ice cream. Everyone is different but nothing seems to work as well as miralax/restorlax and magnesium.

As for surgery, only you can decide that. I finally gave in after almost a year and 3 rounds of botox. It's not to be taken lightly as there are potential complications. I developed an abcess and sinus and required a second operation to deal with that after 3 rounds of antibiotics and many weeks of pain that way. I am still recovering from the second surgery almost 6 weeks later, although this is definitely the exception, one has to prepare for the worst (and of course hope for the best).
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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