I have to say - I have been dealing with fissures for five months now. I had NEVER had any trouble with BMs or constipation or hard stools but obviously, things can change as you get older. I'm 50 and in August I had my first tear after a VERY HARD BM. Went to a rectal doctor and followed all the instructions (with prescription ointment -Diltiazem/Lidocaine), sitz baths, more fiber, etc. and it healed after a month. Yay! Such relief. But it returned even though I didnt slack off with diet/fiber/water intake. This time it was just nagging, not the severe pain of the first one but just I would have days of normal soft stools and then ONE BM that would seem to re-injure the fissure, the king tag would enlarge to protect the area. But this month, I had a very rock hard BM (only the tip though) and there was blood and I knew I had really hurt it again. But after a few days of softer stools today's BM HURT so much - and same thing - very wide, very hard tip that felt like it was going to rip me open but once the tip passed the rest of the stool was soft. I did a sitz bath but as the day progressed, the throbbing & pain was almost unbearable. And I am taking Metamucil AND a stool softener. I just don't know what to do but today was AGONY. I was almost in tears. Here's a question - when anyone else has the isolate pain, the bad throbbing right at the rectum - does ice help? Heat? Sitz baths don't seem to bring much relief for me. Im seeing my doctor again on Monday. Maybe I should ask him about glycerin suppositories. I also wonder if the rock hard BM tip is scraping my internal hemorrhoids and its NOT the re-injured fissure area. I do not know but I really want this to end.

I know some people have success with Metamucil, but it never worked for me and I had much better luck with stool softener only. Fiber supplements made things worse for me. Although it took about nine months for me to fully (I think) heal. Glycerin suppositories have worked well for me. If I feel like I have to strain I stop and insert one and try again in 30 minutes and it softens things up, though that wasn't advice from a doctor, just trial and error so it might not work for everyone. Hopefully you get it under control soon!

Metamucil didnt work well for me either. I always get that scraping feeling right at the beginning and the rest used to be fine. It has insoluble fiber which tends to add mass to your stools.

I shifted to an organic 100% soluble fiber and that really helped me so maybe you can try that. Acacia fiber is best for this.

For some reason stool softeners didnt work for me either or at least I didnt like the results. I tried Restoralax and that made a world of a difference so you can try that as well.

Skoonix...Welcome to the forum...sorry you had to find us. From what I understand internal hemmies may not be the cause of your pain...but good to confirm that with your doc. Sounds to me like you are aggravating your fissure with the hard tip of each bm...been there and it is no fun as I know you know. All that said, it is best to speak with your doc and have some sort of exam if you can manage it at the time.

Movicol/Miralax/Restoralax is a softener that has worked wonders for many on this board -- it helps make sure the tip is soft. Sounds like your body simply needs a bit more time to heal itself...as it did just that off the bat and then you had a set back with a hard bm. If I were in your shoes I would look towards combining the Miralax with some amount of fibre to keep it soft for a least a month or two...then you can think about tapering off the miralax and perhaps stay with the fibre and drinking lots and lots of water.

As for dealing with the pain...try taking some ibuprofen in addition to using heat and cold. Both temperatures worked well for me and i liked the variety in changing it up. Good luck with this and keep us posted on your dr. appt.

Canadabum

Thanks for the reply & advice. It is so odd because obviously (as these boards show) there are SO many theories and combos that people have tried. My doctor had me try Kondremul (a mineral oil based laxative) and glycerin suppositories. Then he told me to taper off with the glycerin suppositories but keep using Kondremul every night before bedtime. And miraculously, this was working. I was having soft BMS EVERY morning & it got to be so routine I actually stopped thinking about the fissure, etc. I was still drinking lots of water, etc. But I had to travel & didn't bring the Kondremul & I quickly learned what two days without it will do - sure enough I had a hard stool (not super hard) but it still showed a bit of blood and the skin tag was enlarged. Damn! I learned my lesson & haven't missed a night of taking Kondremul before bed & sure enough, I was doing good. Back to normal morning soft BMs, no strain but then this morning, a hard tipped stool & I had a business meeting to make (otherwise I would have truly taken the time, maybe used a glycerin suppository and waited 30 minutes before trying again but I knew with the commute & where the meeting was, I didn't have that luxury). So I did strain a bit, the BM was painful, there was a bit of blood but later, a few hours later, the throbbing and pain is bad. I really don't want to have surgery but this is ridiculous. Obviously when you have a few weeks of good soft BMs and everything is fine & there is no pain, you think you are clear of this, but if all it takes is ONE hard BM then you're back to square one!! So frustrating!

I totally relate - set backs are no fun!! Personally I am keeping to a regimen that helps with maintaining generally soft bm. I will give myself a solid 3-4 months of that with no pain/blood then slowly wean off and see what happens. I think that once you have been dealing with a chronic af you are just more sensitive down there.

You may not need surgery - try and be patient with yourself and your recovery...one day at a time.

Wishing you continued healing.

Canadabum