Well I posted on here like 2 years ago, went to the doctor and was told to basically eat porridge for breakfast every day. Not liking to think about it too much, I hoped for 2 years that it would heal at some time and indeed the pain level (and blood level) has waxed and waned over those 2 years... but it has never healed. I now get consistent pain (although not usually blood) when having a BM, even though I think my stool consistency is pretty normal. Doesn't seem to hard, nor too soft.

So I've decided to "take the fight to the fissure" now. I'd rather not have to deal with this for the rest of my life. I went to my doctor again the other day, after the 2 or so years, and he has prescribed glyceryl trinitrate to be applied to the anus about twice a day. We'll see whether that helps. I'm also going to start taking hot sitz baths for maybe 10-15 minutes after each BM.

Interestingly, my doctor said that the glyceryl trinitrate was primarily for relaxing the muscles in the area rather than increasing blood flow, although I've read that it's mainly for the latter elsewhere?

He also strongly recommended against surgery (presumably he was referring to LIS). I'm not sure why he was so against it, considering everything I've read says that it basically has a 100% success rate (after months of recovery) of healing fissures and being able to take normal BMs again. I mean, you will literally stop being such a tightass for the rest of your life!

I suspect that this treatment won't help much, and I'll end up going back in about 10 weeks where I will insist on a referral to a CRS (I still haven't had one yet). Why would my doctor be so against surgery? Just a kind of medical conservatism?

Hi sorry to hear your suffering,
Glad to hear you fighting back the sitz baths are great and GTN became my new best friend it really does relax the muscle and increase blood flow...you can if needed put it on 4x a day.
Why does your gp not refer you now as if your with the NHS it can take 8/10 weeks for a CRS referral if your in a busy part of the country.
With a bit of luck you could heal with just the cream and my gp was seriously against LIS to the point of saying I would be stupid to get it done mainly because I have crohns...but 16 weeks post LIS I have no incontinence issues even when my BMs resemble nothing more than a volcanic eruption. GPs are so scared of incontinence as that is an issue for them both monetary and time. My CRS has never seen more than slight soiling of underwear from LIS in over 20 years and he works mainly with patients who have IBD.
If you are in pain and getting spasms I would ask to be referred asap to a CRS
Good luck

I'm not really sure whether I do get spasms. It's hard to tell - usually I feel pretty normal down there, except when I'm having a BM or for a while after the BM there is pain, but the rest of the time it doesn't feel very "spasmy". But I don't know, maybe I could be having a spasm without really feeling it?

Trust me you would know if you were having a spasms it can range from strong burning stinging to literally rolling on the floor screaming agony
It's probably a good sign your not having spasms as that means it's easier for your fissure to heal itself, without needing an op

I agree with mbp.

First time I had a fissure I didn't have spasms. It hurt like heck to have a bm, stung badly afterwards, but I would feel fairly normal after hopping in a sitz bath for a few minutes or applying nifedipine. Healed in two weeks.

I thought at the time that that was just horrible...then this time I have spasms - pain for hours after bm, often have to strain to have a bm as the muscle is tight. When the fissure was very active it was a horrible burning/stinging that was unbearable - sent me to the emergency room 3 x for pain meds. Now I just have the spasms (healed fissure) and I get the burning aching for most of the day.

If your situation sounds more like the former, I'd say you're not having spasms and as mpb says have a much better chicanery of healing!