Hello from the UK

I've just joined this forum as I have been reading some entries as a "guest" and it has helped much more than any other webiste or trip to the doctors. i am a 51-year-old male, otherwise very healthy and fit, I do gym and cycling and eat healthily with 5-7 portions of fruit and veg per day, lots of water, and moderate alcolhol intake, no smoking (ever!). However, I have a weakness -- my anal fissure.
I first had a problem 7 years ago, when after constipation, I passed loads of bright red blood. After 2-3 weeks of using suppositories and taking stool softener, the blood stopped (first) and then the pain on passing bowel movements followed a few days later. All good.
However, about once a year, the same thing happens -- again, always takes 2-3 weeks....
Until this Christmas. I ate a lot of festive stodge and got constipated again. I stupidly forced out a bowel movement and sort of really felt it "go" down below. This time there was lots of blood. So, back to the usual routine, suppositories, stool softener...the blood quickly stopped, as usual.....BUT this time the pain on passing continued for weeks before stopping, and now, after 5 months, although I have no blood or much pain on actually passing stools, I do have pain every single day from around one hour after the bowel movement. This pain lasts for several hours or even all day, on a bad day. It is hellish to sit down, I keep getting up, fidgeting, squirming. My doctor has made me an appointment with a specialist.
What I cannot understand is WHY this time it hasnt healed like before. And what will the specialist do? I do not want to have surgery and be left with the risk of becoming incontinent but then again I cant go on like this forever. I can actually feel my mental health going downwards badly (I get anxiety and mild depression).
I eat 5 prunes a day as part of my diet and that keep the stools soft but it still doesnt stop the same old pain developing EVERY DAY 1 hour after the bowel movements. Does anyone have any advice or words of shared wisdom? Getting desperate!

Your experience sounds somewhat similar to mine. Has your GP prescribed diltiazem or GTN cream and a stool softener like Movicol or Laxido? Although it sounds like your stool is soft already. Do you have to strain/push at all during BMs? If yes, ask your GP for Movicol or Laxido if they haven't prescribed it already.

It sounds like you're doing all the right things.
Botox should help you as it relaxes the sphincter. It seems like they usually give it under a general anaesthetic in the UK but it's not surgery 'proper'. It's certainly worth getting a referral to a CRS to see what they suggest.

I agree with BU, about the creams GTN or diliatzem as these will def help stop the spasms that pain you are feeling all day. When mine was at its worst it would start about 30 mins after a BM and could last for 12 hours. It was way worse than childbirth I was literally rolling around and screaming, the GTN brought the pain down from a 10 to a 5/3 it never went completely but I could get on with my life.
The Botox basically does what the creams do but Ina stronger way. With Botox your internal sphincter cannot spasms I had great pain relief from Botox it was amazing.
See if your GP will prescribe the creams and if not if they would give you gabapentin the only painkiller that actually worked on my spasm agony.
Also no wiping after a BM I shower the area. Lots of hot sitz baths to relax that sphincter too
Good luck

MPB thank you for the no wiping remark as it's very important. It slipped my mind today! It must be sunstroke from sitting in the garden or something. ;)

Thank you for your kind replies! It sounds obvious maybe but it actually helps tremendously to hear from others who have had similar experiences. I did get prescribed the Diltiazem -- it worked MIRACLES for about 3-4 days but then stopped being quite so effective and then the side-effects kicked in....the worst itching down below I have ever experienced! If I put it on at night, I simply couldnt sleep, it was so itchy....plus swelling, weeping.... In the end I had to switch back to Anusol cream plus Anusol suppositories with Hydrocortisone just to calm down the itching and weeping (and I'm still using it now as it helps easy bowel movements and my doctor said it was fine to use long-term).

I was wondering if you could use Diltiazem in the morning (itching is easier to deal with in the day) and then Anusol suppositories at night? I mean, can you mix up what you are using in this way?

Interesting to hear about "no wiping". As my BM are so easy and painless maybe it is the wiping that triggers the pain 1 hour later? I am so gentle when I wipe but nevertheless....

Here's one more complication -- because my diet is high in fibre, I often have 2 BMs in the mornings. This means 2 lots of wiping. But if I drop the fibre, the BMs will become harder....Catch 22!

Can you ask your GP for GTN (rectogesic) instead of diltiazem? Many people get headaches after using GTN creams but it's certainly worth trying as it sounds like you're better off not using diltiazem. My GP told me to buy Daktacort cream OTC rather than using straight up hydrocortisone cream.

Do do the Anusol products contain hydrocortisone? If yes, don't use them for more than a week or two at most.

Regarding the wiping, it's easier on the fissure if it isn't exposed to toilet paper no matter how soft it is. The most gentle way to clean is in the shower or use baby wipes (I like the WaterWipes brand as they don't burn like other brands, you can strip paint with them...) to gently dab the area.

Some unsolicited advice: make an appointment with your GP, tell them that you've got a bad itch from th diltiazem and ask for rectogesic instead, ask for a Laxido prescription as that will give you consistently soft BMs (keep up the soluble fiber though) and ask for a referral to a CRS. Two separate GPs told me I had an internal hemorrhoid when it turned out to be a sentinel pile. It was the CRS who correctly diagnosed the sentinel pile. I may have some internal hemorrhoids too perhaps but what caused me trouble was the sentinel pile.
Good luck and keep us posted!

Also new guy here with acute fissure,this site is great.
Also similar diagnose like you,doin diet,coconut oil and honey helps,and also laying naked in the sun on my terace helps.
Doin sitz baths 2,3 times a day if i can,
Gonna order rectogesic in a couple of days.

My specialist appointment is June 16. I still can't believe it has come to this though, as every time before it was done in 3-4 weeks and this time it is into the 6th month. I get health anxiety and started to think "cancer" which I know is really stupid as incidences of anal cancer for someone my age is 3 in 100000 (yes really!) but my anxiety issues mean I can't think straight for very long. Also I don't have any blood, etc, and general health is excellent.

I actually think my fissure and health anxiety feed off each other and keep the vicious cycle going. For that reason I am glad to be seeing the specialist. Maybe he will suggest the rectogesic you guys have mentioned, or the botox. I prefer the thought of botox to surgery as botox wears off and for that reason I guess it is less likely to lead to permanent incontinence?

Does anyone take daily painkillers, such as ibuprofen, to help you deal with the pain? I haven't up until now but starting to consider it.

That's good as June 16 is just over two weeks from now. The mental state you get in to when you have a fissure is awful. I've been painfree for three weeks now and I'm starting to relax again when it comes to having BMs. Stress and anxiety isn't good for fissures as we tense up when we're stressed.
I'm surprised that your GP hasn't prescribed rectogesic or diltiazem as you've had the fissure for quite a while. I'd go back and ask for some tomorrow as it helps with the spasms.
The specialist should listen to your concerns and be willing to try Botox first if that's what you prefer.

I didn't take any painkillers for the spasms but I'd like to think that I'm a tough cookie. It possibly would have been a good idea to use some... ;) I have bought a packet of paracetamol for after my surgery. There shouldn't be a problem using painkillers if it helps with the pain. Whatever makes you more comfortable is worth doing.
Sit in the bath as well as that helps with the spasms when you're in the bath.
Apologies for the unstructured answer! I think my brain thinks it's weekend already.

How much an how often do I need to use the diltiazem ointment?