Hi all. New here, and very grateful to have found a community like this one. I've been battling a fissure for 3 months now and am weighing my options.

This nightmare started for me in early March after a bout of food poisoning (from salad, of all things). I don't have a history of gastro issues or rectal pain, so I initially thought I'd developed hemorrhoids... but a Google search of "feeling like I'm pooping glass" introduced me to the excruciating world of fissures. I spent several weeks trying to heal it myself (coconut oil, sitz baths, prep H ointment, olive oil, honey, you name it)... and then things got really effed up.

In early April I suddenly couldn't have a BM, which wasn't normal for me. Even with the fissure I was going at least once a day, although in retrospect it wasn't much most days, but it was something. So by the 3rd day, after no luck with Miralax and with increasing rectal pressure, I went to the ER. I was diagnosed with a severe fecal impaction... I truly thought i had some kind of abscess blocking my rectum or something by that point, so the impaction news seemed better than that.... or so I thought. After 4 days and an extremely aggressive clean out (in addition to enemas, rectal exams, and a sigmoidoscopy) the impaction was cleared, but SURPRISE I now have 3 hemorrhoids and my fissure tore deeper.

The past 2 months since I got out of the hospital have been filled with endless pain, spasms, creams, baths, stool softeners, anxiety, obsessing about food and every aspect of BMs, and being basically stuck at home miserable 24/7. I saw a CRS 3 weeks ago who prescribed yet another cream, which did help with inflammation in the area, but did nothing for the spasms that I experience for 7-8 hours after a bowel movement.

At my follow-up appointment last week, the CRS said that my fissure is now chronic; I've developed a small skin tag and, although the fissure itself is not bleeding or ulcerated, it is deep to the muscle and causing the relentless spasms. He recommended I have a fissurectomy, but stated it would just involve him cauterizing the fissure and putting a dissolvable stitch in it, but I can find no info on this method online. Does anyone know of or have experience with this?

Also, how will a fissurectomy help me if the spasms are the problem? He's said that he believes my fissure would've healed already if it weren't for the spasms... but I guess I don't see how stitching it shut, while still having the spasms and reduced blood flow to the area, will help it to heal.

Also, the external hemorrhoid I have bothers me after every single BM and I feel like that may be hindering my progress... along with my randomly bulky/ difficult BMs that seem to happen no matter how perfectly I eat and how many softeners I take. So frustrating.

I'm just trying to figure out what makes the most sense and has the best chance of freeing me from this hell. I don't want to have the fissurectomy if it's not going to fix the problem... but I really just desperately want my life back.

I appreciate any and all insight and advice on any of this.

The journey to a forum like this one is a painful one... sending hugs and healing vibes to everyone here.

I am so very sorry you are going through this nightmare. Your doctor didn’t say anything about an LIS? I have found that the only thing that helps my external hemorrhoid is witch hazel though that does not help everyone and certainly has not taken it away. You’re doing sitz baths?

Tryingtorelax wrote:I am so very sorry you are going through this nightmare. Your doctor didn’t say anything about an LIS? I have found that the only thing that helps my external hemorrhoid is witch hazel though that does not help everyone and certainly has not taken it away. You’re doing sitz baths?

He didn't mention LIS until I asked about how the fissure would ever heal (even post fissurectomy) with the spasms. He said that if during the fissurectomy, once the anesthesia kicked in, my sphincter muscle didn't relax, that would be the sign to him that a sphincterotomy cut is needed... but otherwise he felt the fissurectomy would be enough. I just don't get how the new wound would heal any better than the current fissure if the spasms are still happening and restricting blood flow to the area. I'm seeing another CRS tomorrow for a second opinion

I am doing sitz baths. Nothing seems to help, honestly, and I've developed really severe anxiety and now trouble sleeping due to all of this, which isn't helping anything.

Are you having just LIS done? Or LIS with fissurectomy?

I'm very sorry you're going through this too.

Hi pita,

So sorry to hear about the impaction, that's one of the last complications you want to deal with. At the beginning of my "journey" I was in some danger of that as well- couldn't BM for like 5 days.

It sounds like your doing the right things talking to doctors and getting a second opinion. Doctors generally have a good reason for what they say, but I'd be curious as well why he went straight to fissurectomy and not LIS.

I use lidocaine ointment for the pain (prep-H 'rapid relief'). Also I'm sure your drinking plenty of water, and if I were you I'd drink a lot of miralax as well. I take a full heaping cap every day just to make sure no constipation happens. For me the recommended dose just doesn't do that much.

Bloodybum wrote:Hi pita,

So sorry to hear about the impaction, that's one of the last complications you want to deal with. At the beginning of my "journey" I was in some danger of that as well- couldn't BM for like 5 days.

It sounds like your doing the right things talking to doctors and getting a second opinion. Doctors generally have a good reason for what they say, but I'd be curious as well why he went straight to fissurectomy and not LIS.

I use lidocaine ointment for the pain (prep-H 'rapid relief'). Also I'm sure your drinking plenty of water, and if I were you I'd drink a lot of miralax as well. I take a full heaping cap every day just to make sure no constipation happens. For me the recommended dose just doesn't do that much.

Thank you for responding. I'm realizing I may need to add Miralax into my regimen. I've been using stool softeners since all of this happened, but they don't prevent the occasional hard stool that totally debilitates me and inflames everything (which happened yesterday, ugh). I hadn't tried the Miralax before out of fear of giving myself diarrhea and more BMs - seemed to make sense that 1 BM a day was better than multiple to give things time to heal, and my diet and stool softener regimen works for that... it's just the occasional hard BM still happens and feels like it sets everything back and puts me in excruciating pain again. I am eating such a limited diet and have lost a ton of weight I really didn't need to lose, that I find those hard BMs especially unfair. Have you had diarrhea/ watery BMs with Miralax? Or just soft stool? Do you take it at night or multiple times a day? I know everyone is different, I'm just curious.

I'll update what the the doc tells me tomorrow after the second opinion. She's a great CRS who's operated on my parents before, so I trust her opinion. Would've seen her first but I live out of state now, so I'm actually flying back to my home town tomorrow for the appointment. Desperate times, right?

Are you having LIS?

Pita,
I’m having LIS but he said he might band some hemorrhoids too. I’m terrified of him having to cut hemorrhoids since that is a longer and more painful recovery. He didn’t say fissurectomy but I imagine if he finds it in a way that needs it he’ll do it.

Tryingtorelax wrote:Pita,
I’m having LIS but he said he might band some hemorrhoids too. I’m terrified of him having to cut hemorrhoids since that is a longer and more painful recovery. He didn’t say fissurectomy but I imagine if he finds it in a way that needs it he’ll do it.

I have the same concern about my hemorrhoids. I have an external one that really bothers me, but I am afraid of the awful recovery for that procedure, especially while battling whatever I have to endure to get this fissure to heal.

I hope all goes well for you... I'll keep an eye out for your updates.

I take miralax at 6pm. In three months i've had a random watery BM in the middle of the day 3 times. Not a big deal really, the watery BMs don't actually hurt much compared to the regular ones. If it makes your stool overly loose or watery you can dial back, I'd say better than constipation or god forbid another impaction.

Pita, what did the CRS say? Are you eating a high fiber diet? That has really helped to make my stool soft. I had to really learn the best amount for me though. They say 25-30 grams a day for a woman but 30 made my stools too formed and big. I try to get 22-25 grams a day. I bought an app called Lose It that helps me keep track of how much fiber I’m eating a day. It’s supposed to also track calories but at this point I’m lucky if I get 1000 a calories a day. I’ve lost 20+ pounds in about 6 weeks. It’s hard to eat. I am eating and I am eating healthy but it’s just hard to eat when you know that’s going to have to come out eventually. I would also try the miralax. It does sometimes make me go more than I’d like to and I’m still figuring out what the best combination is. Right now I’m trying to take the miralax every other day but I’m taking stool softener every day. I have no idea which is the best combination and it has been frustrating trying to figure that out. It is a relief though to go and feel empty rather than not. I was doing too much miralax at one point though (more than once a day) because that is what was recommended to me by my GI doc. I have been to several doctors though and they all say something a little different. The first surgeon I went to was of the “let’s see if it will heal” camp. Well that was about 3 weeks ago. My LIS surgery is on Jun 18th so I’ll post updates.

Tryingtorelax wrote:Pita, what did the CRS say? Are you eating a high fiber diet? That has really helped to make my stool soft. I had to really learn the best amount for me though. They say 25-30 grams a day for a woman but 30 made my stools too formed and big. I try to get 22-25 grams a day. I bought an app called Lose It that helps me keep track of how much fiber I’m eating a day. It’s supposed to also track calories but at this point I’m lucky if I get 1000 a calories a day. I’ve lost 20+ pounds in about 6 weeks. It’s hard to eat. I am eating and I am eating healthy but it’s just hard to eat when you know that’s going to have to come out eventually. I would also try the miralax. It does sometimes make me go more than I’d like to and I’m still figuring out what the best combination is. Right now I’m trying to take the miralax every other day but I’m taking stool softener every day. I have no idea which is the best combination and it has been frustrating trying to figure that out. It is a relief though to go and feel empty rather than not. I was doing too much miralax at one point though (more than once a day) because that is what was recommended to me by my GI doc. I have been to several doctors though and they all say something a little different. The first surgeon I went to was of the “let’s see if it will heal” camp. Well that was about 3 weeks ago. My LIS surgery is on Jun 18th so I’ll post updates.

Your experience sounds just like mine. I've been having the exact same battle with diet- incorporating fiber, which helps me go daily but makes my stool too bulky to go comfortably. I've been eating under 1000 calories a day because I struggle to know what to eat that won't give me hard or bulky BMs, and because of the fear of "what goes in must come out." I've lost almost 25 lbs in 2 months and truly feel weak from it and the pain most days. I know I need more calories, but from where?! (I track mine in the MyFitnessPal app.) I take stool softeners every day twice a day. I'm now incorporating Miralax.

As far as my second opinion visit, I flew back to my home state to see my parents' CRS who we trust and have known for years. I saw her at 3pm on Thursday (June 13th)... I explained what's been going on and what the other CRS said, and she outright said that I probably need surgery if I ever want to get better since the fissure is chronic and the spasms are so aggressive and causing me so much pain. She took me into the exam room and (sorry for TMI) couldn't even get a q-tip with numbing gel into my rectum to do an exam because my sphincter muscle is locked so tightly. She examined what she could and took me back to her office, where she said I definitely need a sphincterotomy as soon as possible, and that she wasn't sure how I've been functioning with the pain I must be in from the muscle spasm. She said I may need more done too, but because she couldn't do a full exam at that point, she couldn't say for sure. She also said she would "clean up" the edges of the fissure so it can heal properly and likely remove the skin tag. It was at that point she asked if I was up for the surgery as soon as the next day... because she was so concerned about the state I'm in that she didn't want to wait.

I agreed and went in for my surgery yesterday at 8am. I had a sphincterotomy, hemorrhoidectomy, "clean up" of the fissure, and skin tag removal. I am in a ton of pain and of course very freaked out by what has happened, but I knew that I couldn't just keep living how I was. I also will be healing at my parents house, out of state, abruptly, and have had to rearrange a lot of things in the last few days to make that doable. My husband and parents are saints for all the help they've given me.

Your surgery is coming up soon so I don't want to freak you out, but so far this has been no picnic and I don't think I'll be one of those "I feel great in 2 weeks!" success stories. I am hopeful that it will be worth it though, because I know that I couldn't live with the sphincter pain and spasm forever.

If you want to chat, feel free to message me. We can try to get through this together.