Ok, I am new to this forum and new to the world of fissures. One month ago I had horrible pain and thought it was my hemorrhoids. My family doc sent me to a Hemorrhoid Treatment Center. They tried to do an exam and I about jumped off of the table it was so painful. They gave me cream to use with Nif in it. I used it for a few days and it did not help relieve pain. That weekend I ended up in the ER with severe pain and suffering from lack of sleep. This was worse than childbirth, worse than a appendix attach. They did a flexible sigmoidoscopy and it revealed a fissure. I was sure I had a tumor or growth but they did a CT scan as well and it is all "normal" in there except for the fissure. The Gastro doctor at the hospital sent me to a CRS. He said if I was a man he would do surgery asap but since I am a woman and have damage to the sphincter he would not do it yet. He said I would run the risk of becoming incontinent. I am only 52 and active so that does not appeal to me. He wanted me to use the cream for 2 weeks and if it was not better to schedule surgery. I am up every night until 2 a.m. or so because the spasms are so intense at night. This is affecting my work, family life, and every aspect of my life. Help! What suggestions do you have. I really want to avoid surgery. I am keeping my stools fluffy with my diet, using the cream, drinking plenty of fluids, but still the pain follows me day and night. Especially night!

You need to keep your stools soft and easy to move too. Most of us use miralax or milk of magnesia and a fiber supplement like benefiber or fibersure. I know it keeps me regular and most of the time it helps to keep things soft. You don't want to bulk up with something like metamucil because it makes the stool too large. Sitz baths help so does sitting on a warm heating pad. Try to get some of the ointment inside just a little. Put some on a lubricated cotton swab and try to get a bit inside. I think the spasms are the worst part of a fissure because they can last so long. I sometimes use ibuprophen and valium if things get really bad. That can help too. There are options other than LIS. Flap advancement surgery actually involves cleaning the edges of the fissure and then stretching a piece of skin over it (like a skin graft) to help it heal. Most LIS surgeries today involve just slightly cutting the muscle, just enough to relax the spasms. Find a good CRS you can talk to and ask questions of. I personally think a doctor who would do a sigmoidoscopy without sedation on a person with an active fissure isn't the kind of doctor I'd want to go to. But that's just my opinion. I hope you find some relief real soon Suzy.

There was a time when my fissure acted up real bad and the pain was absolutely killing me. It peaked when I had a bowel movement at work one day and just couldn't get up from the toilet. I swear the pain was a minimum of a 9 out of 10. Wave after wave of extremely painful spasms just kept hitting and I had to be carried out in tears because I couldn't walk. Anyhow I ended up at the ER that day, and the doctors gave me some kind of antispasmodic drug via IV, which stopped the pain immediately, then sent me home with Valium and Percocet to relax the muscle spasm and break the cycle of pain.
I know Valium and Percocet are somewhat controversial (and non-conventional) approaches to fissures, but I swear it helped me, if only for the short term. I was also using nitroglycerin and nifedipine ointments at the time, but the Valium and Percocet took away that crazy throbbing pain and bought me some time for the ointments to work.
I didn't use the Percocet for any more than a few days because I didn't want to be constipated. But that day it all happened, I couldn't have cared less, I just wanted the pain to stop for a moment (and the MiraLAX I was taking helped me avoid any constipation whatsoever).
Anyhow, take it for what it is: my personal experience only. I know others here haven't necessarily gotten the same relief from the same medications, and not everyone believes these drugs should ever be used for fissures. Personally I think it's a mattter of whether the potential benefit outweighs the potential risks, which in my case it absolutely did.

So Neuropathic Guy, did you have surgery?

bengtar wrote:So Neuropathic Guy, did you have surgery?

Nope, I didn't. Not yet, anyway. Some days are better than others fissure-wise. My diet and drug regimen definitely got the fissure under some level of control, but I don't think it's totally gone. The fact that I haven't gotten surgery as of yet is partly because the fissure isn't kicking my arse as much as before (knock on wood) and partly because some other things took priority (we wife gave birth to our twins recently and one of them had a serious complication). I'll need to circle back around to the fissure at some point, but for now the combination of topical nitroglycerin/nifedipine (I alternate between the two and never use both simultaneously) and Valium (only a very low daily dose at this point) with a super high fiber diet and MiraLAX every day is enough to keep the fissure symptoms at bay while I deal with the other stuff going on.

bentagar,
Make sure you give nitro a try. Nif did not do much for me but the nitro really helped relax the muscle.

i remember mine spasm was bad as that ( I didn't slept for more than 3hours a day for more than 6months) :( it didn't go away till after the surgery.

Just had a bit of a relapse myself, really thought I was beating this thing then went on a bit of a bender over the weekend. Maybe the alcohol didn't help but am almost back to square one.
Was awake till 5 am this morning and arrived late for work.
Have been trying to take the Lactulose in smaller regular doses rather than as one dose. Had a BM just before bedtime which was a nightmare the bM was ok ish but throbbed like hell after. I had taken some lactulose about an hour previously. Going to try reverting to morning and possibly lunchtime for the lactulose.
Can sort of deal with the pain during the day/evening but bedtime is a nightmare.
Going to trawl other topics, but does anyone have any advice regarding best time to take the Lactulose (its an osmotic laxative)