I'm worried after a visit to a local dr. yesterday. It turns out that now I have three separate fissures (when my fissure problems started three years ago I only had one), and this lowers my chance of success with LIS (from 98% to 90%). I'm still afraid of the surgery and although I have pain with every bowel movement, things could be worse. But now I'm wondering--if I had had the surgery back when I had only one fissure, my odds of cure would have been better. If I continue this way, is it possible or likely that I will get worse or less likely to be helped by surgery later? Is it risky to NOT get the surgery? I wish I would have thought of these questions while I was in the dr's office!
Also multiple fissures raise suspicion for more sinister underlying conditions, although my dr. yesterday said that my fissures don't look suspicious for such things, and in fact don't look chronic (no tags or anything). But this was just from looking at the outside.
Anyone here have any similar experience and/or advice?

I'm about a month after surgery and the jury's still out for me as far as whether it was a good idea. When I went in for surgery, my fissure wasn't causing me that much discomfort, so for me the pain was more after the surgery than before. But if I had gone in while my fissure was totally kicking my ass, I'm sure I'd be singing a different tune. Also, I had a complication that required a second surgery, so that kind of skews my perspective and recovery curve, I suppose.
For me I think it would depend on how much pain you're having. If the fissure is causing great discomfort, then that's one thing, if it's just a minor nuisance then that's another.
But yeah three fissures at the same time is a lot. I'd definitely consider some other diagnostic tests to rule out underlying conditions before going through with surgery. If you have Crohn's disease or ulcerative colitis, for example, the surgical wounds will take a really long time to heal, much longer than in a normal person. I'd think a flexible sigmoidoscopy or colonoscopy wouldn't be a bad idea. If you want something less invasive, an abdominal/pelvic CT scan with contrast is another option, but it has lower diagnostic value than actually getting scoped. Obviously getting these tests is no fun (I hated getting my colonoscopy) but it's better than having a surgical wound that won't heal properly.
Also, I apologize if you're already stated this before in the past, but what treatments are you trying or have tried so far for your fissure(s)?

Where are your fissures located ??? :roll: If they are off regular 6 and 12 position, you definitely need to do a scope and maybe local biopsy to eliminate the Crohn's located just in the anal area which is possible.
I would choose the Colonoscopy over CT due to more accuracy and also due to VERY high radiation dose associated with CT
I also do not understand why (if you do not have other underlying cause for fissures) LIS would have less effect in healing . If your sphincter is tight - than LIS or other relaxing methods are necessary to promote the healing - ABSOLUTELY !!!!
Did your CRS ever measure your sphincter pressure with manometry or at least with a finger ???
If you are tight - LIS can only help and 90 % does not seem small % IMO anyway.
The bottom line is that you should ask for more explanations, do more exams and even ask for a second or third opinion. That is what I would do :roll:
Best of luck with it all

NG and Fissulyna, thanks for your thoughts. I'm so glad that I found this forum.
Actually I saw a CRS who has a lot of experience with LIS, and he's recommending that I do it. He didn't mention anything about testing for underlying causes like Crohn's or colitis. When he said there were three fissures and that they're off the regular 6 and 12 position, I asked him if that could mean something more serious, like cancer, and he said that it didn't look like that to him. He said the three cuts are on the surface and that I don't have tags or anything else going on. He only looked at the surface, didn't put a finger or anything else inside--which I was very happy about at the time.
I've looked up Crohn's and colitis and they don't sound like me--I don't have diarrhea or abdominal pain, just fissure pain. Also I had a colonoscopy two years ago and it was completely normal. I was already suffering from fissure(s) at that time, so if the fissures were related to Crohn's or colitis, that would have shown up on the colonoscopy, no?
NG, you asked what treatments I've tried. Here's my story: I got my first fissure 3 years ago, tried diltiazem, got a rash and then an abscess that had to be drained 3 times, and spent the next 2 years + on conservative therapy only (fiber, stool softeners, diet, baths), fighting off fissures the whole time. I'd get a little better for a week or two, then have a tear and be in bad pain for days or weeks. For the past few months, I've had bad pain with every BM (and usually bleeding too), but the pain generally goes away or at least starts to fade after 10 or 15 minutes. For the rest of the day, often I more or less forget about the fissure, but sometimes I have some pain or irritation--but nowhere near as intense as right after the BM. I started using nitro about three months ago and I think it's helped a little, but I'm not sure.
I've heard about people who have severe, incapacitating, round-the-clock pain from fissures. That's not what I'm having. I'm not even sure if I have the 'spasms' that people talk about--what I feel mostly is a burning, stinging, bleeding kind of pain. It happens with every single BM and is distressing, but is that bad enough to risk surgery? On the other hand, I seem to be getting worse--three fissures where there used to be one, and it didn't used to be that every BM was so painful too. So, if I don't go for the surgery soon, am I putting myself at risk of degenerating further, and maybe reducing my chances of being cured when I finally have to have the surgery sometime later?
NG, you mentioned that you weren't feeling so bad when you went for the LIS--were you like what I'm describing? And are you feeling any progress now as the weeks go by?
Well, that's it for now. Thanks again you guys for your thoughts. Best wishes to all...

Hrm yeah if you already had fissures when you had your colonoscopy, I'd think it should pick up more sinister underlying causes. I've read that in rare cases, Crohn's can manifest in the small intestine first (beyond the reach of a colonoscopy), but if it were causing your fissures, I'd think there would definitely be some inflammation visualized already.
Have you tried other ointments besides diltiazem? I tried nitroglycerin, nifedipine, and diltiazem and found that nitroglycerin works the best for me. I also had Botox injections and that healed my fissure for several months but then I re-tore it. It could be something to consider if you want to try something other than LIS.
When I first got my fissure, I did have severe, extremely intense, and yes very, very debilitating pain, along with bleeding during bowel movements. I definitely had the sphincter spasms -- for me it felt like my anus was constantly (and painfully) pushing to poop. All of that stopped after months of ointments, stool softeners, and finally Botox.
After I re-tore my fissure, the pain (it was more like "discomfort") was much more manageable. I don't know if that's because I got used to it, because I was managing it better, or simply because the fissure went chronic and my nerves were deadened to the sensation.
I think I was actually feeling less pain than you are now when I went in for LIS. Although my diet was still mostly veggie soup, I was able to eat other foods (potato chips, chocolate, fried foods) here and there without causing any problems. Bowel movements actually usually didn't hurt, they just felt mildly uncomfortable on most days, and moderately uncomfortable on bad days. It was just that I had some lingering discomfort that wouldn't go away no matter what. The discomfort was a dull ache most of the time, although I did get some sharper pains on occasion that radiated up toward my lower back. The discomfort kept me from doing things like running or riding bikes, but not from doing anything else.
As for my progress after LIS, well that's a little complicated (literally). I had LIS a month ago, developed an abscess 2 weeks in, and then had a 2nd surgery to have the abscess drained. So it's only been 2 weeks since my 2nd surgery. I do feel some progress, but it's been very slow. Right now I honestly have to say that I feel worse than before surgery. But my hope is that in the long run, I'll be better off -- I just can't say that just yet though.
LIS was the last option for me, too, which is why I tried everything else first. There are some risks either way. With three fissures, you could potentially get another, or one could get infected, or they might just become harder to cure (even with surgery) as time goes by. If you get Botox, a bad injection could cause a thrombosed hemorrhoid or something. And of course with LIS you could get some kind of complication like I did... Personally with three fissures I'd consider at least trying Botox and definitely give LIS some thought though.
If I had to sum up my experience with surgery, right now I'd say that I wish I had done it earlier when my fissure was causing me severe pain. That way I wouldn't feel like I was in more pain afterward. If you ask me again in a month or two, I'm hoping I'll have something different to say at that time though :)

Well, you know , I really do not want to scare you or anything , but the fact that fissures are not at regular position is even more concerning and having infections on top of that can definitely point to inflammatory process present in your anus. Yes- Crohn is most of the time present in the upper colon - but can be located only in the anus and we have a member here who had that exact scenario going on . His name is Bernard and user-name Berhna , I think - NP- do you remember the user name ???
Having fissures that are not on the classical position is one of the signs of "atypical fissures" and having more than one also : ((((.
If I were you - I would ask about possibility of present strong inflammatory underlying cause and ask for all tests necessary for that particular case.
Bernard suffered for years with such fissures until they finally diagnosed him properly and prescribed Canasa foam and he recovered very fast ! I do not know where you are located - Bernard was finally diagnosed in mayor research hospital in TX.
I really hope that you will seek further evaluations and maybe go to GI doctor who would know how to test for those rare disorders. You might be having something that can be treated different way than with a LIS
Best of luck, and please read all threads made by Berhna and especially his last post here : ) !

Hey Fissy, good memory :) Yep here's his thread on his atypical fissures:
http://anal-fissure.org/general-anal-fissure-discussion-f2/my-break-through-with-stubburn-fissures-and-fistulas-t2112.htm