I'm a 22 year old male and I've been a sufferer of this affliction since December '09. I'm really glad to have found a place where there are other people who have the experience and guidance to help me through this process. It is emotionally tiring and wearisome. When I try to share this with my family or friends, they can't relate at all and I don't get much peace of mind when trying to discuss this with them.
Well, it first occurred when I was abroad visiting family in England. I first spotted a red toilet bowl after straining heavily after a meal and ever since it's been an ongoing battle for control. I have sometimes experienced the itchy effect but have never had a substantial amount of pain or bleeding last throughout the day after a BM. Since coming back at the beginning of January, it's been an up and down struggle trying to find someone who was capable of figuring out what's going on with me. I've seen plenty of doctors who gave their usual hemorrhoids lecture, only for me to continue experiencing outstanding pain despite taking heed of their advice and medications. I was prescribed proctofoam and nitroglycerin which felt like it was doing something, but never alleviated my symptoms for longer than a couple of days. I even had a sigmoidography (sp?) done to check for anything unusual. They found nothing alarming, but told me I had hemorrhoids that looked liked they belonged inside of an older person. o_O It wasn't until late July when I saw a specialist and he recognized my symptoms as an anal fissure. He told me it was very minor and that I wouldn't need surgery for it to heal. At the most he told me it would heal itself in a couple of months and a change in diet to include high amounts of fiber would benefit me greatly.
I changed my diet significantly to get this thing taken care of and it too has also been an up and down battle. I take about 2 teaspoons of Metamucil a day while incorporating plenty of high-fiber foods as much as I am able. I've grown accustomed to having a bowl of Kellogg's All-Bran cereal every morning and 2 teaspoons of metamucil mixed in a glass right afterward, usually with a wheat grain peanut butter sandwich for lunch and whatever I like for dinner. I've also been taking Miralax from time to time, but never for more than a week at most as stated on it's label. Is it safe to take Miralax daily for an extended period of time? I was doing great all throughout August and September with absolutely no pain nor bleeding when having a BM. Granted, I made sure to spread Vaseline around my anal area before ever using the restroom each and every time I went. Today however after some heavy lifting and moving of furniture and a hardened stool later I experienced a pure red toilet wipe. Plus my diet has been horrid for the past few days with Halo Reach since coming out and I haven't been getting any exercise as well. I am absolutely devastated and now I'm worried that whatever progress I made was tossed away. It's strange as I don't remember having any sort of pain or discomfort when having that BM earlier today.
Could it have been the 4-5 hours of straining while moving furniture all over the house that caused me to have bleeding? Should I go see the specialist I saw earlier and ask if I need a procedure done or wait it out and see how I feel in a couple of days? This is probably the worst I've had it since late July and any feedback would ease my troubled mind.

Hi Rakuen..
If you've been suffering since December 09 then it's likely that your fissure has become chronic and is more difficult to treat, I find it strange that the docs said you have hemmorhoids that belong in an older person maybe they have grey hair or something LOL
On a more serious note, it's possible to have no pain or very little pain and bleeding or not, although bleeding can be due to hemmorhoids also, if you have a fissure though you'll be having spasms from the sphincter muscle and tightening which makes BM very difficult and usually painful, these are the classic symptoms together with blood on the TP or in the Toilet bowl.
With regards to the Miralax, it's totally safe to take it regularly, most of us on here, me included have been using it for months, personally I will take it for the duration as long as it makes going to the toilet easier.
It's possible you did pull some muscles during lifting, any kind of lifting will pull on the anal muscles which is not good for fissure sufferers and yes it could of caused the bleeding, I would make an appointment with a CRS to get double checked for AF, if it's chronic (most likely) then surgery is the most effective solution.

Well it happened again. After a while of having no pain or bleeding, my BM from tonight and the night prior have sealed the deal. I'm considering talking to my doctor about the possibility of having an LIS done. Is there anything specific I should ask about this procedure before jumping in with both feet? I've had to endure this for almost a year and I am tired of dealing with it. It's time for me to move on from this and get on with my life.

Find out everything you can about the surgeon. Mine had the reputation as the best CRS in this part of the state but I still peppered him with tons of questions. These are some I asked:
1. How many LIS operations do you perform?
2. What is your personal success rate for healing fissures ? (some docs will quote you the success rate across all doctors in their clinic - you want their personal success)
3. Have any of your patients had recurring fissures?
4. Have any of your patients had issues with incontinence after the procedure?
5. What is the recovery like? How long can I expect it to last?
This isn't an easy decision to make so no question is out of bounds here. My CRS was happy to answer any and all that I threw at him. If he wouldn't have been so willing, I think I would have looked elsewhere. I wasn't in this to protect his ego. He was absolutely wonderful.
I am now 3 weeks into recovery from my LIS and I couldn't be happier with my decision. The first week or so after the surgery I had discomfort from the incision and general soreness from the procedure but I haven't felt any of the old fissure pain since that day. There has been nothing outside of what my CRS told me to expect. I truly believe that choosing the best surgeon is a number one priority. That is if you have the option available. If I was still living in my home town, I would have no choice at all which is sadly the case for a lot of people.