Hi. I am new here.
I have a 3rd appointment (in 2 weeks) with a CRS tomorrow. I was diagnosed with a fissure at the first visit but it hurt all the time so I went back to have it looked at because it seemed like it was getting worse not better.
Then for the past few days it has been great. I felt I was on the mend and pretty excited. Then today at work it started to hurt, then hurt so badly I left work. I took a hot bath and 400 mg of ibuprofen and felt a little better but the fact I left work I decided to call the doctor.
When I originally was diagnosed I was told if I was not "better" in 2 weeks I should schedule a surgery. I was given Analpram and told to add fiber to my diet. My diet is pretty excellent because of the following experience.
I had an external hemorrhoid removed 3.5 years ago and I would do anything not have a surgery on my anus ever again - and hence the excellent diet. I was told by that CRS (different from current) that it was nothing big and they do these all the time - it was done in the office at my first ever appointment. It was a Thursday (I will never forget) and I was told I would be "good to go" by Monday for work. That was the biggest lie I have ever been told. I was in pain that made me cry like a child for 2 weeks and could not sit long enough to even get to work in a car for over a month. At 4 months I still had bleeding - infrequent but there - and it was almost a year before I thought I back to at least as good as before; I was not better but as good as before surgery. It was the biggest mistake I have ever made in my entire life.
I would do ANYTHING to avoid surgery. Someone here must know of dietary changes - no matter how extreme - or naturopathic, or homeopathic remedies - cost is no object - I can try. Who on the board has avoided surgery and cleared up there AF problems? How did you do it?
I can work from home, prepare all my own meals, have a natural healing center type place a few blocks away where I can get plant extracts or whatever, I will build a new squat toilet in my house, anything, anything anything to get better without surgery.
PLEASE help me. I cannot go through a surgery; I cannot handle the emotional and psychological trauma. I am desperate. My mental state is so bad; surgery will destroy me.
I do not think I can make it through recovery and I have no faith that I will actually recover.

Super,
Welcome. I am glad for you that you have found our little group. I don't think LIS can be compared to having a hemroid surgically removed. I was able to heal my fissure with Diliatzem ointment, which has also helped many others. Fissures can be mentally challenging. But there is much hope for you. Stay positive and learn from the many members of this group.

Hey there,
Welcome to the group. I had surgery for my fissure, but some people do indeed heal them without surgery. Basically for fissures the things that can be tried are as follows:
OINTMENTS
2% diltiazem
0.2% nitroglyerin
0.2% nifedipine
DIETARY CHANGES
High fiber diet
Lots of water
Stool softener such as Colace, Miralax, etc.
NON-SURGICAL TREATMENTS
Botox injections
SURGERY
lateral internal sphincterotomy
fissurectomy
Most people try the ointments first. If those don't work, then some folks consider Botox. Others go straight to surgery. Regardless of what approach they take, a good stool softener is a must.
Looking at your history so far, my personal thoughts would be as follows:
1. I don't know long you've had your fissure. If it's just been a few weeks, then you still have a very good chance at healing it without surgery ... but only if appropriate measures are taken. Once fissures go chronic, they become very hard to heal, so it's imperative that you start with fissure-appropriate treatments now.
2. "Fissure-appropriate treatments" do not include Analpram. Analpram is just a mix of hydrocortisone and pramoxine. I was given the same stuff when I first got my fissure. It is absolute GARBAGE for fissures. Most everyone here has had hydrocortisone thrown at their fissure in the beginning. Most everyone here has gotten no progress at all from hydrocortisone. It's useful for hemorrhoids (which is an inflammatory condition) but a total waste of time with fissures (which are due to a spasm of the sphincter muscle which in turns reduces blood flow to the area). I know it's hard to second guess what a doctor prescribes. But I can't stress this enough: DO NOT mess around with hydrocortisone when you have a fissure. It will only increase the odds of it going chronic and requiring surgery.
3. Ask your CRS about one of the ointments above. Most CRS have a personal preference of what they find most effective. But if you look at the medical literature, the data is all over the place. There's no consensus on the single most effective one. IMO they're all comparable. Individual results are what matters. I tried them all and found nitroglycerin to be the most effective for me. Use the one that works best for you; if one doesn't work, don't be shy about asking for another. Note that if you do try nitroglycerin, it does give you pretty bad headaches in the beginning. These completely subsided with time for me, and they do for most folks, but for some they're intolerable.
4. Use a good stool softener right away. Doctors love recommending Colace (docusate sodium). If that works for you, use it. It didn't do a thing for me. I personally like Miralax. It's worked for many here that Colace didn't help. Again, try and see which one works for you, regardless of what others or even your doctor says.
5. Dietary changes can help get things under control. Most fissure sufferers reduce or completely remove red meat from their diet. I personally ate a ton of boiled veggies. It helps a lot with stool consistency. For protein I ate boiled chicken and fish. Your mileage will vary here, but boiled veggies are a pretty safe bet.
6. If you do have to have surgery, it likely won't be like hemorrhoid surgery. Hemorrhoid surgery is supposed to be a lot worse than fissure surgery. This is particularly true if you "just" get LIS (lateral internal sphincterotomy) without anything else at the same time (such as a fissurectomy or skin tag removal). All surgeons underestimate recovery times. This true whether it's anorectal surgery, knee surgery, whatever. They give you the best case scenario and most people don't recover anywhere close to that best case estimate. But most folks do very well in the long term after fissure surgery, and again, if you've had hemorrhoid surgery, this would likely be a walk in the park by comparison IF you even get there. If you follow the above, or at least a good part of it, odds are pretty good that you won't get there :)
Anyhow I know that was long winded, but I personally went through all of the ointments, got Botox, and finally had LIS. My clueless doctors gave me hydrocortisone in the beginning, I spent months looking for some magic cure and tried all kinds of remedies, etc. etc. A lot of us did, so we know how it goes. I've tried to summarize some of the things I've learned from my own experience, so hopefully it helps you. I'm sure others will add their own helpful tidbits. Best of luck tomorrow!

I second what NG says above,
Try to heal with everything available first before opting for the surgery, if your fissure is in it's early stages then you'll have a great shot at healing.
Best of luck.

NG,
Good info/summary. Why don't you list that as a "sticky thread" so you won't have to repeat for other new people.

NG is very thorough :)
He helped me out so much. I agree, he should post this in the sticky thread.
I just wanted to say-
LIS isn't that bad. From what I've read, hem. surgery is the worst. Good luck on your healing but don't be afraid to have lis- if it comes down to that. I understand your fears. I was the same way. I made myself crazy for no good reason. I wish I had of done the surgery sooner. Take care & good luck.

The CRS says the fissure is healing but I have a small thrombosed hemorrhoid. Also, he said I am not on one of the more common fissure creams because I get migraines - I would likely not be able to tolerate it.
He said the clot will mostly likely reabsorb but if not...
Does anyone here have experience with treating a thrombosed hemorrhoid? This is basically the problem I had before and that surgery was awful.
I know this a fissure forum but it is the first place I have found for my bum problems that is not covered with advertisements for miracle cures disguised as posts. Folks here seems to know and understand the difficulty of bum issues and are trying to give good advice.
I guess I keep up with the fiber and hot baths but is there more I can do to promote healing?
Thanks.

I think those things can be lanced to remove the pressure and pain.

Hey supersad, I don't think many of the current board members have had thrombosed hemorrhoids :( A lot of us have had "garden variety" hemorrhoids at some point, but that's about it. I think maybe PaulsPain had hemorrhoid surgery if I recall correctly. I'm not sure if his were the thrombosed type though. I know the medical literature says to surgically treat those, but beyond that am not real qualified to say, unfortunately.
About the fissure ointments, though, I don't quite follow. Nitroglycerin is known to cause bad headaches so it would make sense to avoid that one if you get migraines. But nifedipine and diltiazem aren't known for any such side effect. It's entirely possible for some people to get headaches from them, I suppose, since there's no accounting for our individual biochemical differences and anything is possible. But in general, fissure victims with migraine problems should still be able to use nifedipine or diltiazem. I have to disagree with the recommendation to keep using Analpram and nothing else. It's true that many acute fissures heal without any particular treatment outside of keeping stools soft, and the Analpram may be good for the hemorrhoid, but it's probably doing nothing for the fissure. Hopefully that one simply takes care of itself...

hi supersad,
i had a really nasty fissure for about four years (took about six to completely heal though).
the turning point for me in year four was diving in deep into a macrobiotic diet.
i have a very sensitive stomach/digestive system apparently and having that macrobiotic time really helped turn things around.
never did the LIS and never was given those creams or done botox.
all the doctor ever gave me cream wise was palmer's cocoa butter. LOL!
squatting is a plus if you can do it.