Hello,
I am in the military currently deployed. Back arounfd May 2011 I got what appeared to be a stomch virus in this foresaken thrid world coutry in southwest asia. Needless to say, during my stomach flu, I had about 1 weeks worth of th emost painful diarhea ever in the history of this event. There was mutiple explosions on a daily basis during BM in this period. I like to call this phase of my life explosive diarhea. In the past years prior, I have had small hemorhoids, and can recall times where I saw some blood in the toilet paper, but they were never there long enough to bring up any concerns by myself or doctors. Now during this explosive diarhea it felt like no other burn ever before down there. It was like a dragon just kept flaming the area without rest. After my stool came to regain it's streghts I did not think much of the burning sensation and things appered to be ok. The first week of june I began to lift wegiths and almost immediately a hemorhoid came like no other before. I figured I would change my eating habits and things would get better. A month later I found myself loosing sleep and not being able to concentrate in anything due to the constant throbbing and painful feeling coming from the region. I quickly saw a local medic who said probably had an infection and gave me antibiotics. I took these for a month with no success whatsoever. My wonderful wife and mother sent me almost every over the counter product for hemorhoids as the medic on site here did not have any. I instantly fell in love with those preperation H wipes and used them as tuck pads. THe 1st week of agust I saw able to make a 2 hour trip to see a PA. They did a blood test and told me there was nothing they could see wrong, but ended up giving me some novacine cream and fiber lax suppliments. A week later I saw a doctor at another location and he told me I was recovering from a thrombose hemorhoid, gave me medicated suppositories, wich hazel tuck pads and some anti-inflamatory medicine called naproxin. Also told me to follow up in two weeks and if matters were not improving tha he would send me back home to the states to see a surgeon for hemorhoid removal. I was not able to get back in those two weeks but made it a month later the first week of SEP. With my luck he was no longer woking there and had returned to the states, but I saw another PA. She told me that I had exterior and internal hemorhoids and gave me more medicated suppositories told to take sitz bath (as if I could do that where I am at) and some metamusil and sent me on my way. When I arrived back at my usual location, I used my laptop's camera to see what exactly were these doctors looking at. I did not see any hemorhoids but did see what appered to be a fissure( I compared it to pictures online) at the 6 o'clock when I lay on my back. Immediately I began to panic introvertedly and continued to follow all the reccomendations from the medically trained personnel. To this day I have found no remedy. I have read forums online and most the suggestions I cannot attempt due to the lack of resources, medically and hygene wise. Everyday I wake up with the fear of it being one of those days that I have to grasp and clinch my fists and grind my teeth when the spasms come in. Most days I just take the spasms like a champ, thanks to the preparation H wipes I was sent from home and that I keep above the area on a 24 hour basis, nothing else soothes the pain.
Well that is my inroduction frommy current phase of life called explosive diarhea! I believe this is what triggered the whole thing to begin with.
I am looking for any advice, words of encouragement, and ways I can remedy the cureent situation until I can go back home and see a specialist or a surgeon.
Thank YOU for reading this post and passing on some kind words and knowledge I may be lacking at the moment. Feel free to ask any questions regarding my symptoms but please refrain from asking about my job and military activities.

Hi Myass! I'm Canadian, but I just wanted to thank you for your service. I'm a lefty-liberal peacenik (like most Canadians, eh?), but I still appreciate and admire what you're doing. You are really brave and your service means a lot!
I honestly think you are the strongest person I have ever heard about! Anal fissures are among the most painful afflictions known to humans! (I don't know about other primates). In my opinion, if you can see what looks like a fissure, you very likely have a fissure. Lots of doctors diagnose us with hemmies, but we actually have fissures (that is SUCH a common story on this forum). Unfortunately, the hemmie meds can make things worse. The pain-killing agents in hemmie meds can ease the symptoms, but over time, the hydrocortisone and other meds can thin the skin and cause other problems. At least that's been the experience of many of us here.
I'd advise going back to the doc and asking them to check you for a fissure, and then asking for proper fissure meds, like Diltiazem, nifedipine, or nitro ointments. Those are vassodiators, which promote blood flow to the fissure, which in turn promotes healing. Acute fissures (those that are younger than 6 weeks old) can heal on their own with stool softeners and lots of hot/warm baths. Chronic fissures, those older than 6 weeks, are much harder to heal. They are also characterized by spasms, which would account for the throbbing/burning pain you are experiencing. The spasms prevent blood flow to the fissure, and that's what prevents healing. Thus, you need ointments that are designed to heal fissures, and not just hemmie creams. Lots of hot/warm baths are also important for healing, again to promote blood flow to the fissure. (I guess that might be a problem where you are, though).
Unfortunately, the success rate of the ointments is pretty low. Very often surgery is needed to heal the dern thing! Some folks get botox injections. That has a moderately good success rate, but usually more than one round of injections are needed, and recurrance rates are pretty high.
The gold standard treatment is a Lateral Internal Sphincterotomy (LIS). The surgeon makes a small cut to the internal sphincter muscle so that the sphincter loosens up and stops spasming. The success rate is very high (90-98%), and the complication rate is quite low. Among the complications are incontinence to gas (from what I've read, that's about 10-30%), incontinence to liquid stool (2%) and incontinence to formed stool (less than 1%). Other complications include fissure recurrance and infection (abscess and fistula formation) at the incision site. But, again, those complications are relatively rare.
Lots of people really hate the idea of getting ass surgery, for understandable reasons! But many of us here would say getting an LIS gave us our lives back. That includes me. I had an LIS back in May and it gave me my life back. So please try not to worry too much if it looks like surgery is the way it's going to go for you.
I really, really wish you could get your butt back home for proper treatment because if you have a fissure, it's not likely to heal without proper medical treatment, and maybe even surgery.
Also, stool softeners are and important method of treating fissures. Keeping the stools softs helps you avoid traumatizing the butt and it helps you avoid straining to go - and no straining is very, very important. So if you can use them where you are, you might want to ask your family to send you some Miralax (that's a favourite stool softener among the folks here).
I hope I'm not making you more anxious. I'm just trying to give you as much information as I can in case it will help you out. Don't despair! With proper treatment, you can get past this and get back to your life. This is a common ailment among young, healthy and active people, so you are definitely not alone! You are, however, dealing with this in very difficult circumstances and you have all of my sympathy and admiration! You're one tough sonuvagun!
Hang in there and stay safe, buddy!

Hope, thanks for the words of encouragement. I cannot beleive I have been dealing with this pain for 5 months now, and haven't even been able to take one sitz bath. I can only imagine how glorious they must feel. I think I am going to stod using the hydrocortizone cream based on your recomendations, because I beleive the scar tissue forming around that area is now turning whitesh/greyish, and I believe its due to the cream. The biggest surprise to me is that I have had blook on the TP just once and it was so minimal. I was wondering about the PrepH wipes with witch hazel and aloe, should I continue to use those, I just keep them around the area to provide soothing moisture. I really wish I would of gone home 3 moths ago, but since it is not "LIFE THREATNING" (life, limb or sight) not too many people care. I have seen the LIS on youtube and it doesn't really look like something a normal person looks forward too, but this guy cannot wait to stop feeling on the verge of going nuts over this. I hope to be cured sooner than later. 1st diagnosis was an absces, 2nd was there is nothing wrong, 3rd you are recovering from a thrombose hemi, 4th you have internal and external hemis.....I just hope they would listen to me next time and stop thinking they know everything before actually seeing me, the patient. I have not done any exercise in 2 months, I want to get back in the gym and in good shape. I feel as if my whole life is falling apart in front of me. Whenever i start to even try and pickup some weights its like a hemi, or tag, or something right next to the fissure acts up again and makes it 3 fold worse. So for now I don;t lift anything I do not have to, execpt this dang 100lbs rucksack I carry on my back at times. Well I hope yo hear back from this place soon, GOD bless whoever started it you are an angel from the rearest place a man has in this wonderful place we all share. THANK YOU! i will do my best to keep updating here and throughout in regards to my experiences and (fingers crossed) upcoming recovery.
Can the LIS be done by a general surgeon, or does it have to be done by a specialist?

It still amazes me how freakin' clueless doctors are!
So many of us here had to fight like hell to get proper treatment. We get dismissed and belittled and ignored. No, a fissure is not life-threatening, but it is health-endangering. Many of us here lost LOTS of weight and muscle tone, our digestive systems got messed up, and we generally got rather ill - fissures aren't life threatening, but they are not trivial either. They can be worse than hemorrhoids and it's bloody time doctors understood that! Sorry for the rant - I've just seen this so often, and it's so unfair!
I don't know about the witch hazel or Prep H wipes. For some people, they can cause too much irritation and over-dry the area, which is not good for fissures. I found that anything put on the butt irritated the tissue there and caused swelling and pain. Other folks use aloe ointments or vit A and D ointments. Maybe others here can chime in with advice about that. I found it helped to use alcohol free moist wipes instead of toilet paper. You can also buy sitz baths at a drug store. I wonder if your peeps can send you one? My fissure bled like you wouldn't believe, but I've read on here that some folks didn't have a lot of blood, so that might not be too unusual.
Lifting is a not a great idea with any kind of butt problem, but I understand you can't really avoid it all the time. That tag you describe might be what's called a 'sentinel pile' or 'sentinel tag'. It's like scar tissue 'stands up' to protect the fissure, and it's a classic symptom of a chronic fissure, I'm sorry to say. If you point it out to your doc, and if you ask them to look it up, s/he might finally get a clue and realize you are a potential candidate for surgery.
I think a colorectal surgeon is best for an LIS, but a general surgeon with good experience with LIS might be fine too.
I don't know how it works in the military, but if you can, fight like hell to get proper treatment. Too many doctors don't treat fissures nearly as seriously as they should, and you really have to get assertive with them to get the proper attention. I hope you're doing okay. :D

My heart goes out to you man. Thank you for your service and I hope and pray you can get someone's attention to deal with this. It is unbearable some days and I can barely get through the day at Home Depot. I cannot imagine your situation. If it makes you feel better, even nonmilitary doctors get it wrong and under estimate the seriousness of the pain. I hope you have family to send you some comfort products, if not pm me and I will try to help as best I can via mail.