Hi
New today and I have never joined a forum before.
I developed an anal fissure in June 2009 and still can't get rid of it or the pain. It followed a stressful time at work when I lost my job and I was using Lanzoprasole for gastric problems which I thought contributed to getting constipated. I have had banding done for haemorrhoids in the past and thought they were back.
I was given GTN cream Anoheal for the fissure by a specialist and completed a whole series of test. All were normal thank God. 6 months went past no success with healing and then in September 2010 I had first Botox which worked well and I nearly healed I was offered a second botox in March 2011 which I thought would be the end of it and awoke from the anaesthetic to be told by the Dr that during the procedure I had torn worst than before. Since March until now I have been in pain almost everyday and the only comfort I trust is baths which are not convenient to take.
In June 2011 the Dr told me I was not a good candidate for LIS as I had an episiotemy during my daughter's birth in 1998 which took a year to heal. My own GP keeps saying "you do not want to get this surgery done as you will likely end up incontinent" and the surgeon says he prefers to do this on elderly patients only. So what choice do I have? 2 weeks ago the pain was relentless and going through the pain of spasm for 4 hours per day everyday was wearing me down to the point of depression.

I also have a confession that although I have been given GTN cream it sits in a bag with all my other ointments as I am afraid to use it as I have had problems with migraine auras. I am out of work since July 2011 but feel I couldnt hold down a job anyway.

Two Years Gone wrote:Hi
In June 2011 the Dr told me I was not a good candidate for LIS as I had an episiotemy during my daughter's birth in 1998 which took a year to heal. My own GP keeps saying "you do not want to get this surgery done as you will likely end up incontinent" and the surgeon says he prefers to do this on elderly patients only. So what choice do I have? 2 weeks ago the pain was relentless and going through the pain of spasm for 4 hours per day everyday was wearing me down to the point of depression.

Sigh...I am so disgusted and angry for you because of your doctor's attitudes right now...I had THREE big babies, THREE episiotomies, then LIS and guess what? I am not incontinent, in the least. That is a lie they are telling you, or at least a common misconception. You need to find a really good CRS (elderly patients only? WTF I have never heard that one). Lots of people of all ages and both sexes end up needing this surgery, but if you look around on this forum you'll see most of us are young--one guy was even 16! Generally though most of us seem to be in our thirties and forties. I am a woman who developed a fissure because of childbirth, and there are a lot of other women in the same boat! In fact, when I was waking up from LIS surgery, one of the nurses who was tending to me told me that my surgeon does a booming business thanks to women like me, who've developed fissures after childbirth.
The comments that your surgeon made tell me that he is a hack. You should be able to find a confident surgeon who will tell you that they have never made anyone incontinent from this surgery--the caveat is of course, AS LONG AS you aren't already suffering some form of incontinence. My surgeon did ask me that question, and he did say that sometimes episiotomies can compromise the muscle enough to cause some incontinence. But as long as that isn't the case with you, I doubt you have anything to fear from the surgery! Please, please find a good surgeon. It is so stupid that your doctors are allowing this to continue to ruin your life, when it doesn't have to. We've all been through the hours of spasms that ruin each day, it's such a familiar story. The surgery will END that.

Also, if you have migraines and the doctors knew that, I have no idea why they would have prescribed nitro. There are headache-free alternatives like diltiazem and nifedipene ointments. They have to be compounded which can make them expensive and hard to get, but there are alternatives!
And, if your episotomy was in 1998, it's practically ancient history by now! I'm not exactly sure what you mean when you say it took a year to heal, though--as in, was it just sore and stiff? Or raw and bleeding? Mine were sore for months because I was breastfeeding and I needed estrogen cream to help the area stretch and heal. At any rate, with LIS, it isn't uncommon for complete healing and regaining of tissue strength in the area to take a whole year. BUT you will have immediate relief from spasms and hopefully from tearing as well.
I'll admit that LIS hasn't cured me 100% because it is still possible for me to tear. I have to be careful and continue to take small amounts of Miralax everyday and a fiber supplement. But I never have spasms anymore, and for the most part I'm getting along just fine. It has been 7 months since my surgery and I hope that I'll continue to get better and be all healed by the time a year has passed.
Best wishes!

Hi there,
Welcome to the forum!
I agree 100% with everything Alpine has said!
You need to find a new CRS with some confidence in performing this surgery. I had 4 babies and it was never a factor in me getting my LIS.
Age really shouldn't be a factor either with a good surgeon. I would be more afraid of becoming incontinent if I were old with this type of surgery....What is boils down too is a confident, well experienced CRS would have done this surgery more times than they could count and never made anyone incontinent.
Read the surgery post and you will see there isn't a post in here where anyone reported incontinence from all ages/ and genders.
You definitely need to run from Doctors who say this is a possibility.
Also as Alpine mentioned already, there are other ointments besides Nitro. I used diltiazem. It did have to made by a compound pharmacy and it was around $40 for the prescription...

Many thanks for both your replies - I am not alone - someone understands.
The Anoheal cream I believe was the lower concentrate nitrate cream. I used it unsuccesfully. It caused nothing more than a rash in the end.
I am going to an appointment with my specialist next Tuesday as I was too concerned in my last consultation and I felt too frightened to go ahead with surgery - the last resort. I have seen advice on this forum regarding questions to ask the consultant. He is the "main man" in my hospital area. He has operated on my mother who had her major bowel operation after suffering from divericulitis. He is thee specialist but I tore during the last botox he administered.
A month ago I found this forum by chance - if only I had found it sooner. I have found the advice on diet, surgery pros and cons and advice on just generally how to live with a fissure, very valuable. I read all the new posts and I think " I know the answer to that!" and it makes me feel not so isolated. I have only started to tell people about this recently as really who would want to know and only because you can see something is taking its toll on me.
I couldn't image being incontinent. The thought terrifies me. I went through IVF treatment twice as I have endeometriosis, had a traumatic delivery with my first child and a section with my second. I know what pain is and I measure my fissure pain on that scale (gas and air and above during some bm) yet I am terrified at the thought of this surgery.

Believe me, we all understand your fears for the surgery. There are very few people who would develop a fissure and then six weeks later go ahead and get the surgery! Most of us live with this for months if not years before we get the surgery (five years for me). It does seem like a drastic measure and on such a private area! And your doctors probably haven't boosted your confidence any either.
So remember, this is coming from someone who avoided surgery for five years: The surgery is cake. It is so minor, and the pain you experience will be far less than that of the fissure! It's nothing like hemorrhoid surgery which is notoriously painful. The people who have trouble are usually the ones who have a fissurectomy. But the LIS incision will heal really fast and you'll be surprised that BM's don't hurt immediately after the surgery as much as they do now. Yes, there can be complications like fistulas but that's pretty rare if your surgeon knows what he's doing, and anyway they are fixable.
Only you can know when you're ready for any surgery. I also had sinus surgery and I put that one off for at least 3-4 years because I was so scared. When I finally booked the surgical consultation, I remember getting out of the car and slamming the door shut, then I walked with determination into the ENT's office. Because I had HAD it with sinus trouble, at that point I was more angry than fearful.
It's scary to give up control of your body. The only thing you can do is make sure you have the best doctor's available, and leave it in their hands!

41, m, no incontenece but I have farts that irritate. I think that might be because of Miralax.

I am from Northern Ireland. I notice a lot of the posts are American. I am fortunate in that I have the National Health Service but I cannot choose a specialist to go to. I go to the one provided and he is not going to show me statistics of his failed surgeries thats for sure.
There is a certain claim culture here as well and I am wondering is there less LIS surgery success here in NI or are the Doctors setting out the worst case scenario so you cant say you didnt know and start claiming against them for damages. It is the only operation I have actually been put off by the Drs whose job it is to do it.
The Dr who said about doing LIS mostly on elderly people did not know at that stage I was going to be one of the unfortunate statistics who didnt heal naturally, so he sent me away saying dont worry about needing this op, change your diet, use lactulose and GTN cream and it will eventually heal itself. That was almost a year ago and it hasnt heal even with botox.
This may be a stupid question but how would you know if it was even starting to heal. I have only recently plucked up the courage to look at it. I also have a sentinel pile.
I have had to find out everything from the internet as I feel there is absolutely no understanding of the pain and as it looks like a wee cut that you wouldnt worry about elsewhere - I feel that there is no sympathy from Drs but rather a get on with it attitude.
To be honest I am not even sure that LIS is the surgery I would be getting as no-one mentioned surgery options until the one consultation in June when the Dr said I have nothing else to offer you - Two years later.

Hey there, don't worry too much about incontinence, it is very rare although you can experience mild transient incontinence after LIS that can last for a while, besides, even if I was incontinent after LIS I would rather be that than have the constant pain of a fissure.
I'm in the UK also and like you can't pick and choose my specialist, unfortunately, which may explain why I'm still unhappy with my surgery of 14 months ago, the people in USA are paying for their surgeries so they can pick and choose, to be frank it sucks, we should be able to do the same.

It's true Steve, that we in the US have more freedom to choose our doctors (sort of). Most of us have insurance that's based on networks of doctors and hospitals, and if you choose one that isn't in your network you'll pay substantially more money. So I had to stay within my network but I still had maybe 6 or 7 different CRS's to choose from.
This board has given me a real education as to what 'free' public healthcare is really like...and I don't like what I'm seeing. Some of these doctors are like crappy college professors with tenure. Who cares about the patients or the quality of their work as long as they're getting paid.
Two Years, your question--how would you know if it was beginning to heal? That's a difficult one. Fissures can lie dormant and everything looks fine on the outside, so that even the doctor who's looking at you thinks that all is well, but the underlying problem of an overtight sphincter is still there and all it will take is a larger or harder BM than normal and BAM! A new tear.
The best thing to do really is to cut the muscle. I don't know what the population size of Northern Ireland is like, but I'm assuming your doctor must not have seen a lot of people with fissures. Because they really are fairly common and they affect people of all ages!
You may just have to be an advocate for yourself and push the idea of surgery with your doctor. I would ask a lot of questions about it even if you think he won't give you the answers.
Good luck to you, I hope you can get your life back soon!