Had my fissure diagnosed six weeks ago and have been on GTN (Nitro) for about eleven days now. The GTN has made a huge difference, i no longer have pain during BM's and the spasms during the following 4-5 hours are probably about a 3 (Pain factor 1-10 with 10 being the worst).
Fortunately i have a doctor who has worked with me the past six weeks making me visit fortnightly for examinations and offering a daily walk in service should the pain become too bad.
As the fissure has not healed during the acute phase my doc has decided that we should get specialist help as soon as we can so as to not prolong my pain. In the UK if you have private healthcare you can normally see a CRS within 24 hours so this evening i am making my first trip to visit a specialist.
I am presuming this will invlove a full examination and recommendations for diet, lifestyle, etc. I am also presuming that surgery will not even be a consideration at such an early stage.
Can anyone give me some more information about what i should expect??
Also if anybody has any general non-specific questions to ask the CRS then i am willing to do so.

Hey Davo – I hope this post doesn't get to you too late to be useful. I'm not a morning person!
The first time I saw my CRS, I got the ‘Full Monty’. I was put on a ‘jack-knife’ table – so I was face-down and the table raised in the middle so my butt was up in the air. Not exactly dignified, but I guess it’s a good position for inspection. Other docs I’ve seen, though, just had me on my left side, knees to chest. I got inspected on the outside and then an anoscope, which is about 7-10cm long, was put up my butt. This didn’t hurt too much, though, because the doc used a good amount of lube. The doc won’t do it if it hurts too much, so please don’t worry too much about that.
As an aside, I also suggest that you not be tough in this particular situation (this is a good time to let your inner wimp take over!). Many of us try to be brave and hide the pain, but if the doc hurts you, it’s best that s/he knows it!
I think you’re right that you will get the diet and lifestyle lecture and surgery will likely not be considered. But I wonder if maybe you want to go to the office prepared to talk about surgery in case the doc raises the topic. If it seems appropriate, and it’s what you want to do, maybe you could use this visit as an opportunity to get a sense of your surgeon’s knowledge of and confidence about the surgery. That way you can avoid a rude surprise down the road, should you learn that your CRS isn’t as self-confident and experienced with the LIS as you’d like.
I had a list of questions for my doc, which I asked after I had been using Diltiazem for a while and it wasn’t working. My doc was quite a jerk and was very impatient with my questions, which should have tipped me off; but I did get the answers I needed to feel like he knew what he was doing.
Anyway, that’s only a suggestion. You may not be at the surgery-questions stage yet – but I certainly recommend a good list of questions when (and if) surgery is the next step. If you’re interested I can find the list I brought with me to my appointment.
I hope your appointment goes wonderfully! :D

Thanks Hopetoheal
Ahhh well nothing to worry about as the CRS put me totally at ease. I guess there was no need for me to question his knowledge either as he told me all about my symptoms and what i was experiencing without me even opening my mouth!! (thats probably why he can charge Ј10 per minute!)
Anyway i have what he described as a 'nasty little fissure' but he thinks the GTN should cure it within six weeks and if not then he would be giving botox injections next. So his advice was this:
1. Keep taking the GTN (0.4%) twice per day for six weeks and DO NOT stop even if the pain clears up altogether.
2. Take Ducoease stool softeners three times per day
3. Take Magnesium tablets once per day
4. Take one sachet of movical (Miralax) before bed each night
5. Drink at least 6-8 glasses of water per day
6. EXERCISE! Treadmill and X-trainers are fine - Exercise bikes are not.
7. Keep eating fibre and do everything possible to avoid constipation
8. Do not strain during bowel movements
He did say that there is no evidence that taking sitz baths improves things but he said if i think it helps then thats fine.
He also said that their rule of thumb with GTN is - if you experience pain relief within two weeks then it will probably work if not then there is probably not much point continuing to take it.
Finally he is writing to my doctor to say Well Done - she has done everything exactly right!
So there you have it

Glad your appointment went well!
I just want to say though, that I had pain relief after about a week of using GTN - but still had to have the LIS as it didn't heal the fissure!

Hi Val,
He did say "as a rule of thumb" so I guess it does not apply to everybody. His upbeat character gave me some confidence though.
How are you since the LIS - are you fissure and symptom free now?

Umm, no!!!!
I guess I was one of the unlucky ones .... I'm on my third fistula now, and waiting for something to be done about it! The LIS did help with the spasms though - before it I was laying on the bed screaming in agony and wishing to die every night- the LIS totally stopped that. I just wished I hadn't waited 7 months to get it done and had "manned up" sooner - it really isn't too bad!
Glad you have a good CRS! A positive attitude is a wonderful, helpful thing to have.