Hi Guys
I'm new to the site and i was attracted to this post when i saw the mention of GTN ointment.
I have been suffering with this since January and I have tried local anaesthetic creams and corticosteroids but having no luck. It was getting better but then all of sudden everything just went awful and I didn't know what to do. I ended up at accident and emergency with the pain and was admitted to the surgical ward where they recommended i try using the GTN ointment for three weeks.
I started using it about 3 days ago and i've to apply it once in the morning and once at night. I feel like even in the short time i've been using it I feel less pain and more like discomfort. I am on laxatives also and trying to keep my diet as good as possible to get this sorted.
Can I ask if anyone else experienced anything similar to this? I just want to be well again cause it feels like my life is spiralling. I'm 20 and at university and I just want to get on with my studying and be ok for my exams but this problem has literally left me depressed and I feel like i just can't cope anymore.
Any advice is really appreciated cause i feel like i have no one to talk to.
Thank You
Lauren x

Hi Lauren,
Welcome to the board and sorry to see you here.
For me GTN has been fantastic, it gave me significant pain relief within two days and allowed me to get on with my everyday life whilst healing. For me personally i have been referred for LIS surgery however my fissure was pretty severe and had it been in a better state i believe GTN would have offered full healing.
It seems your GP has followed the standard route of medication with anaesthetic (normally lidocaine), some sterioids (I had proctosedyl which was completely useless) and after six weeks they offer GTN.
Fissures can be as painful as hell during a toilet visit and the spasm pain that follows can last for anything up to 6 or 7 hours or even longer. GTN provides a chemical sphincterotomy which basically means it completely relaxes your internal sphinter to reduce the spasm pain and allow blood to flow to the sphincter which improves healing.
Some other hints (Sorry if you already know this)
1. Using cotton wool dipped in warm water rather than toilet roll
2. Drink at least 6-8 glasses of water each day
3. Eat lots of fibre and stick to soft foods
4. Take plenty of baths and try to take one after each toilet visit (Many use Sitz baths)
5. Never strain when you visit the bathroom - always allow things to move naturally
So to sum up what you are experiencing is completely normal. If things are working for you at the moment stick to what you are doing and dont start trying new medications or ointments.
If you have any further questions please feel free to ask - this board is full of experts!
Davo

I can't thank you enough for replying honestly I just felt like my life was crashing in around me.
I feel like after a BM it's more like discomfort than pain so it seems like I am going in the right direction but it's just such a horrible situation cause I feel like I've been dealing with it for so long that it's hard to see the light at the end of the tunnel.
The headaches are hell with the GTN after its been applied for about 2 hours but i'm willing to deal with that if it's going to fix me! It's just with my university exams approaching its just a lot to deal with feeling like you'll never be better.
I was reading earlier posts and I'm sure you understand what I mean in terms of your wedding. It's like you just look into the future and still picture yourself being ill.
Its so difficult as well cause it's not something that you can just tell people easily about, it's horrible. I feel like this forum and my doctor is the only time I can be totally honest about how it's making me feel.
What stage are you at now?
Can I just say I know this sounds horrible but I've noticed a lot of people saying they notice a lot of blood after BM I have never experienced this which makes me think my fissure is maybe to a lesser extent and should hopefully heal with the GTN and not need surgery.
Thank you so much
Lauren x

Hi Lauren,
I always tell myself that a fissure is just a tiny little cut and not life threating. These things are awful and what makes them worse is the time they take to heal so an awful lot of paitience is required. Also its a bit of a roller coaster ride so one day you can think that everything is going great and the next day you can re-tear and be in agony again.
As for the headaches i was lucky that i did not suffer from them however i believe that after a week or two these should calm down and be more manageable - if the headaches persist there are equivalent calcium channel blockers that your GP can prescribe.
You are in good hands on this board - I feel if i knew at the start what i know now then i probably could have healed this myself.
With regards to blood - I experienced this only once and that was the day my GP told me i had the fissure, I have never experienced any blood since that date.
So my advice to you is to try and stay positive and dont let this thing rule your life. Go out, enjoy yourself but be strict with your medication, food intake, baths and personal care. Ohh and one other word of warning (i was once a student myself).... Go easy on the alcohol!!! Drinking too much dries things out and your stools can become hard and dry which can re-tear things!
As for me i have been on GTN for 13 weeks now and to be honest my toilet visits are pain free and i just get some mild discomfort every now and then during the morning but nothing bad. The thing is if i stop applying the GTN and eat normal food i just re-tear so thats why i need the surgery. Providing the surgery goes well then its back to the wedding planning!
So i hope this thing does not affect you too much and that you can concentrate on your study/exams without the pain or worry.
Just remember if you ever need anyone to talk to or you just need to let out some frustration then feel free to post or send a private message. Although we are all on different time zones there is normally someone who can give you some support.
Davo

I can't thank you enough honestly. Been a bit weepy and feeling sorry for myself but it makes it easier to know I'm not along in this.
I hope you are sorted out soon so we can both get on with our lives.
Can't thank you enough.
x

Thanks Lauren
Be positive, dont let this thing get on top of you and keep us updated with your progress.
Davo

davo thanks for the updates. I had a question on magnesium tablets. How many grams do you take, what type and how often ? Any particular brand seems to help better ?

Hi tiredofthepain,
I take one 250mg magnesium tablet with my evening meal each day which helps keeps things soft (almost toothpaste like)
I am in the UK and use Holland and Barrett magnesium tablets however i am sure any brand will do the same trick.
This is what i use:
http://www.hollandandbarrett.com/pages/product_detail.asp?pid=222&prodid=435&cid=143&sid=0
Hope this helps
Davo

Hi Davo. In much the same boat as you. Had been using GTN and Movicol over the last few weeks and had a completely pain free time of it but things started to get a little uncomfortable these last few days in the time leading up to my appointment with the surgeon today.
Well he confirmed the fissure (no surprise there) and offered LIS straight away. I am having a think about it this next week.
Sadly he seems to have been a little rough as when I got home to try and have a BM, I passed a disturbing amount of blood but couldn't manage a BM. Scared to death of having my next BM; busily chugging down the water and trying to get two Movicol in tonight.
Really can't face a return to the spasms; would rather walk under a bus....
Came back on here and saw your thread so I am thinking GTN isn't going to be the long term option I had hoped for as I am terrified of faecal incontinence. I worry because I have had a duodenal switch operation and don't digest all my food (particularly fatty food) so faecal incontinence would be a miserable affair for me. Flatulence would also be a real concern as again my digestive system has gone through a lot of replumbing :(
Really don't know what to do...

Hi Jaybee,
Funny you should say that as I thought I had a dilemma on my hands as the past few days have been pain free and the fissure looked like it had cleared up. The dilemma being do I still go ahead with surgery or hold off but low and behold I felt a little tight this morning and when applying the GTN internally I felt a bit of discomfort and now I am mildly sore.
How long have you been on the GTN for? I have read that if patients really don’t want surgery then it is ok stay on the GTN to relieve the pain and keep things relaxed down there however for me personally I want to completely put an end to this and if I have to endure simple ten minute procedure and some post operation pain to do this then that’s a small sacrifice to pay.
Reading your post and in particular your comment, “Really can't face a return to the spasms; would rather walk under a bus....” then if I was you I would be seriously considering surgery. I know surgery can be petrifying but if you read about other people’s experiences the common comment I see time and time again is, “The surgery itself was a breeze”. Also whilst the post operation pain and first BM tend to worry most people I am lead to believe this is no worse than the pain experienced from the fissure in the first place. LIS incontinence statistics on the internet do vary immensely but I would take a lot of these with a pinch of salt. Unless it is from a respected organisation or healthcare provider then I would fairly much ignore it – We have not witnessed one case of permanent incontinence from anybody on this message board.
Below is an extract from another post of mine, this is word for word what my CRS told me regarding LIS. He is a highly regarded surgeon in the UK and extremely experienced in his field:
LIS - Offers between 95-100% success rates and full pain relief can be experienced in 2-4 weeks, the chances of recurrence are virtually zero. However he says it is extremely important to choose your CRS carefully as some almost guess the length of the cut required (he lines it up by sight with the length of the fissure). He said Sphincterotomy has got some bad press over the past few years with incontinence being quoted at 10% - this is apparently related to Sphincterotomy rather than LIS which has less than a 1% chance of incontinence. He said he has performed 1000's of LIS procedures and not had one report of incontinence.
Davo