So here we are again folks!
This is second time around for me. Last time, it started in 2002. There didnt seem to be much awareness and my doctor had little to suggest treating me for piles for a while which I am sure made the fissure worse. I researched on-line and discovered that some people in Austrailia werer using 2% GTN. I had ask my GP to prescribe something that didnt exist in the UK then and find a Pharmacist to make it up for me. You know it now as Rectogesic. To be fair it did help for a while but never healed me completely and I had a constant head ache to go with the pain from my bum. Had Botox 2003/4 when the GTN cream just didnt work anymore and the daily pain became unbearable. After which followed even worse pain and absolute hell for about 6 weeks... but I did eventually heal. There was talk that I may have been allergic to the Botox but who knows maybe it had just got that bad!
Anyway, I have managed for 6/7 years to keep the fissure from coming back by looking after my bum carefully, always cleaning/moisturising the area after BM with Vasaline and by not getting constipated. It did start up from time to time but when I felt it coming back (after a couple of hard stools) I got some GTN cream for use for a couple of weeks and was very careful about what I ate. No alcohol etc and got even more fastidious with my routine to include vasaline before and after BM.
All good till this year when I thought I maybe had piles. I had been straining a bit an felt a roundish lump on the outside of bum so used some standard issue hemorrhoid cream which had a local anesthetic in which seemed to help at first. Big mistake, HUGE! I think the steroid in the cream thinned the skin over the old fissure site and opened it up. Pain worsened over several weeks of trying to settle it down and more GTN cream but to no avail. Past the point of no return I fear. Saw the Consultant last week and have a tube of the Anoheal (Diltiazen) Is it just me or does it hurt even more after applying the cream? Sort of burning and stingy as well as the usual pain. The Consultant did say it would take 6 weeks to heal and its only been three days so I know I have to give it a chance. What else can I do? Everyday BM followed by 4-6 hours of pain. Ibuprofen tablets 3 at a time - they dont work but I am too frightened to take anything else as it will make me constipated. I am keeping my stools soft with a good diet as if I take additional fibre I go to the loo more than once a day which just adds to the duration of the pain. Its 4-6 hours from the last BM no matter what. I am a tough old bird normally, dont even have injections at the dentist but this pain is so distracting I just can't deal witrh it. Warm baths dont help really since any relief is so short lived. I work from home thank goodness coz I need to stay sitting on my bum, the pain is worse when standing up is like having a stabbing pain ( small kitchen knife being stuck into an open wound again and again..) so I dont go out in the mornings till the pain backs off. Made the mistake of popping to Asda last week and was ready to scream while waiting in the queue at the checkouts.
So like I said here I am again.I am worried I wont heal, that Fissure no2 in scar tissue from Fissure No1 is too deep. Will keep on with the Diltiazen and post how I get on. If it doesnt work then it is Botox and absolute Hell.....again! Great choices we have dont we?!
Good luck everyone else whos out there trying to heal.

Hi Suze,
I'm so sorry to hear of your recurrent fissure problems. I can relate! I chuckled when I read that you found out online about using GTN and asked your doctor about it. Way back many years ago I did the same thing. It was unheard of here to use nifedipine for fissures and I found this little study done years and years ago that I printed out and brought to my doctor. He had never heard of it, but was willing to let me try it. My next problem was finding a compounding pharmacist who knew how to compound it. But it did work to heal my fissure back then. I haven't been so lucky this time and actually have longstanding multiple fissures, aggravated by multiple bowl movements per day (sometimes up to 5).
I had local irritation too with the Diltiazem, which my CRS wanted me to try this time. I had to stop using it and went back to the nifedipine, which doesn't give me that problem.
Welcome to the board. I'm so sorry that fissure pain has brought you here, but there is excellent information and a lot of caring, supportive people to be found here, and it makes a huge difference to have a place where people totally get what you're going through.

Thanks jr2,
You are right it does make you feel better to know other people do understand. I am fine right now but come tomorrow morning..... well you know its like!
I am unsure about the Diltiazem I think the pain was worse and more sustained after application this morning. Ended up in the bath to get it off and popping three more Ibuprofen. Not sure if the Ibuprofen even works anymore but am afraid to take any codeine which would work better but no doubt bung me up so I just take loads of Ibuprofen instead. I have just put a tiny bit of Diltiazem on for my bedtime dose. I can feel it burning. Is that how it was for you? Hope it isnt going to keep me awake. Night Night.

Suze... Yes, a burning and stinging pain. I get that with nifedipine too, sometimes, but the difference is that with the nifedipine it calms down after about 10 or so minutes. The diltiazem just got worse and worse. Sometimes it is the carrier it is compounded with, and sometimes it isn't the medication itself, but rather one of the inert ingredients in the medication. I found it really helpful when my pharmacist switched manufacturers to a different one.
Hope you get some sleep! It's really the only time we have when we aren't constantly enslaved to these fissures!

So its been 6 days since I got the Diltiazen. Heres how I have got on. The first two days (Sat & Sun ) definately had more pain using the Diltiazen stinging and burning. I was using a little way inside and on the site of the fissure. Decided to make some changes on Monday. I have already managed to get my stools soft by eating porrige every morning and dried Mango at night and 3 ltrs of water throught the day. No alcohol. ( feel like a Saint) Also limiting meat, cheeses and bread. So on Monday:
Used Vasaline and Rectogesic as a preparation ahead of a BM putting alittle of both around and just inside. Not too much pain during BM but that had been improving even before the Diltiazen due to diet changes.
Then after BM, Good clean up with vasaline and more Rectogesic on the inside. Waited 5/10 mins then got the Diltiazen from mthe fridge an d applied a pea size amount to the outer area and edge. Within 30 minutes I was feeling quite comfortable apart from some stinging ( say 3/10 and usually I would be up at 6/7 by then and if standing to 8/10 even with three Ibuprofen ) I followed this with a warm 20 minute bath and a little more DSiltiazem on the outside. Within an hour or so had hardly any pain at all. The first day that I havent had rotten pain for 4- 6 hours. Monday afternoon felt like a new person with the chance of getting my life back. Used the Diltiazen again before bed just a peas size application on the outside.
Tuesday did the same with the same result feeling loads better.
so cut down a few dead daffodills in the garden later in the day. Could feel a slight deteriation in comfort but still okay.
Wednesday continued with the regime and did a bit more gardening early evening spreading some bark and noticed that I felt less comfortable at bed time and decided to end all activites in the garden for a while. Also I ate some dried pulms instead of the mango for a change.This morning am definately worse with more pain with BM and stinging after although I dont think I have done too much damage as I havent bled from there. I think that resting is a key part to healing and we all need to think about what we are doing when bending, stretching and lifting. I think we use "that muscle" alot more than we realise.
I am very active when I dont have an AF and keep a very tidy home so rarely sit down for long spells which is what I seem to have to do now. I even prepare meals sitting at the table to limit standing when it is rerally bad and I wonder if thats why after a couple of terrible days I improve - probably from resting up. BTW the plums may have been alittle too helpful so watch out for them! I had to "go" again which messed up the routine and also contributed to my feeling more pain today.
I will continue with my regime and let you know how it is going. I am on a flight to New York next Friday so I am keen to be much improved by then. A shopping trip with my daughter as a treat for her so really want to be well. If anyone has any tips for coping while travelling please let me know. Healing thoughts to all who come to this great forum. Suze.

Suze,
It definitely sounds like you are making progress and finding a routine that's helping. Any improvement in pain is a great thing! I think you are really right about balancing activity with rest periods. Being active is good for circulation, but with any injury to the body we also need lots of rest time so the body can put energy into healing. I think it's important, whether relaxing or being active, to get used to focusing attention on relaxing the tension in the anal area, frequently practicing deep abdominal breathing to relax the entire pelvic floor. Pain is a good reminder to bring attention back and relax.
Wow, what a fun trip you have planned. I hope you are much improved by then! It's been so long since I traveled, but I would suggest first off to make sure you take in enough fluids before, during, and after the flight. Flights are so dehydrating, and that's the last thing you need. Also, get up at least once per hour to stretch and take pressure off the anal area and to promote circulation in your whole body. Be sure you pack enough of whatever supplements, medications, or other things you use for your fissure. What I like to do is carry a little kit in my purse with me that has a small jar of Vaseline, some latex finger cots, and premoistened clean up towelettes that come in little packages. That way, if I'm ever caught away from home having to use the restroom I have a portable fissure kit with me wherever I go. Obviously, you will want to be careful about your diet, which is so hard when you're on vacation. I would also stick to drinking mostly bottled water if you can. Sometimes changes in water when you travel can lead to constipation and/or diarrhea, just because mineral contents, etc., are different in different areas and it can take time for your body to adjust. No reason really to take that chance while you have a fissure.
And the most important part... Relax and have fun :)

Thanks jr2 some good advise especially about drinking bottled water which I wouldnt have thought about. Last weekend I was seriously thinking about cancelling the trip because things were so bad. This week has been a bit better and I am going. I have upgraded our plane seats for greater comfort on the flight I have told my daughter that I may need a slower start some mornings to get myself sorted out. I expect to have to take things a bit steady with lots of water stops ( not coffee!) and Ill take plenty of meds with me too. Like you say, I will have be a bit careful about eating the wrong foods. I wont be able to take my usual mango and porrige with me either so will have to shop when I get there for something similar. Its only four days and I am much more hopeful at being able to cope now things are beginning to settle down.......I do feel a bit nervous though just hope this trend continues and that NY doesn't set me back again. Look after yourself jr2 . Sx

Hi Folks
So I am back from my trip to New York and things have been really good. Infact, while I was away I had one day without any pain at all! I have gradually improved day by day so thought I would share what I has worked for me.
Okay before I left for New York, the fear of travelling meant I had three days of being ultra careful what I ate. Porridge in the morning, some sort of 5 bean salad for lunch and a fish and vegetable dinner at night. Also I ate dried mango and plums before going to bed. No meat or chicken and very little bread products. Things were definately getting easier with less pain while passing a BM but still had pain afterwards. Also, I waited until I was desperate to go to avoid any straining. I started using Vasaline before a BM and more Vasaline and Rectogesic afterwards, inserting a generous amount of Rectogesic inside my bottom as hign as I could manage ( accepting the headache that it would cause). Then, 20 mins or so after that I applied the Diltiazen cream, only on the outside and only a "pea" sized amount. Seemed to be working quite well. By waiting to apply the Diltiazen it didnt sting or burn so much. The day of our flight , I couldnt go to the loo before leaving for the airport despite getting up at 5am to have porridge as usual. Didnt eat much on the flight. I was too scared I might have to go to the loo and then would have pain for the rest of the flight. I just picked at a few crackers. Drank loads of water. When we got to our hotel I took two stool softeners and went out to the drug store to buy some dried plums to keep my regime going. Another stool softener before bed and ate 10 plums. Went to bathroom as normal on Saturday morning with very little discomfort and took the usual 2 Ibruprofen for the after pain but it felt was okay just a little stingy. Shopping in New York and another trip to the bathroom after breakfast but still okay with just a couple more pain killers as a precaution. It's important to say at this point, 2 weeks ago I would have not been able to stand for 5 mins without feeling like I had a knife stabbing me in rear end never mind walk about for hours shopping in New York! By Monday ....my first day without pain not during, or anytime after a BM. Horray!! :D Still being very careful what I was eating despite all the tempations in New York. No steak much as I would have loved one, no doughnuts just sensible light meals. A careful mexican meal and a couple of margarita's meant a slightly firmer stool oin Tuesday which I needed to push alittle to evacuate it which I could feel did some damage. This was enought o remind me to stick to the plan!!
Flight home loads of water and no food. More stool softeners and dried fruit yesterday and I seem to be okay today.
So there you have it. Keep what you eat really simple with loads of fibre, as l;ittle meat as you you can manage and if you do eat something more bulky take a stool softener to be sure. The key is really soft stools. Then use all the cream that your Doctor has given you inside and out. Lubricate with vasaline before and after BM's and remember to re apply creams after showers and last thing at night. Stay on plan, it only takes one too firm BM and you are going backwards. I am definately healing but at this stage things are still very delicate and I need to remember that!!!! Hope this helps others to find their way. Sx

Thanks so much for the good news Suze!
I am so afraid to travel. It sure takes courage.
Glad you are almost healed!!

-Tanya

Suze!
So glad your trip went so well and you are home safe and sound and not too worse for wear. Also really happy to hear you feel you are still progressing on the road to healing!!!