Hey folks.
I am new here so forgive any dumb questions. My fissure began about 4-5 months ago. I have pain (mild) with all, and bleeding with some, not all, bowel movements. I have a posterior fissure with a skin tag and now an anterior fissure as well. I have seen a CRS who prescribed Diltiazem and Metamucil with follow up in 6 weeks with plans to take me to the OR if not better. I did not follow up as I was not yet ready to "go to the OR" for the LIS. Also the CRS did not seem too confident during the exam. During the exam he said "hmmmm".
My biggest concerns, from a day to day basis are these:
1) Itching. Sometimes at night I wake up having given in to the itching. I awaken to horrible itching, increased pain and some wetness on the underwear where I have been itching.
2) On days that have been more "itch or bleeding" related....I often find that I have a small amount of wetness that makes my life miserable. On those days I am afraid to sit for fear of having "spotting" issues when wearing scrubs. I would not consider some clothes due to this fear. Kakhis, shorts, light colored scrubs, yada yada.
3) I no longer eat at work for fear of having to have a BM and risk irritation and possible wetness issues. This means 9 hours without food most days.
I find that the tissue around the anus is irritated, itchy and swollen more often than not. I can live with the pain. Its the itching and wetness issue that are changing my life.
Oh, and I have tried the Wheatgrass stuff too. I am no longer using the Dilt or Wheatgrass as they seem to irritate the tissue more. I am drinking a TON of water, eating a TON of fiber and sitz bathing when appropriate. (Although the sitz baths are now making me itch.)
When the itch is really bad I find Preparation H to help. Is this bad to use??
Just when I am ready to give in to surgery....I have 3 or 4 good days and decide that the risk of infection, abscess, fistula or incontinence are NOT worth it.
Trying to find a second opinion CRS now.
Any advice would be appreciated.
butthell

Butthell,
Gosh, these are not dumb questions at all. I think you are very wise to seek out a second opinion from another CRS. While itching, irritation, pain, and bleeding are symptoms of a fissure, the source of this 'wetness' you describe needs to be explored further as this kind of drainage is not typical for a fissure. You may also be experiencing some itching from the diltiazem, as this can happen as well.
As far as Preparation H, it depends on the formula you're using as they have different products. In general though, I would steer clear of it for fissure issues because those products usually contain a vasoconstrictor, which is the opposite effect of what you want with a fissure. You want more blood flow, not less. Sitz baths and/or brief applications of ice alternating with the warm baths can be soothing for pain, and just a simple emollient moisturizer like coconut oil, olive oil, or emu oil might give you some comfort and can get you through until you can get another opinion.
I would definitely go for the second opinion.
Good luck, and please keep us posted on what you find out.

Jr is a wealth of info.
Just one possiblility to add about the wetness.
If the wetness and itchiness preceded the fissure, you might read this guys's posts about a possible food allergy;
http://anal-fissure.org/t4648-no-pain-hardly-ever-any-blood-could-it-just-be-a-temp-af#72483
Best wishes,
Tanya

Tanya,
Wow, that is great to know about food intolerances. When his surgeon mentioned food intolerances and increased mucus production could cause this kind of drainage it really got me to thinking about whether in some cases this can also give us another explanation as to why fissures are so hard to heal, especially in people who don't have the elevated resting pressures. If a food intolerance messes with the pH it could conceivably create an ongoing inflammatory reaction that we unwittingly contribute to by continuing to eat something we don't even know we are intolerant to!

Hey butthell, these are not silly questions at all! I had some mucous from my fissure and it can happen from IBS although it doesn't sound typical. I am glad you are getting another opinion about this! The only thing I can suggest is maybe not having as many sitz baths. If you are constantly wet then this can cause itching, I was unable to have sitz baths due to another skin condition in a related area. But I did find when I first tried that the baths caused an itching which drove me crazy! Could you try using something like E45, savlon or dermol (not sure where you are and whether this is what it would be called!) ? This may soothe it until you can get to see your CRS. I'm also not an expert but I can't imagine going without food for 9 hours is a good thing. This will mean your digestion may be irregular and may cause other problems. Could you eat a very small amount just to keep you going? I don't know how you are coping not eating at regular intervals! I hope you feel better soon and are able to see another CRS :)