Got my first fissure back when I was 19. Excruciating pain for months. Didn't go to the doctor for some reason so just had sitz baths to get me through. It healed at some point but ever since have been plagued on/off with pain and new fissures, always from the site of the original (posterior).
I finally got referred to hospital about 3 years ago and have been getting batted back and forth ever since, and now I just don't know where I stand. I went for my first consultation with the idea in my head that the fissure had healed, but healed 'wrong', like there was some sort of nerve exposure or something. Because to this day, I get pain but no blood. However, I get assessed and he says I have a small fissure. So I take nitro cream and laxatives, it heals up.
Second consultation I felt good, have pain free bowel movements for a while, however, I get examined, feel a sharp pain, and he tells me I have a fisssure still (yeah thanks!). So he books me in for botox.
So, a few months later after being back on the nitro, I get the botox. I come round from the anasthetic and the doc tells me I haven't got a fissure! "So why have I got pain?", he says "spasms", and walks off while I'm still drowsing. However, he still administered botox. Got a huge frombosed hem the following day, which finally went, and I had pain free bowel movements (and I must say big bowel movements), for about 3 months. Then back to square one after about 6.
So back to hospital. They send me to have some thorough tests done. Sphincter tone, pressure, muscle control test. The guy inspects me, no fissure. Inserts probe, sphincter starts to spasm and shows me on the computer screen. In a puzzled tone he says "must be sensitive scar tissue". I subsequently fail the muscle control test. My colon won't straighten, and the sphincter won't open. But he tells me "you have to sort out the pain first before controlling your muscle coordination". So I think okay, write that back to the doc at hospital.
Finally get to be seen by doc at hospital who says I'm not controlling my muscles correctly, so go get that sorted at pelvic floor retraining. I say "what about the pain and spasming, shouldn't that get sorted first?". He says "the lack of muscle coordination is what is causing the pain".
So after several months, I get a lesson in how to s***! None of which is anything new to me. I admit in the past I used to deliberately contract my external sphincter in order to 'control' the girth of the stools before they came out. That might sound a bit strange, but having always had softish stools, I could compact them down before coming out using the external sphincter, and then pushing it out with the pelvic floor. So yes I didn't relax fully in the past, but that doesn't mean I don't know how to, and I certainly don't do that anymore, because the side effect of doing that is that your backside never gets a proper dialation from a bigger stool. So now I have lots of fibre, I have bulky stools and I couldn't 'compact' them down the way I used to even if I tried.
So I'm still in pain and have a new fissure today even when doing the proper relaxing and having stool softens, loads of water, nitro cream, baths, etc. It just seems like the posterior area is so compromised it won't stand any punishment. Everywhere else around the sphincter is pain/fissure free, its just that posterior area. Its painful to touch, and I can't even get my finger in there properly to apply cream. It just spasms shut as soon as anything goes near it, either going up, or coming down!
Concerning pelvic floor coordination. Often times I don't even need to push, it just comes out. And all I do is concentrate on my breathing. Supposedly, the sphincters will then voluntarily open. Once I heal a fissure, I seem to get about 4 good weeks, then the beginning of a bit of pain, a bit of spasming, and then before long another fissure.
So I don't know where to go here? Is there still work to do with the coordination thing? Is the posterior area just too compromised now to stand up to even slightly hard stools, in which case the flap operation seems like a likely cure for me. I know my fissures can heal, so I don't need to go the LIS route, but the scar tissue at the posterior just won't stop being painful. But is this a coordination issue? Or is it painful scar tissue which needs to be dealt with?
The pelvic floor doc is referring me back to the hospital doc because she says I shouldn't still be dealing with pain.
If anyone finds my position familiar, please give your thoughts.

Have you tried squatting when you go - that is a much more natural way to do it. Put some blocks under your feet or if you feel like spending some $ I have a very nice stool called "Sqatty Potty". Also some very gentle anal dilation might also be helpful for you. I healed my last fissure that way. There is a thread on here somewhere about self dilation.

Baba wrote:Have you tried squatting when you go - that is a much more natural way to do it. Put some blocks under your feet or if you feel like spending some $ I have a very nice stool called "Sqatty Potty". Also some very gentle anal dilation might also be helpful for you. I healed my last fissure that way. There is a thread on here somewhere about self dilation.

Thanks for the reply. I've done the self dilation in the past with proper dilators. It gave me a fissure in the process but when it healed it stayed healed the longest. But as usual it didn't last long enough. Everything started spasming back up within a couple of months.
I was told to raise the legs when going by the pelvic floor doc. It's feels like that position is more likely to give me a fissure, but I will give it another go.