Hi Badd825
I'm so sorry you're having such a tough time. Many of us can relate to how you are feeling. (unfortunately). Some of your questions don't have easy answers (unfortunately). The decision on when to have surgery is so individual and really depends on so many factors. You definitely have to have a doctor you fully trust and believe in, who is very experienced with the procedure. The timing is different for everyone. I'm not a good candidate for surgery so I'm kind of stuck just trying to learn how to live with multiple chronic fissures. I reached the end of my rope a long time ago, and the rope is fraying.
Anyway, you are right about the residual feces on the fissure. Are your stools too loose? When you clean up after a BM what are you doing? Some people find it helpful to soak in a sitz bath after a BM, some use a shower wand, some even use a rectal bulb syringe with some water in it to get up in there and get clean. It makes a huge difference for my pain levels for the day if there is even the slightest residual of stool left so I am pretty meticulous about cleaning.
While most people don't have trouble healing from LIS, there is a small percentage of people who do have trouble with the wound not healing. It isn't as common as you'd think but it does happen. Good postoperative wound care and lots of baths help prevent infection and also promote healing, but still, it is a mystery why sometimes these things happen.
Are you still suffering with hemorrhoid problems? Hemorrhoids are the evil twin of fissures and they often go together hand in hand.
I'm so sorry there isn't more wisdom I can offer. Tears are pretty common for me too. Just wanted to pop in and say I totally understand feeling desperate for relief and let you know that you aren't alone in your tears.