I posted here a while back after I was first diagnosed with an anal fissure. My doctor prescribed me the Nitro cream, told me to soak twice a day, quit exercising and eat more fiber.
I was pretty religious about the soaking and nitro cream at first. I stopped jogging and lifting weights. After just a few days, the blood and pain while defecating was gone, but soon a sentinel pile began growing. I kept up the religious application of the Nitro cream, but stopped soaking my bum and began going to yoga.
Fast forward and my sentinel pile is huge, my sphincter itches terribly anytime it is exposed to air (like when I am sleeping in boxers or naked) and although I am soaking and applying the cream all the time, I think the itchiness (and my inability to not respond) is killing any chance of this thing getting better. The fissure is somewhat painful (not nearly as bad as it was when I was diagnosed), but it looks more like an open sore now and although I may be getting surgery in a few months, I'm worried that I'll just itch my butt right back to where I am now. After reading a few new posts, I'm a little hopeful because I've been applying the Nitro to the exterior of my anus, rather than inside (which may cause some itching?) and there seem to be quite a few remedies for the itching itself, from baby powder, to tiger balm, to whatever else. I can put up with the pain if it helps me heal.
Main questions
1. I'm thinking of removing the sentinel pile myself using thread to cut off the blood supply (a la "elastration" that can be used for skin tags). If I can get rid of that unsightly thing it will give me the motivation to stop lifting weights again and keep myself from scratching myself raw.
Any informed input? I know this sounds crazy to non-do-it-yourselfers, but there wouldn't be any open wound and chance for infection.
2. How the hell do I keep from itching so that I can heal and hopeful never have to deal with this again??

Hi duvie,
If your itching is that severe, I would recommend having a talk with your doctor about switching you to something like topical nifedipine, which would work similarly. You may be having an allergic reaction either to the nitroglycerin or the base it is compounded in. If the itching is severe enough that you are scratching, you are making things even worse by inflaming the skin and making it even more fragile.
Also, you might want to make sure you haven't added a yeast problem that is contributing o the itching. Do you only have the itching with the nitro. and then it subsides if you give the nitro. a break?
As for the skin tag, even if you could tolerate the pain that would likely create on a skin tag that large and inflamed, it will likely just come back again anyway. And there would actually be a risk for infection.
How is your diet and BMs? Are you able to keep things soft and easy to pass?
I'm so sorry things are so miserable for you right now. These afflictions bring more misery than anyone who has never had them can possibly understand. I hope things start improving for you soon.

jr2, thank you for the very helpful input. I guess I have a case of the chicken or the egg. I've been itchy for well over a year, and although my fissure was only diagnosed 2 months ago, the way my doctor described the fissure (starts as a very small cut), perhaps some initial issue caused the itching and I then created the fissure by reacting (scratching) and it has only gotten worse over time. I tried the Nitro on the inside only last night and it seemed less itchy. Long story short, I don't think I'm allergic, but perhaps I do have some other issue. I often see orangish colored fluid after BMs or if I just use baby-wipes midday, but I figured that was just a function of my fissure being an open sore now.
My BMs vary, but are usually soft due to my previous high protein and fiber diet. I do however sit for long periods at work without the ability to get up and move around.
Bottom line, luckily I'm not in that much pain and the itching is more frustrating than anything. I guess I'm going to wait a little bit to try and remove the sentinel pile, because it would just return as long as the fissure is very aggravated.
Thanks for the help,
Duvie

Hi Duvie,
The nitro. will work better anyway if you can get it applied more on the inside than the outside. I posted a study in another thread that showed these topicals have a higher success rate when they are applied inside the anus rather than the outside.
The discharge you're having ... That will definitely make the itch even worse. Have you been back to the doctor more recently to have thngs checked out? I just wonder if in addition to thefissure problem if you've got something else contributing to the severity of your symptoms? Yeast or hemorrhoids or any number of other things.

jr2, I read up on yeast problem and I don't think I have that. I've experienced Jock itch on and off due to a military assignment with many layers less and few showers, but it didn't seem like what most websites described. However, I do believe that my deployment was significant because I went from a job where I sit down for extended periods to being on my feet most of the day. During my military assignment, virtually all my symptoms were better. When my fissure was diagnosed, my doctor said that I had hemorrhoids, but not in a significant enough way to require treatment, this leads me to believe that they may have been a catalyst for my itching & discomfort that lead to me probably injuring myself.
And now, I just have to say that it is such a relief to be able to talk about all this so factually and openly.
Things are bad right now, but I feel that they'll get better. Thanks for all the support, I really appreciate it :-)

Three suggestions for the itching:
After a shower you can put Witch Hazel on a Cotton Ball and put it firmly against your anus for as long as you can tolerate it being there. For me, I can do this for several hours.
Get coconut oil and rub on and in the anus, seems to take away alot fo the itch.
Get Gold Bond Medicated powder, cover a cotton ball with it and press firmly against the anus and leave it there. It will keep you dry and comfortable.