Well, here is my success story. I've written a very basic account of what happened week on week.
I'm 9 weeks in on Nitro now and fully healed. It's like I never had a fissure now, in fact I had been having trouble with pains down there for over 3 weeks before my tear so this is the best I have felt all year.
For anyone reading this who's got an acute / fresh fissure and have just started using Nitro, what I will say is don't lose faith. My first week on Nitro was absolute hell and it seemed to do nothing, but stick with it because after a couple of weeks you start to get control of the pain.
I didn't bother with any lubrication like vaseline or lidocaine gel, I stuck to a very simple routine and tried to leave the fissure alone as much as possible. I ate the exact same foods every day as it gave me confidence I would not have a large BM and be able to heal. In 9 weeks I have still not had a single large / hard BM.
This was my daily routine;
Drinking
200-400ml water every hour. Around 4litres per day in total (did this even pre-fissure!). Allowed myself one small, weak cup of tea every day but other than that only ever drunk water. Some days didn't even have the cup of tea.
7-8am
Get up, run a hot bath and try to get in quickly before BM urge to loosen things up, then back in afterwards.
9-10am
Apply Nitro. I found that Nitro (when it started working) could relieve my spasms for around 3 hours. These would be strongest around 11am>1pm so I tried to apply the Nitro as late as possible so I would have relief during those hours.
12pm
Soup time. I ate vegetable soup every day on the basis that it wasn't much volume and I'd get good nutrition / fibre from the vegetables. Spoon of olive oil before the meal.
1pm
Cry if the pain was bad... it reduced me to tears a few times let me tell you.
6pm
Dinner time. Fish and vegetables. Spoon of olive oil before the meal.
9-10pm
Second dosage of Nitro as instructed. Never had spasms this time of day really, but stuck to the routine on the basis that it's working round the clock then.
10-11pm
15ml Lactulose.
And this is my (rather basic - apologies) account of events;
29/01/2013
Fissure tear - unbearable pain wanted to go to hospital. Fissure pain has me in tears - the first time in my life I have ever cried from pain.
05/02/2013
1 week into Nitro. Doesn't seem to be working and went back to the doctor who wasn't much use. Fissure regularly reducing me to tears.
12/02/2013
Started applying Nitro to internal shpincter and got some relief. Doubting I would heal with Nitro so booked a CRS appointment. Fissure still managing to reducing me to tears on bad days.
19/02/2013
Noticed a senitel pile for the first time. CRS confirms fissure and senitel pile in the normal position. Still very painful some days but noticing an improvement now.
26/02/2013
Continued with diet and treatment. Some good days some bad. Eating or drinking anything outside my normal diet seems to upset things. Pain seems to be mainly under control now with the Nitro, but it's definitely still there and I need to be careful.
05/03/2013
My Pain 'changed' over the weekend. There was no more intense knife like pain with the spasms, instead I had a 'pressure' type pain. Booked a CRS appointment as I was concerned. CRS confirms fissure has healed over but is still tender so to be careful. Senitel tag is also a bit swollen and tender.
12/03/2013
Stopped using Nitro after 2 painless days following the CRS visit, only to find spasms return! So started up on Nitro again. I went away for the weekend and freaked out because I expected to be back to normal and wasn't. Spasms were very painful but felt like a horrible pressurised sensation. Starting to worry this is all in my head as I know I'm healed. Levator syndrome?
19/03/2013
Nitro has spasms under control once more and things are starting to get better. Sometimes a bit of burning and aching after a BM, but not really painful. Perfected squatting and no longer need to push when I have a BM - this seems to be really changing things fast for me.
26/03/2013
Things getting much better now, slight burning and itching after a BM. I am introducing different foods into my diet again; lamb, beef, curry and of course red wine!
02/04/2013
Feel almost back to normal so dropped the Nitro down to 50%. No pain or sensation during or after BM, other than sometimes it's a little bit itchy. Been drinking alcohol (lots!), eating curry, red meat, chicken... almost back to normal. Still continuing with sensible diet most days, lots of water, olive oil and Lactulose.
09/04/2013
Going to stop the Nitro completely… I do hope the spasms don't return!
So assuming all goes well on Tuesday I'll be off the Nitro but will continue with my diet of fish and vegetables most days, plus olive oil and lactulose. I'm going to continue the diet forever when possible, but come off the Lactulose after 3 months. I'll reduce it slowly and monitor the effects closely rather than just stop completely.
The biggest shock for me with this illness has been how long it's taken to return to normal even after the fissure has healed. I had some really quite bad spasms after healing which scared the crap out of me (no pun intended!). Getting your mind to the right place is what it's all about and I can sympathise with anyone who is struggling with this - it is not easy. I'm absolutely socked and amazed that your mind is so powerful it can induce something as painful as a sphincter spasm. Even without an open wound down there these things HURT!
If I had to pin my recovery down to any one thing I'd have to say it's toilet technique. I think I've pushed my entire life and the fissure is all my own fault... I did this to myself. Now I've learnt to go to the toilet without pushing which I didn't even know was possible! I notice that (even now) if I get at all worried it causes me to tighten up, then if I try to push it makes me tighter again... this is a vicious cycle and I am absolutely convinced was the cause of my tear. If I relax again or just give up until the urge comes later then I have no problem what so ever - even if I have to go twice. It's really difficult to do but my advice to anyone with a fissure is learn how to go without pushing and don't give up until you can do it.
Well that's it folks... you can all get better too, just stay positive.
