Hello everyone,  I just came from the C.R.S. and he did an examination and I couldn't believe it when he told me that the fissure showed some SLIGHT improvement over my last visit.  I asked if I should reschedule the LIS and fissurectomy and he said that only I can answer that, it depends on how much pain I feel.   Right now I'd consider it slightly uncomfortable but not as bad as before I started the Nifedipine ointment back in February.  My appointment is July 10th and I don't want to cancel on him  at the last minute and he started vacation today until July 8th so he won't be seeing many patients between now and my surgery date.  I was so nervous and confused that I didn't ask him if a fissure can stay "dormant" for a long time.  By that I mean is there a chance that the fissure will stay in the uncomfortable stage without completely healing or getting worse and more painful.  I was thinking that maybe if I stay on the Nifedepine I can deal with it as it is.  But, if I cancel this appointment on July 10th, I won't have another chance to do it until October at the earliest if I want to have time to recover.  I was uptight enough thinking about the approaching surgery date, now I'm confused about if I should just leave well enough alone and see if it changes for the better or worse.  I'd hate to cancel all of this and find out that I should've had it done and not be able to schedule it again for almost four months.  I can't believe that I didn't think to ask him this at my appointment.  For those who've had surgery already, did you have it while the pain was minimal or wait until it was severe?  Any advice would be appreciated.  Thanks!

Hi, sorry you're so confused, I don't blame you. Is your fissure chronic or acute. An acute fissure has a good chance of healing and staying healed. A chronic fissure not so much. The longer you have the fissure the more scar tissue it develops as it tries to heal. Spasming cuts down the blood supply needed to heal it also. It can become a vicious cycle. You can heal for a few months to a few years at a time only to retear again and again.  If you're really tight there LIS is a really good option. It loosens the muscle some. You have to remember that after LIS you should feel looser there but in about a year that muscle will return to about 80% of what it was. It's an excellent surgery if you get it done sooner than later. I waited too long with mine so it didn't give me relief like it does for most people. The surgery itself required nothing more than ibuprofen for pain for me. I finally had to have double advancement flaps a few weeks ago, I let my fear of surgery keep me from getting help and if I had to do it all over again I would have done everything differently. You have to decide for yourself what would be the best for you but whatever you decide don't let fear make the decision for you. Weigh your options and how this is affecting your life and you'll make the best choice for you. Wishing you all the best. Suzy

I had a similar experience before I found this website. Thanks to my surgeon brother, I was already doing the right things (Miralax, Metamucil, and nitro) a few months but thought it was hopeless when I  went to see the CRS. This surgeon said he didn't like nitro and set me up for LIS the next month. Well, in two weeks I noticed more relief, so I cancelled the surgery. I must say I wasn't too fond of the CRS anyway.
Now after 6 months of nitro, I'm 95% pain free. I had a colonoscopy this week and the gastro-intestinal doc says my fissure is healed. Oh I can still get blood stains on the toilet paper on rare occasions but I suspect the tissue will always be thin in that area (just like the skin on my hands).
The important things I learned from this website was to BE PATIENT and use surgery as a last resort.

Hi GeorgeTheCatMan
If I were you I would postpone the surgery, you have a chance to heal with the Nitro and that is so much better than surgery. As you say the worst that could happen is that you would have to wait a few more months. 
I hope you the best with any decision that you make

Hi George, 
Such a decision so close to surgery. Before I had LIS I had Botox on 27th march this yr a wk before Botox my pain disappeared I couldn't believe it I was going to cancel but didn't 2 days before Botox I had another tear. When I decided to have the LIS I just couldn't take it anymore. 
As Suzy says you have  to make that decision yourself weigh up your options. I hope you make the right choice. 
Best of luck 😊

You stated it is just uncomfortable at this point of time living with fissure.
How many limitation you have coping with discomfort only? Do you eat everything? Are you afraid of BM visits? Are you limited to things you used to do? (some likes biking).
What is quality of life for you? As for me I would be fine just to be with no pain. But human is such being they are always not enough. I bet, when I will be pain free I will say, ohh if would just get pizza, I would be absolutely happy, ohh if would just get some beer.  And etc.
The choice is difficult, LIS is good operation, but still it is operation. You know I was feeling 100% when I jumped into external hemmie removal, and what now? I have fissure/non healed wound.
Somebody says have surgery only when absolutely necessary! If you can cope, and enjoy life with this discomfort, if you don't want to eat pizza everyday, probably you should not have LIS done.
I am bad in advising and quite straight forward person, but hopefully you will make you choice.

suzyljank wrote:If you're really tight there LIS is a really good option. It loosens the muscle some. You have to remember that after LIS you should feel looser there but in about a year that muscle will return to about 80% of what it was.

I was not aware of this. I always thought LIS permanently loosened the muscle and that's why most people don't get recurrences of fissures after having the surgery. Interesting.
George - Ultimately, it is up to you how long you are willing to put up with this. If the fissure is healing and you have the option of the ointment to continue, I would give it a chance and see how you do. That's what I would do, but it's your decision. For myself, I don't really have a choice but to try to heal this naturally and with Diltiazem. I can't afford surgery and don't have health insurance right now, so that's just the way it has to be for me. My pain is manageable, though, and I have more good days than bad days. If I had a lot of bad days and this was seriously destroying my life with constant pain, I would get surgery ASAP no matter the cost. But, as of right now, I am doing well. It all depends on how your pain level is and how much more time you're willing to invest into healing it on your own. These things are very physically and emotionally draining. I think you will know when enough is enough.
I wish you luck in making the right choice for you. Best wishes and hope you get over this soon no matter what choice you make.

Hi George... I just got back from surgery today and I'm up from my lil nap... What made me decide to finally get the surgery was the fact that I was in constant pain and going to the toilet terrified me. Also even though I work at home, the constant pain and the emotional stress got to be too much so I ended up actually getting depressed. At one point I was like "ENOUGH IS ENOUGH!" and I found a CRS.
The CRS said my only option is surgery because in my country, creams like nitro and diltiazem are not available. Lord's operation isn't a good idea either. Luckily for me even though I have no healthcare/insurance, my parents paid for my operation.
I would not have gone for the surgery if I wasn't so desperate to get rid of the fissure and starting to get dependent on pain relievers just so it wouldn't hurt as much when I had a BM. However today after my surgery my doctors told me that it was good I had gone in for one because my fissures were too deep and would not have healed naturally.
I guess it's really in a case to case basis. Maybe consult with your dr, if he thinks your fissure has a chance of healing naturally. Has he done an examination under anesthesia?

Hi George,
I waited until it was severe and unbearable.  However, that was wrong on my part.  I should have done it sooner, when I had all the strength to cope with it.  By the time my surgery was scheduled, I had lost a lot of weight. My body was lacking of all the vitamins, proteins (especially collagen), and minerals needed to recover and keep infection at bay.
Now to answer your question... Yes, "the fissure can stay in an uncomfortable stage .... and more painful".  We all know, that it is solely connected to our internal system.  As a matter of fact, if you know what suits your stomach, then the fissure can be taken care of, without surgery for a long period of time.
I too could handle it for quite some time without surgery.  However, sometimes diet is not the only factor that can make you fissure-free.  Your over-all health also matters.  Incidentally, I had this horrible throat infection (due to severe cold), and the first thing that the doctor prescribed was "Antibiotics".  That just messed up my whole internal system and history was repeated with an instant rerun of the fissure episode.
I think you should hold the cancellation until the last couple of days.  I know it doesn't sound like a good idea, but it will give you some time on hand, to think.  In addition, you will have two whole weeks to test your new cream.  You could be honest and make your doc aware of this fact.  I am sure he will understand. 
Take care & stay healed.
Mabel.

Thanks very much to everyone for the replies.  I'm going to talk to the primary care physician on Monday afternoon.  I have an appointment that was supposed to be for the preadmission physical, but I'm going to try to talk it over with him first.  I think that in the back of my mind, having the LIS and fissurectomy done now before it get too severe is the right way to go, but I'm afraid of taking something minor and making into something major if things don't go well.  The CRS just tells me that it's my choice.  The stress of this and some other things going on right now have brought back my panic attacks which had been well under control for quite a few years.  I had to start back on the medication for the panic attacks again yesterday after several years so I don't know how I'll react to mixing it with the pain medication.  Anyway,  thanks again to everyone for your input,  I'll see how things go between now and Monday afternoon.