So, it's been about four years since I started having problems with fissures. Things have been up and down since, I've made posts here, before.. While things looked better for a while, I was using coconut oil and zinc oxide, and I was so pleased I could have a BM without pain. But one bout of constipation, and I'm back to where I was. This pain is so bad, I can barely sit down right now. I have a current yeast infection back there as well, but took a Diflucan yesterday.
I'm scared my GI will just suggest to cauterize them shut (for the third time) and nothing will come of it, AGAIN. What is the next step here? What are the surgeries or options I have?..
I'm at the end of my rope.. The pain is too much. I have worked very hard the last 4 weeks, and lost nine pounds, but suddenly-- this. And now I cannot use the gym and work out comfortably. It's keeping me from achieving my goals and so forth..

Hi kyrehe
Its unfortunate, and we are so sorry for your recent setbacks. It may be best to try and see a Colon Rectal Surgeon CRS instead of your GI as they are much more informed as to what to do next for you.
Constipation will do it everytime. As for surgeries, as you discuss this with your CRS they may suggest an LIS if they deem it necessary if in fact your fissure is not healing.
Other less evasive measures are botox, Diltiazem, Nitro G, the like. The extreme pain may be due to tightness from the spasm so you may want to try these less invasive measures first.
Stay tuned for more help here as I'm sure you found out last time, this is the place to be for great feedback and info.
HTH GL
P.S. In the mean time try your darnedest to keep your stools soft.  

When nonsurgical methods (high fiber diets, stool softeners, warm sitz baths, topical analgesics/anesthetics,) fail to heal the anal fissures or relieve symptoms, surgical treatment may be necessary. The surgical treatment options are:
1) For uncomplicated fissures, Botox - a temporary remedy, or Lateral Internal Sphincterotomy - a permanent remedy to relax the internal sphincter muscles can be carried out.
(Please note the word "remedy". Botox or LIS is a remedial procedure carried out to help with the healing process of the fissure. It may or may not be a cure.) Just like cauterization - a remedy but not a possible cure.
2) Fissurectomy, and
3) V-Y advancement flap.
I did Botox with Fissurectomy three months ago and have been doing excellent since then. The recovery period of eight weeks was a bit stressful, but honestly??? it was no where near to the fissure ordeal that I had undergone for almost a year before the surgery.
Before you do the surgery, having a flexi-sig to rule out other serious conditions would be a great start.
Good Luck and Happy healing !

I'm so sorry you have had this set back when you were doing so well.
Swimming is always a good exercise to do. I never find it irritates my fissure.
I think mabs has got your options covered.
OMB x

Thanks, guys. Sorry it took me so long to reply. I was supposed to see my GI today but she didn't call me, so I'm stuck with at least another week of this. The pain has calmed significantly, but the itching is back. She gave me that Diflucan, but I don't feel it has done anything. It's been almost? a week since I took it, and no results. I am switching between Zinc Oxide and Miconozole to help calm the irritation and itching.
I'll have to look into these surgeries. I broke down sobbing the other day watching one of them being done on youtube. I can't imagine the healing process being fun, so I'm just terrified. However, willing. Thank you so much for the support and information.
Edit: I had a flexi-sig about two years ago. (All was normal.) My BF buys me cake on that day every year because it took my butt virginity.

Hi, I'm so sorry you continue to be in pain. I know how you feel, I suffered for over 10 years with the pain. I would heal and tear and heal and tear. It was driving me mad. I had LIS and it didn't help much. I continued the pattern of tearing and healing because I was so afraid of more surgery. I ran out of options this year and finally had surgery again. I had a double advancement flap with the donor sites left open to heal. I was expecting terrible pain but while it was very very uncomfortable at times it was all managed with toradol the first 3 days and then ibuprofen during the day and 1 tablet of norco at night. My recovery was slow and long but I had a very good CRS who encouraged me all the way. Don't be afraid of surgery. You are probably in more pain now than the surgery itself will cause. I'm going on 11 weeks post op and while my full recovery will take about 2 years ( it can take that long for the surgical site to completely heal and calm down.) I can tell you I wish I would have done this a lot sooner. There was nothing short of surgery that was going to fix my fissure. My CRS told me I was just a few short weeks away from emergency surgery if I didn't do this. My opening was scarring over and was almost totally closed. Make sure you talk to your doctor about all your options and what your best chance for healing your fissure is. And please don't be afraid if surgery is the option your doctor gives you. Remember the moment you have it done you will be on the road to recovery. Wishing you all the best Suzy.

In the meantime, while you work through your options....I hope you're doing hot baths or sitz baths.  That is what they recommend after childbirth and it really helps fissure pain in my experience.  My sitz bath is my best friend.  I was a little embarrassed to buy it but boy am I glad I did!  Get lidocaine ointment (5%) from your doctor to help you cope as well.  And then figure out your best option(s).  Hang in there, you can heal (with or without surgical help).