Hi everyone. I got two fissures after childbirth two month ago and tried basically every conservative method (psyllium, diet, sitz baths, galons of water, creames, ointments, self-dilation etc.) but still have pain every single day. Ntg ointment helps only with the spasms, but my BM is still with great pain.

I went to the doctor for SAD (standardised anal dilation) but he told me my sphinkter tonus is great and normal and there is no use of SAD for me and to just keep going with conservative methods. But they are not working, I am in terrible pain every day. Every day!

Hi there, I think you should seek out a second opinion. Sphincter tone should be measured by a anal manometry to be absolutely certain of the level. That said, it is possible to have fissures with normal tone. Please take a laxative like miralax to keep BMs soft, and reduce insoluble fiber that can make BMs bulky and cause more pain.

Thank you for the reply. I will for sure seek another opinion because it has been two month of therapy without any progress whatsoever. We dont have miralax here but I am using lactulose syrup and just have to get the right dosage to make my BM soft but not runny.

My doctor only used a finger to asess the sphinkter tone I think, but said it was completely normal. Could a normal sphinkter be an effect of ntg ointment I have been using?

If it is truly normal, does that mean I am not a candidate for LIS and Botox also? What would my options be? I am presuming fissurectomy... but as I have read, it is not as effective as LIS, and the recovery is terrible.

I think ntg ointment will not make the pressure completely normal, but it should reduce it some. As far as I know it only works for a specific amount of time after application so will not permanently affect pressure.

I'm really not sure what your options would be if pressure is normal. I imagine fissurectomy would be a possibility. It's best to get another opinion, from an experienced doctor if possible.

Just to add so anyone with this question can have an answer - yes, nitrogliceryn ointment can cause normal sphincter tone.

Just been to the doctor and he said my normal tone could be due to ntg oitment use (I used it for two months).

I managed to heal my two fissures but then I stopped with the ntg and had a re-tear with days of blood. Then it healed again with ntg. So I dont know what to think… Dr. said to keep using it for two more weeks and we will see.

Second opinion - CRS told me again I have a normal sphincter tone and no need for any kind of procedure. Why have I not be able to heal my two fissures for 6 months then?

I have done everything. Please help me.