I met with Dr. Feingold and he did a gentle exam (no fingers in) and said that he can see a fissure and he thinks it is small. He also said that he sees a skin tag. He also switched me to Diltiazem applied outside only (not inside) and asked me to apply it 3 times a day.

I mentioned to him that the pain was quite severe and lasts for 4 to 5 hours. He said that since I am having a lot of pain (though the fissure is small) he thinks I could have a fistula, but he can't see one right now. I also mentioned to him that I was very concerned about being able to work only half the day, he suggested that if I don't show improvement in the next 2 to 3 weeks, I should consider getting his Kenalog procedure done and he would remove any fistula if he happens to find one during the procedure. It has been 2 weeks since I started Rectiv and another 3 weeks would put me at 5 weeks. I am wondering if I am rushing into a procedure. So confused

Yes, I eat whole wheat bread with quinoa and flaz seeds on it.

I preferred it in a smoothie in the evening with banana and and almond milk, I found it easier to digest that way. I took it in the evening as it made me feel quite bloated, and because i tended to eat most then.

However, most advice says to start with a small amount in the am. It can cause a bit of heartburn and is better digested when you're not lying down right after consuming. Plus if you drink lots of water with it, you may have to pee a few times after (if you're like me!) so bedtime is not the most convenient. The idea though is to take it with food and water - so whatever meal you are more comfortable with. If you're starting off, you may want to spread a small dose out over several meals or snacks.

FissureVictim do you have a brand name for the bread you eat? I have seen similar bread in the US in the frozen section. The brand name is Ezekiel. I was worried about the full flax seeds on the bread. Don't want it to come out rough in the BM.
GG will try out a small dose spread across multiple meals. Will post here how it goes.

Oh an drew about the surgery - I'm totally just saying this from personal experience, and is not meant to pressure you at all. But, I was offered the surgery earlier in my journey and I wish now I had just done it then. I had the lasting pain you describe. I do have ibs so that does not help, but I'm feeling SO much better pain and bm wise now almost 4 weeks post op. And what bothers me most is that between the time I originally could have had the surgery and now, I got two external hemorrhoids and another fissure, likely because my rectal tone was too high and I had to strain at every bm.

Again - this is totally just my personal experience. The doctors would not offer the procedure if they did not think it beneficial.

If you're unsure, you could ask if he could do a rectal scope under sedation or local anesthesia to see if you do in fact have a fistula.

But like I said - my pain was very like yours, I had a small fissure (was often told it was hardly visible or healed) and yes the pain lasted hours. The spasms hurt no matter the size of the fissure.

Thinking of you, I know you'll get through this!

-GG

Hi GG thanks for your always encouraging responses. It is great to see that you are feeling much better compared to the initial troubles you had post op. It is great to see people feel better.

I am going to give myself atleast another 2 weeks to get better than where I am at now. If I see no progress (It would be almost 5 weeks since I got the pain first and 4.5 weeks since I started the medication in 2 more weeks) I am going to start thinking about doing something about this pain. My job won't allow me to be in this state for much longer.

Dr. Feingold offered me the Kenalog procedure and told me it has a 85% success rate. But there doesn't seem to be too many successful people on this forum. I saw a couple of people come down with bad hems, and a bunch of others get secondary fissures after few months unrelated to the original one that they started with. They end up having a second cleanup Kenalog or end up moving on. This is causing some confusion for me, wondering if I should talk to a another surgeon for a different opinion.

I am surprised there is no section for CRS recommendations on this forum. I am not sure why people are not posting which CRS they had a successful procedure with. It would be very helpful for people to choose.

Hi raoden, this sub forum may be helpful for you viewforum.php?f=31

Thanks patience_and_healing the subforum is pretty useful.

​I saw a CRS near my house now, as the one I was seeing was too far away.

The new CRS mentioned to me that I actually have 2 fissures slightly away from the center. He drew a diagram describing where he saw them. From the diagram it seemed like they were at the 11:00 and 1:00 position slightly off center (from the classic 12:00 position near the tail bone for men) He said that fissures generally happen on the front or back but in the center of the muscle and my 2 fissures were slightly off the center. He was asking to rule out IBS or some other reason for the off center location. But I said I had done a colonoscopy about 3.5 years ago and nothing was found during it. Then he said he was not overly worried about it. Does anybody else have a fissure that is not in the center? Does it necessarily mean something more than fissure alone?

Also should I create separate topics for new questions...? What is the standard thing that people follow here?

Ideally you should create a new thread for a question on a different topic. If you are concerned about the off center location you could go ahead with the colonoscopy. It's been a while since your last one. My CRS told me the same thing about off center fissures, that they do further investigation to make sure it's not another cause. Also they can tell by the look of the fissure (highly inflamed) whether it could be caused by an underlying condition.