Male 31 years old, Canada
no other health conditions
no medications except for butt creams lol

Well my journey all started when I got this gastroenteritis infection in 2005, it caused me to have severe watery diarrhea (20 times a day) for 8 days followed by constipation for about a week. I took an antibiotic to treat the infection which worked to stop the diarrhea but caused the constipation. Well I do not know which caused the fissure, the diarrhea or the constipation. Anyway I have been battling this fissure ever since, here is what has happened so far.

After my infection, the fissure was diagnosed by way of anoscope (doctor said the fissure was small and more external then he thought) and I was put on stool softeners and some suppositories by my GP. That did nothing for me after 3 weeks of this treatment. Went back to my GP, he sent me to a surgeon (We do not have any CRS in Canada, just general surgeons) He put my on nifedipine 0.2 ointment which was successful for the time I was on it. I took it the nifedipine for 2 months then stopped, the fissure returned and I started a second course for another few months. Basically this cycle continued for the past 3 years with about 3 different courses with the nifedipine. I also tried that wheatgrass cream and that was the biggest rip off ever ! After the wheatgrass, I went to this specialist that is supposed to deal with hemmoroids and fissures exclusively http://www.haemorrhoids.ca/index.php
Well he gave me nitroglycerin ointment but at a dosage I have never heard of... 0.125, not the typical 0.2. He told me he has treated over 20,000 people with fissures and likes the nitro over the nifedipine although he did not mention the diltiazem. I am not sure what to think of this... he also said that he does not like botox because of the unknown risks and does not approve of LIS for me because of the risks involved. (especially at my age) I am not in severe pain at the moment, just some stinging and discomfort when I go to the washroom.
Well to make a long story longer lol, I feel pretty good but the thing is I go poop more then the average person and sometimes I get diarrhea. I go poop like 2 to 3 times per day, the stool is pretty soft but sometimes too soft. I think going that often is making the fissure more irritated!
So my fissure hurts me on somedays, It only hurts when I take a poop... normally I have no pain or discomfort through the day. I have no bleeding or skin tags, just some stinging after I poop, sometimes when I workout or exercise it bothers me. What scares me is not so much right now but of what would happen if I got severe watery diarrhea again or get really constipated. Another thing that I want to know is... will I have to stay on the nitro forever ? will I ever be able to come off the ointment ? everytime I go off the ointment the fissure returns
It also bothers me that this new specialist said my fissure was healed when he last saw me a week ago, if this is true... why am I having stinging pain after my bowel movements this week ?
is the nitro he prescribed me really effective ? nitro 0.125 ? not too weak ? he also told me to get it in as far as possible, he told me to put a pea size amount on my finger and get my whole entire in there if I could. He said the mistake some people make is not getting the ointment inside as far as possible.
My fissure remedies are as follows, I use my nitro 0.125 twice a day after I poop in the morning and before I go to bed, I always use baby wipes to clean myself. I also tried this carmex lip balm and that seems to be soothing as well. I carry vaseline because If I get diarrhea I may need that as a barrier, but I also purchased this zinc oxide cream which I heard was even better as a barrier and skin recovery cream.
Thanks guys and gals, I will be a regular member here :D
So glad I found this site.

Hi there! Welcome to the board. Thanks for sharing your history and where you are at this point. I can imagine your frustration of being told different things and to be told you are healed yet still be symptomatic.
The first thing that popped out to me was that your gut flora might be out of whack since you were sick. Your bad bacteria may outnumber your good bacteria at this point and can set you up for digestive problems. Do you take probiotics? A broad spectrum probably the way to go to repopulate your gut with beneficial flora. That should help to keep you regular and strenghten you immune system too. I had a GI bug this summer that put me in the hospital and I have had terrible burning afterwards. I thought it was only because of the trauma of pooping after having 2 rectal surgeries but the burning was caused by the bacteria so I thought I would pass that along since it sounds like your fissure may have closed??
I don't know much about the dosages of Nitro but others on here will be along. I used diltiazem which is the same as nefidipine as the Nitro caused terrible anal burning. (which is another consideration).
I would be concerned about a doctor who only uses creams in his arsenal to treat fissures. Some are chronic and you can apply cream until the cows come home and it may not be effective so it is good to have options such as botox or surgery. The risks are particularly low in your age and sex so I am not sure why your doctor implied that it wouldn't be recommended.
I think you are doing a lot of things right. You may want to evaluate your diet and also look into supplementing with fish/flax oils, glutamine, probiotics, fiber etc. Have a look around and you'll find a lot of great threads to get you started. Let us know if you need anything and welcome!

Hi there and sorry you're suffering!
yes, it does seem odd that he said LIS wouldnt help, for the amount of time you have been suffering I would have thought he would have suggested it long ago. Especially as you say that it is better when you are on nitro and comes back when you stop - the LIS is like a permanent nitro!
Just ask any questions you want, there's always someone here who has the answer!

Hi and Welcome!
Glad you found this site, it is a great place to learn and get support.
Sorry you've been suffering so long with this. There are many here that give great advice.

Best of luck to you.
Jo

Ahoy there :) !!!!
Welcome and sorry that you are suffering with this annoying and very "hard to kill" enemy,
but I am sure that you will find relief soon with proper treatment since you tend to heal for short period of times - it is just a matter of finding something that will ultimately and permanently work for you.
I am sorry that you had to suffer for 3 years and that your present CRS is so conservative in offered arsenal of anti-fissure treatments , and especially with such an odd % of Nitro cream, LOL, but don't despair. Is he kind of flexible in any way or what he says is non negotiable ? If he is the later one , I would look for another specialist who will be willing to try it all and who is experienced and up to date with ALL available treatments, including Botox and LIS, of course ! It might take a several tries, but most of us changed couple of doctors until we found the one that "knew it all" and was kind and supportive. They DO exist , you just need to search for them.
Fissures are sometimes hard to see just by exam. I had 2 CRSs telling me that they can not see it, and than third did thorough exam doing colonoscopy and not only found it - he made a photo of it so I can have it LOL. He explained that sometimes fissure is hidden in crevices and folds of a skin and very hard to see if anus is not completely dilated and relaxed.
I agree with Lecia that burning can be caused by many other things (bacteria, yeast, sensitivity to a cream ) but it can also mean that superficial or small hidden fissure is present , although not visible and is causing inflammation of that area and sensation of burning.
I also agree with Lecia and Val that LIS might be the best long term solution in your case - just find surgeon who did a ton of them and never had a case of incontinence. Your age and gender actually put you in the category who would be the least prone to have such side effect.
I was told by on CRS that having a fissure for many years can cause formation of so much scar tissue that slight incontinence occur since anus than can not close properly. Another CRS told me not to wait more than a year with conservative methods since scars start formation. So, if I were you, I would ask for second opinion .
I wish you all the best and finding perfect treatment for you very fast. You are doing well with all other things (baby-wipes, creams erc.). BTW, I healed first time with Nitro but I used it only outside - on the other hand it was 0.2 % and than 0.4% after 2 months. Many members here used creams inside and had great result - for me it was impossible to apply
it inside because my sphincter was soo tight, and I was also advised by my CRS to use it outside. I am telling all of this just for you to know that different docs and different people find what works for them the best by experience and nothing is "written in the stone" !!!
You have to find what works for you personally the best and it could be combo that nobody here had ; )) !!!
Both creams and the LIS not only bring more blood to the area but relax the sphincter which is VERY important. When sphincter pressure is too high it keeps the fissure OPEN and the edges can not adhere properly or timely.
All the best

thanks for the replies,
see thing is... my pain is very minor compared to some on here, there are days when I have no pain at all. When I do have pain, I just have some stinging after a bm but it goes away a short period after. I have no bleeding or spasms either, some days but rarely I have minor spasms (very minor) I do not even know myself that having surgery would be the right choice for me at this time.
What really scares me is what would happen say if I had severe diarrhea again or got constipated, like I picture myself lying in bed in excruciating pain if one of those things happened ! That is honestly my worse fear right now, I have like diarrhea anxiety because of the fissure ! I think that if the diarrhea I had before caused this fissure before, what would it do now to my sensitive anal area with a semi healed fissure ? It really, really scares me !
has anyone had a open or semi healed fissure and had severe diarrhea ? was the pain unbearable ? how did you deal with the fissure and the diarrhea ? if someone could ease my fears about this, it would really help me get over this anxiety I have had for the past 3 years !
If I got some sort if illness right now that caused diarrhea, would it mean the end of the world (in terms of fissure pain etc) When I have one bout of diarrhea it makes my fissure feel bad, having severe diarrhea like I had before would kill that area wouldn't it ?
thanks again for the help.

I can understand the worry about it happening again and how you would handle it because diarrhea is irritating to even normal butts. I would start taking probiotics every day. It will strengthen your immune system so you may not get sick and if you do if will keep the bad bacteria from multiplying as quickly.
I would agree if you aren't in daily pain from this, then surgery probably isn't the way to go.

hi canuk! welcome to the af board!!!!
well to me it seems you are more pre-occupied with what will happen in the future if you get D and it affecting the fissure. i think that if you can suspect when the diarrhea will onset, then the next best thing to do is to help coat your anus with some vaseline or palmers cocoa butter - i would recommend the vaseline.
this basically is the same instructions that my CRS gave me when preparing for my colonoscopy and with the anticipation of the "prep" releasing a lot of watery stool or fluids, he advised to coat the anus with vaseline prior to the beginning of the evacuation during the prep to help shield/protect the fissure and avoid or minimize any further damage or irritation.
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i personally would rather have diarrhea over any kind of stool!
i was sorta in your situation from 2004 through 2007 and well, i opted to get LIS (and then some) but after starting up macrobiotic eating (for me it worked and for some it may not), that helped reverse things and my LIS was cancelled and now i am healed.
i didn't even go through any of the creams for those years of intense madness and psychotic breakdowns from just going to the toilet!!!!!!
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sounds like you are doing well and making the most of every day.
i wouldn't worry to much about the occassional burn here and there. i think that is normal - do you eat spicy food? i know i get the burn poop when i have something with peppers in it!
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also going 2 or 3 times a day is a great thing! i am trying to get there again. i felt so much better going to poo 2 or 3 times a day!!!! it sure beats going once every 3 days or so......

also forgot to mention, that if you do have diarrhea, i think the best thing is to wash (shower if you can) right after so you can rinse the residue that is left in the anus from the liquidy stuff - i can only imagine that because it is liquid that it may cause more of a stingy sensation than say a normal stool. it's like an acidity that leaves the body and then it pours around the fissure causing it to burn.
so better to wash up and dry off well after a diarrhea visit.

Good luck new member :)
Happyass, about the vaseline and d. Would you put vaseline inside? Since the fissure is inside...
Corsica