This forum is great....I'm glad there is a group of people out there that can relate to my issues. I'm 38 years old, and had a colonoscopy in early March 2009. After drinking a gallon of sea water, in preparation for the colonoscopy, I was apparentley completely dehydrated...the day after the colonscopy I had the most difficult stool of my life...and I believe this caused my fissure (if not the procedure itself).
I've been to two CRS and have been through the fiber and stool softener supplement phase. Last week my doctor gave me the Nifedipine mix cream. Still no improvement, my fissure seems extremely spasmy. It feels like a pulsing on the outside lip of my anus. It's worst after a BM, it gets gradually better (over 5 hours or so), but then inevitably it's time for another BM. On "normal" days I have two bowel movements, close together, in the morning...so sometimes at night I can actually feel somewhat human...but some days there is an add'l afternoon BM and I know that the whole day will be uncomfortable.
I'm not sure what to do next. I'd like to hear a lot more from people that have had the surgery. If you read up, it sounds like 90% of people are very satisfied with the surgery; however, I've found it hard to get them to speak up on their after surgery life. If there's anyone that is male, in near 40 years old, I'd really like to hear about your experience. It seems like many of us would do the surgery in a heartbeat if we could know the extent of incontinence, perhaps by age, gender.
Right now I'm trying decide if surgery should be sooner versus later. I don't think I'm going to do the middle steps of Botox...I'm either going to get better with cream and therapy or surgery.
I have three young children, under the age of 5, and these past months have been awful, they have truly gotten the short end of the stick. I use to be very athletic and interactive with them...now I find myself limited motion and often sitting, watching them play without me.
Oh, I can offer some advise here. For the two months after my fissure appear I used Tucks with WitchHazel to wipe - EVERY time. This was a horrible idea. It made me burn and sting for hours (different than the spasms). The problem with those type of wipes is that the area remains wet...when you have a wound it needs two things - dryness and air...both very difficult for the region. I suppose if you use some kind of "wipe" and then dry off afterwords you might avoid this...
Thanks for listening...my BM's are getting so painful again I almost want to black out!!!

Welcome to the board, Safaller. I don't think we have any males who've had LIS surgery at around forty currently on the board...but I was 47 when I had mine and the symptoms you describe are pretty identical to what I went through. My spasms would last 3-4 hours after they started, and when I did get the horrible burning, it could last forever.
Since you have only been on the nefedipine for a week, it really hasn't quite had time to kick in good. It takes 14-21 days for it to start becoming effective. Use it often (2-3 times a day) and don't be too stingy with it. You should see "relief" but not a cure in a few days *if* it is working for you. Like botox and nitro it has about a 50-67% success rate in eventually healing.
I personally am glad you are skipping the botox, as I have seen too many boardies here who tried it and still wound up getting LIS.
Now for the reality -- once you hit the three month mark, your fissure is chronic and it is all just up to you as to how long you are willing to wait before you opt for LIS. No one can (or will say) you need it now. Including your surgeon. It is something that you will have to decide -- at some point you give in, like I did, and say OK.
My only wish is that I had NOT waited 7 months to make that decision. Had I done it sooner, I would have gotten my life back so much earlier. Good news is that yes, while there is a risk of incontinence, no one here on this forum had ever had anything but transient incontinence and that was soon after surgery. You will hear varying statistics in researching it, but the risks are probably 97 - 99% in your odds. Just my take. I had one instance of sh*tting my pants thinking I was passing gas a few days after surgery and that was it.
The sooner you *do* get the surgery, the easier you will heal and the better your chances are of healing completely. I personally think the longer you wait, the more scar tissue builds around the edges of the fissure and hinders healing.
I was 47 and recovered in a week and a half and was feeling normal in about a month. So if you are healthy and 38 and have a good surgeon, you should be in pretty much the same boat if not better.
Save the tucks and witch hazel for hemorrhoids, they aren't gonna help the fissure. Eat fiber, forego the junkfood, stay hydrated -- well, read the posts here and you will learn the various steps at managing your fissure and keeping the pain levels down Good luck!

I wanted to say welcome and state that I healed with the ointment (apparently).

Hi there - I am not a male , but just wanted to welcome you here and tell that I had not one but 2 LIS surgeries and am far from being incontinent - so that really should not be even on the back of your mind if you decide to have LIS. Just make sure your CRS did at least 500 of them in his/her life and is well known in your area.
I also skipped the botox path - and good that I did, since it would not help a bit in my case. It is not well researched either and doctors can't even agree on the amount given or how to administer it - I refuse to be a hamster , period LOL.
Yes, Tucks are a no-no . Kim gave you all statistics and other advices in such a detail that I have nothing else to add - except that you can use your cream even more than 3 times a day - I used it about 6 times a day, especially before the BM and than immediately after. I also am very regular - my normal "rhythm " is 2 times a day - on supplements I went FIVE times a day - so you can imagine MY agony !!!! Passing the pineapple through the anus 5 times every day and 5 months like that : (((. I really wanted to die ... Creams helped me heal , but than I would re-tear again : ((. The LIS was the only true solution for me.
Best of luck and you will know when you had enough!!!

safaller wrote: It's worst after a BM, it gets gradually better (over 5 hours or so), but then inevitably it's time for another BM.......so sometimes at night I can actually feel somewhat human...

That's how it is - spot on!
I would go for surgery, I had 3 botox shots and they did NOT heal me. Incontinence risk is higher for women, esp. those of us who have give birth
We all know what you talk about, with a fissure you are very often reduced to being a couch potato - funny life Life as you knew it is over...
Let's hope we all heal 100% :)
Don't give up even though BMs are , there's hope!!!
Corsi

Welcome Safaller
I am sure this forum will help you find the answers you need ..
I wish I could remember the stats my surgeon told me about incontinence I know I was very surprised to hear how very low it was !
I do hope the cream kicks in soon it is so sad to hear you missing out on family life like this, i will second that - do use the cream before BM and after and then some, hot soaks also to encourage blood flow the area !
Goodluck !
Passing a pineapple, Fissy ! Spot on !

Hi Safaller!
I too was a "newbie" not long ago here on the forum (just this year) and I had a fissure that started back in February. Well.... I had LIS surgery on April 28th and boy am I glad I did!!! It was about a fifteen minute surgery and yes, I was very sore for about 4-5 days and then I just kept getting better and better and better! :D I highly recommend the sugery!!!

Thanks everyone for your advice and help. I'm going to see a second ARS tomorrow. The first one I visited said the rate of incontinence was 30%! Either he sucks, has no confidence, or is too lazy to go into the details of what's behind his statement...either way I think that he is not the right person to advise me.
I do have some questions. Does the LIS surgery close the wound or does it simply ALLOW the wound to heal?
Jules, you said you were sore for 4-5 days...I have a desk job...how long do you think I'd be out of work?
Thanks again everyone and I'll keep on posting. You all are great resources!

30% is just not right, not for a capable surgeon. Now, the success rate could be lower than 90%, but incontinence rates at 30%? No way! Yes, find someone else!
The LIS does not touch the fissure, it involves a cut into the sphincter that relaxes it, allowing for normal blood flow and healing.
You need to plan for 2-3 weeks recovery, even though you may find that you can return to work sooner than that.

I agree with Kim that 30% is just not right. I have had just a trace of incontinence and that was only in the first couple of weeks right after the surgery. So insignificant that you could hardly use such a big word to describe it. I'm soooooo glad I had the surgery and highly recommend it! I think about 2 weeks off from work for recovery time sounds about right. Again, Kim is correct in saying that the surgery does not touch the fissure. The surgeon makes a small cut on the outside pretty close to your rectum (I only had one stitch there). The stitch just comes out by itself in about 6-8 days. I anticipated my first BM to be terrible but it was smooth sailing, lol! So much better than what I had experienced for the past several months before the surgery. I say "go for it" if you can find the right surgeon. Best of luck to you!