Hi guys, I wasn't sure which sub forum to post this in, but figured it was close enough to a supplement, so here goes...
I was wondering, has any tried any OTC lidocaine gels for their fissure? As in something to put in the anal canal before a BM. My CRS has given me an ointment of nitro, lidocaine, and hydrocortisone, but I'm trying to avoid using too much of the hydrocortisone and wanted to try something with lidocaine alone. I'm using dibucaine (Nupercainal) as a numbing agent right now but it's not terribly effective.
I saw some products on Amazon that look interesting...
TOPICAINE
http://www.amazon.com/gp/r.html?R=GU8XR6BYF8FP&C=30UI4UKP2P6AK&H=LE0VZZAZGUZ3IUBNOLV0L9H1CPKA&T=C&U=http%3A%2F%2Fwww.amazon.com%2Fdp%2FB001BIU8I4%2Fref%3Dpe_55150_12832750_pe_vfe_t1
LIDO CREAM
http://www.amazon.com/LIDO-Lidocaine-Cream-2oz-60g/dp/B000S09T7W/ref=pd_sbs_hpc_6
LIDOCAINE GEL
http://www.amazon.com/Lidocaine-Gel-2-oz-Bottle/dp/B000XEHOS4/ref=sr_1_3?ie=UTF8&s=hpc&qid=1250703567&sr=1-3
None are indicated specifically for rectal use, so I'm a little iffy. Does anyone have any personal experience with these products or ones similar to them?

Lidocaine is efficacious for many people and is in fact often used as part of the base for nefedipine and diltiazem!

Actually nevermind this topic, I surfed around on Amazon today and saw lots of different ointments that promised to cure anal fissures. It all seems too good to be true, so I'm going to conclude they're BS. Not going to waste money on any more magical cures.
Mods, if you can delete this topic, please do. Thanks.

I'll delete if you like, but I think lidocaine can be useful for some fissure sufferers, you are not off the mark at all, Chen!

Kim wrote:Lidocaine is efficacious for many people and is in fact often used as part of the base for nefedipine and diltiazem!

Thanks Kim, looks like you beat my previous post to the punch. You're fast on the draw :)
The lidocaine part I'm okay with, it's just that I wasn't sure about the other additives and chemicals in those OTC ointments and whether they're okay to put in the anal canal or on the fissure. The nifedipine and nitroglycerin ointments I got from the doctor are all based on either aloe vera or petrolatum. Not sure if that's because they don't believe in lidocaine or some other reason.
Anyhow as I understand it, the lidocaine is only for pain relief and doesn't do anything to actually heal the fissure, right? Assuming that this is the case, then I'm okay on not having it, I'd rather not roll the dice on putting other additives in there that complicate things. I think my interest in these is really driven by the desperation of getting rid of the fissure.

Kim wrote:I'll delete if you like, but I think lidocaine can be useful for some fissure sufferers, you are not off the mark at all, Chen!

No worries Kim, let's leave the thread be then. I did a little more searching and did find one OTC lidocaine cream designed for anorectal use. It's called LMX5:
http://www.drugs.com/cdi/lmx-5-cream.html
It's available from Amazon and some other places too for around $60 a tube. I may order one and see if it helps with BM pain at all.
I already have one nitro / lidocaine / hydrocortisone ointment that was given to me by a CRS. It feels nice after a bad BM. But the CRS I saw yesterday plus other info online indicates that hydrocortisone slows down fissure healing, so I'm reluctant to use it, hence my interest in finding something with lidocaine alone that I can use in conjunction with nifedipine. If I get the LMX5 I'll report back with my results.

I think lidocaine is sometimes used prior to a rectal exam. I posted an article many moons ago about fissures in general, NG. You might try doing a search by my name. I thought it was a very interesting article, and it does talk about lidocaine and the healing rates for ointments, Botox, and LIS. Have you decided which route you are going to take???????

Thanks, Cheryl, I just searched for all your previous posts and they went a few pages back, so I will give it a good read later tonight. I'll also try to research that LMX5 cream I mentioned above. It looks promising, but who knows if it's any better than the Dibucaine (Nupercainal) I'm already using... I've got a feeling it may just be another $60 worth of a magical cure that only results in further disappointment.
At this point, I'm looking to have a decision made (and hopefully procedure done) by the end of August, and am leaning strongly toward LIS. I read through the previous posts on botox on this forum a few days ago, and it seems only a very small minority achieved lasting success from botox, and even in those cases, it tooks repeat treatments over several months, still with some measure of pain during that time.
My only reservation about LIS right now is two fold. One is of course the risk of incontinence, but I'm largely at peace with that risk -- high risk, high reward, right? The other is that I've only had my fissure for 3.5 months, with the severe debilitating symptoms being over the last 1.5 months. And I can have maybe 2-3 "better" (I won't say "good") days in a row (meaning only moderately painful BMs with minor bleeding) at times. Eventually, a bad, terrifying fissure day will arise, of course. But the relatively short duration of my fissure so far (seems like most others here have suffered much longer before going to LIS) and the occasional stretches of reduced pain makes me wonder if perhaps my fissure can still heal with conservative treatments. I just don't know if these patterns indicate that my fissure actually still has a shot at non-surgical recovery, or if they are simply part of the ebb and flow of the disorder (Kim has warned me that fissure symptoms can increase and decrease sporadically). So I'm kind of conflicted right now. I've spoken with both surgeons and they've both said that once I give the word, it's a go, so I have no one to blame but myself for any delay now.
I will definitely look at the healing rates from your earlier post. Both surgeons I've spoken with are quoting me 60% for nitro or nifedipine and 95% for LIS. On those two points they agree. But one surgeon quoted me 75% healing rates for botox, and the other says she doesn't feel that botox really works at all and thus never uses it.
The only other option I have besides those two is to go see a third colorectal specialist at Stanford Medical Center. I have the appointment set for late August, but I think I may cancel it. While they have a real good reputation, they wanted me to transfer *all* my medical records to them, and I get the feeling they're less interested in curing me and more interested in getting some kind of experimental data out of my case. Sorry for the long post, I swear this thing was shorter when I set out to write it :)

At least you seem in much better spirits, NG. Are you getting excited about having babies in your home??? Have you been able to regulate your bowels with the Miralax??

Yeah the babies are going to be awesome! We just set up both cribs yesterday along with the mattresses, bedding, etc. We're beginning to decorate the nursery. I'm a huge Los Angeles Lakers fan, so I'm lobbying to get a few bits of Lakers memorabilia up on the wall (especially since they just won the NBA championship this year), but my wife likes a nature theme, so maybe we'll have to compromise and have some basketball players in a forest or something :) But yeah it's just about a month (or even less) away now so I'm getting HYPED!!!
The Miralax is still a work in progress, some days are better than others. I usually just take a full dose no matter what (once after lunch and once after dinner), rather than try to guess at the amount.
Lately I've been eating maybe a 1/2 cup of Fiber One cereal for breakfast, brown rice sushi for lunch, and for dinner I have chicken and veggie (broccoli, cauliflower, cabbage, carrots) soup with crab legs or boiled fish on the side. If I'm still hungry then I snack on more cereal or soy beans (edamame). This regimen seems to do a little better with the Miralax. I still get hard stools, or more commonly hard lumps in my soft stool sometimes, and those still hurt pretty bad when they come out, but I think that's probably the chicken. Those hard lumps make me cringe, but I need the protein and energy so I force myself to eat at least a little meat everyday.
I'm indeed in slightly better spirits today, but that's mostly because I haven't had a terrifying BM today yet. Once I do (I often have a bad one in the evenings), then my mood changes entirely. Also, the Valium definitely helps the mood (artificially but I'll take it after my depression the last few months), and seems to reduce the spasms noticeably too. It doesn't seem to constipate me that I can tell.
Finally, I think the reason my mood hasn't been as bad since yesterday is that I've now got both the botox and LIS options on the table, and I can pull the trigger on either when I want to. So psychologically, I kind of feel like I have an out, and it's more under my control than it was before.
Thanks for asking, you guys have been a lot more helpful than my physicians. Between advice on what to eat, how to apply ointment, the real world success rates of the various treatments, etc., I don't know what I would've done without you guys. If I ever beat this malady and get back on my feet, I don't have any idea how, but I'd love nothing more than to make it up to you guys somehow!