Hey
Recap: So I went to a well recommended CRS on July 15 who said I have a fissure 1cm x 1mm x 1mm (at 11:00) and some small hemmies. He said that I will eventually have to have surgery. He prescribed me nitroglycerin which i have been using since then. I also started a strict food and stool softener regimen at the same time. The bleeding and the pain went away in about a week. Here's the diet regimen.
- Eating mostly vegetarian food, occasionally fish and may be chicken.
- (1 spoon metamucil + 1 spoon citrucel) -- 3x a day
- 1.5x miralax (1 at night, 0.5 after lunch)
- 2 tablets of colace (1 in morning, 1 at bedtime)
- Nitroglycerin -- 4x a day
This regimen seems to be working -- 2 large and soft BMs a day, pretty much on schedule.
Afraid of the surgery option, a month later, I went to see a different CRS (also supposed to be very good). He told me that the fissure seems to be healing and not to bother with the hemmies for now. He gave me nifedipine and also said that we could try botox before the surgery.
I used nifedipine, for 4 days but it did not feel as good as the nitro so I went back to the nitro.
Now 5 weeks since the earlier appointment, i do not have any major pain at the fissure site, just feel an occasional prick at around the 12:00 position.
But i do have pain on the other side of the anus, as well as slightly up in the rectum -- roughly where the butt crack ends. It is not a severe pain - it comes and goes. Only on one occasion was it somewhat bad where is felt like pain radiating in sharp streaks upwards.
Q. Is this what a rectal spasm is? I never felt these pains before i started using the nitro.
Q. I am a little confused between nitro and nifedipine. The research which I have read suggests that they are both equally effective (or ineffective) but at the margin nifedipine is a little better longer term. I wanted to see if there's anyone who has any experience with this?
NG - i know you've tried both.
I'll be going on for the next follow up on Sep 16. I am keeping my options open in terms of botox and surgery.
Q. Is botox effective? The research papers and patient accounts on the internet are very counter to each other -- both for the ointments and for botox. So far, I have not come across a single 'clean' first hand account of anyone fully healing with the ointment or botox without a recurrence.
So I would appreciate experiences with this as well.
I have been closely following Steve and Philber's posts. Thanks for the detailed posts and great responses from everyone. I wish you both speedy healing and recovery.
I am going for a 5 day vacation starting tonight and am very worried about anything going wrong. I plan to stick to my diet and I'm also carrying my complete kit with fiber, miralax, nitro, painkillers, etc. Hopefully it'll go well.
I am really glad i found this forum.
- Bottomline

Well spasms for me was an intense throbbing pain and tightening of my sphincter.My spasms have never went to the end of my butt crack but spasming pain can effect slightly different from people to people but spasming generally involves a throbbing pain and tightening of the sphincter.I never took nif but I have taken nitro.I think the longer you use nitro the less it becomes effective over time.After a month using nitro it started losing it's effectiveness for me.I'd stop for a week then it started working again.I think you gain more tolerance in the long run with nitro but it does bring you more instant relief compared to nif.As for the botox I have never done it so I can't answer you on that.Gotta wait for NG because he's the man who has done all three.

The prickly sensation and the pain further up the rectum don't sound like typical sphincter spasms to me. In my case the spasm was lower, very close to the anus, and it was throbbing. There will be individual variances in how we experience pain, but IMO it seems unlikely that what you're feeling are the spasms BottomLine. Maybe just some mild irritation from the ointment?
Yup, I tried nitroglycerin, nifedine, and diltiazem. Out of all of them, I personally liked nitroglycerin the best, then diltiazem, then nifedipine. I never felt like the nifedipine did much for me. But this is going to be an individual thing too as some people do well with it. I'm undecided on whether the nitroglycerin decreased in efficacy over time for me. The side effects like the headache definitely went away, but I'd say that overall, I think it still did its job around the anal area even after months of continuous use.
We've had some members (many before my time on this forum) heal from the ointments before, so it is possible. In fact our own CherylK healed from diltiazem (combined with some physical therapy for her pelvic condition if I'm not mistaken).
Many people, myself included, got temporary relief and even healing from Botox, but you're right that recurrence rates are relatively high. Some people do heal completely from it though. Off the top of my head, I know of at least two members here who have, the most recent being mmb0423 just a few months back, so you might search for her old posts. Some people need multiple rounds of Botox before they heal completely though.
Even though I didn't heal completely after Botox, I'm still a big fan of giving it a go before getting surgery. The Botox procedure is a piece of cake and IMO there isn't much to lose by trying it. I'm happy I at least tried it before getting LIS, because then I didn't have any "what if's" heading into surgery.
Hope you have fun on your vacation! Your "travel pack" of fiber, Miralax, painkillers, and nitroglycerin sounds exactly like mine. The only difference is that since surgery, I've been able to leave out the ointment component :) But other than that, great minds (and sore butts) apparently think, eat, and pack alike!

Thanks for the responses and a belated happy birthday NG.
Got back last night from a great vacation. Sorry did not post earlier as I did not carry my laptop.
So the five days went smoothly without any major issues. In fact, the relaxation and little bit of exercise on the beach seems to have helped my butt, after weeks of prolonged sitting at a desk. On the second day I did feel a little sharp pain in the afternoon, perhaps from a change in BM schedule and/or a slightly higher dose of miralax.
All in all I stuck to the fiber/miralax/colace regimen, and i was able to enjoy the vacation. I also went a little trigger happy on the seafood and wine, as I felt deprived having been on a veggie diet for 2 months now. Thankfully it all went ok. My BM schedule is now returning to normal i.e. 2 BMs a day.
I did feel the rectal pain this afternoon again. I think I get it a short while before I am about to get a BM. Wasn't anything crazy today, so I am not overanalyzing.
Have an appointment for a follow up with my CRS on Sep 16 now.