by NeuropathicGuy » 14 Nov 2010, 19:21
I would seriously consider not messing around with the hydrocortisone and lidocaine any longer and get something that actually works for fissures like nitroglycerin, nifedipine, or diltiazem.
Trust me, most of us have been there. A lot of doctors prescribe hydrocortisone, lidocaine, and docusate sodium when they encounter any kind of anal issue. That's what was prescribed to me and lots of other folks here. That regimen may temporarily reduce discomfort, but problem is none of those are very effective for fissures. Hydrocortisone is a mild corticosteroid. It might work for some cases of hemorrhoids but fissures don't respond to it. Lidocaine is a really weak analgesic that does nothing except mask pain, and is frankly not effective for severe pain like what comes with a fissure. And docusate sodium as a stool softener may work for some, but for many (myself included) it doesn't do much at all.
A lot of folks don't want to second guess the doctor and end up sticking to a regimen that doesn't work for far too long. I did the same thing. But at some point you have to look at the evidence and ask yourself if what you're doing is working or not. If it is, then stick with it for a while longer. If not, then change the regimen and try s something else whether your doctor thinks it's necessary or not; after all, it's your health that's at stake. IMO the lack of proper treatment in the early stages is what leads a lot of fissures to go chronic and require surgery. I'm personally a little miffed that I blindly followed my doctor's advice for so long before I woke up and did what made sense.
If I were in your shoes Boxxer, I'd consider the following:
1. If your stools aren't soft enough right now, consider an effective osmotic stool softener like Miralax. For some reason doctors don't suggest this much as first line treatment. But a lot of us here had trouble getting soft stools and found Miralax to be by far the most effective stool softener. In fact the main risk is that for some people it's too effective, but you would know that with a couple days of trying.
2. Replace the hydrocortisone and lidocaine with nitroglycerin, nifedipine, or diltiazem. This is probably the single best thing you can do if in fact what you have is a fissure caused by a tight sphincter muscle. The longer you have a fissure, the harder it is to treat, and the greater the risk that you'll eventually need surgery for it.
3. If you suspect you may have an abscess and/or fistula, get it properly diagnosed ASAP. These also get harder to treat with time. With time, fistulas can form more tracts or deeper tracts and affect more muscle, which increases the risk of permanent incontinence when you get around to treating it. Abscesses can potentially go systemic, and can be life threatening in some cases (rare but possible). I don't mean to try to sound scary or anything, but while fissures can get better with time, fistulas don't.
As for whether there's light at the end of the tunnel or whether you're in for a long mess, there's always light at the end of the tunnel :) But how long it takes to get there will depend as much on what you do as anything else... 14 days is nothing in the lifetime of a fissure. If you institute proper treatment, I'd guess that you still have a very good chance at beating this without any more invasive measures. But the longer you wait without proper treatment, the lower those odds become. I messed around with BS approaches like hydrocortisone and lidocaine on the advice of my clueless doctor for a couple of months and it didn't help one bit. Finally I tried other things that helped me make a lot of progress, but by that time, it was too late and the fissure was already chronic. A lot of members here have done the same. Most of us suffered for months or years before finally getting surgery to address the problem.
I'm sorry if I sound like kind of an asshole, but I just don't want you to go through the same thing so many of us did since you're still so early on in the course of the problem. If you feel like what you're doing right now is working, then continue with it, but if not, please learn from the experiences of other folks who have been there before so you can take your best shot at taking care of this before it turns into a bigger mess.