Hello, all. First time ever posting about a health issue, so I will try to include all the relevant info. Any help you can provide would be amazing! Quick version is that I have a fissure and I am not sure my doctor is treating it properly based on my research online.
The background here: I am early-30s, overweight – could stand to lose some weight - but not obese. In January I had an upper-GI done and when the Barium tried to come out it was hard as cement and caused what I now know was a fissure. It wasn’t bad, my primary care looked at it and shrugged it off and a week or so later it was gone.
It is now back – with a vengeance. About a month and a half ago I started having slight pain with stool and occasional light bleeding. After a month of this I got annoyed and went to a gastroenterologist. They did a sigmoidoscopy and found the fissure right away, and nothing else wrong. The doc said take Metamucil and Colace and chances are it will improve as it didn’t look like there was scar tissue and that it was not “chronic.”
A few days later, following the suggested regimen, I had a hard stool that apparently tore it wide open. For the first time I had a LOT of cramping and enough blood to cover 2 or 3 wads of toilet paper. I called the doc in the morning and they prescribed me Proctisol-HC 2.5% (hydrocortisone) 2-times daily and several sitz baths.
I got in to see the doc the next day and she said to scrap the Colace and replace with Mirolax 3x daily for the first 2 days, then taper as needed from there. That seemed to work well. I also asked why the Proctisol and not Diltiazem or nitroglycerin. Her reasoning is that the sitz baths will increase blood flow from the hot water and that the Proctisol will reduce swelling. However, since that time, I have read several times that cortisone does not seem to work well with fissures while Diltiazem and NG can do wonders.
As I stand today, I am taking Mirolax 2x daily, Proctisol 2x daily, Citrucel 2x daily and working in a significant amount of fiber into my diet (more veggies, Fiber One cereal). I am still having blood (ranging from streaking on stool to all out bleeding that covers a wad of paper. But the cramping is what kills the most. Actually passing the stool is not terrible, but immediately after, YIKES. I basically have to go jump in a nearly scalding hot bath to stop them. After they subside, my discomfort level is somewhat low until the next stool, when it starts all over again.
My questions are these: Should I insist on the Diltiazem instead of the Proctisol? Is the Citrucel an okay fiber source or is something better? Anything I should be eating or avoiding? I read meat may be good to avoid. Any tricks that can help this get better?
I appreciate any and all advice. This is a completely foreign thing to me, and frankly, it is driving me completely insane and my poor wife is tired of hearing about my pain in my butt
Thanks in advance!

Also, does the diltiazem have to be compounded or is there a topical available? Sorry for all the silly questions!

Hi there,
I will try and answer some of your questions. Diltiazem is compounded and can only be bought at a compound pharmacy. I would ask for this or one of the other ointments that promote blood flow.
As for fiber supplements, there are many and they all work different for different people. You just have to kind of experiment and see what works best for you but be sure and drink plenty of water while taking fiber supplements.
As for the stool softeners, many here find that miralax is the best choice and works better than colace, but some have been fine just using the colace. It sucks because none of our digestive systems are the same so we all have had to figure out what works best for ourselves...LOL
I wish that there was a one size fits all, but even my GI said we are all different.
I don't know if you are seeing a clorectal surgeon but fissures and butt problems are there specialty. My GI sent me to one as soon as he saw my fissure. I would find a good one if you aren't already. :)
There are many foods that you should avoid and I'm sure I may leave something out, but definitely avoid sharp food like chips, nuts, pop corn, taco shells, etc... Also anything spicy,fried, caffeine, pasta and constipating foods or foods that may make your poop harder like cheese and meat, except fish or chicken in small amounts. Be sure and eat plenty of vegs. and fruit. Also there are many good high fiber cereals.
There's really a lot of good information on this board on diet and management:)
I hope this helped. Good Luck!!

I'd also like to add , in my opinion too much fiber isn't good either. It always made my poop huge and hurt worse with my fissure( before LIS).

Hey program2, I second everything that dawn said. I would definitely try diltiazem, nitroglycerin, or nifedipine over the Proctosol. And I'm personally a big fan of Miralax as well. Other stool softeners weren't nearly as effective for me. We're all different, though, so the main thing is to find what works for you; don't take the advice of us here or of the doctor blindly :)
My experience is that there are two things doctors love to suggest for any butt problem:
1. Colace (docusate sodium) stool softener
2. Anything (e.g., creams, suppositories) containing hydrocortisone
These are like their de facto opening moves in chess. At the first whiff of a butt problem, whether it's hemorrhoids or a fissure or whatever, out trots the docusate and hydrocortisone! Haha.
I think it's good that you swapped over to Miralax already (assuming it's working for you of course), and would strongly consider one of the "fissure-specific" ointments. Different people have different preferences as to which of the three is most effective. I personally felt nitroglycerin did the most for me.
BTW my fissure started with a similar pattern: I got it, saw my primary care doctor, slapped hydrocortisone on it and took docusate sodium for about two weeks, and it vanished. Then about a month later, it came back HARDCORE, this time to stay and torment me endlessly. It took a couple visits to different colorectal surgeons and also my own online research to work out a regimen that got things under control. Because of my own experience with the fissure and with doctors, I can't stress enough the importance of initiating appropriate treatment early and of listening to your body more than any doctor.
And yep, for me meat was a killer during my fissure days. I ate lots of boiled veggies and fish. Chicken seemed alright too. And like dawn says, too much fiber can be a double edged sword. At first I went on total fiber overload and that wasn't fun. There's a balance and everyone is different, but I think most agree that boiled veggies, little to no meat (particularly red meats), a good stool softener and lots of water are cornerstones of a fissure-friendly diet.

Thanks for the feedback everyone. I have the cramping under control now, actually pretty much gone. I have other issues now though. I had some stress in my family which has caused me a lot of diarrhea. And yesterday and today I noticed blood clots when I bled pretty heavily from going to the bathroom. Is that even possible to come from a fissure? They weren't huge, but certainly got my attention. I am FREAKED OUT, and to be honest, a bit scared. They only happen when I bleed heavily into the toilet, which is always accompanied by stool passin pains.
My GI has referred me to a colorectal surgeon, who I see Tuesday, and has prescribed me some Diltiazem to use in the interim.
Anyone ever experienced a clot from a fissure? Not seeing mention of it online anywhere.

Hey there,
I never passed a clot with my fissure, nor read of anyone else I can see why that would be alarming.
I actually never bled large amounts with my fissure. Just a little on the tip of the stool or paper.
Does your GI know about this?
I would call your GI or CRS or even go to the hospital if this continues especially if your loosing a large amount of blood. You can become anemic. It's good that you have an appointment Tuesday...

My fissure was a heavy bleeder and I had a few occasions where I left a pretty bloody toilet bowl after a bowel movement. But I never saw blood clots. Are we talking about full-on clots as in things that look like red clumps or scabs? Honestly I'm with dawn on this: if you continue to bleed heavily and notice blood clots, definitely go to the hospital. Don't wait for the CRS if that keeps happening. It's not unusual for there to be some bleeding from fissures, but profuse bleeding and blood clots aren't typical.

I had a lot of bleeding and clots coming from my fissure, particularly when it was very wide open, meaning that the fissure was large enough that you could see striated muscle underneath. Everything I've read seems to suggest that fissures only bleed a little, but mine bled a lot. It was kind of like having a period.
I did get some relief from using lidocaine and diltiazem, but it wasn't until I had LIS that I really got it under control and now I am healed. It's important that you use the right ointments to reduce the pain and increase blood flow, or else there won't be any chance of it healing.
Sorry about your predicament.