Hello, I'm new to the forum. I had a bad fissure in 2010, ended up getting LIS in 2011. I was also told that they removed a hemorrhoid. My recovery was very painful but I was feeling much better after a month or so. Had no problems for 6 years. I didn't think about my butt, my BMs etc. Felt normal.

Fast forward to 2017, had a large hardish BM and felt the pain. Since then I've been battling this fissure. I take milk of magnesia every night, which is the only way I've been able to deal with this fissure.

Tried nifedipine a few different times over the years. It's never done anything for me. I don't think I've been offered any other ointment. I was supposed to have botox in 2018 but found out I was pregnant right before I was supposed to have it. Had my daughter 2019. The fissure wasn't bad through my pregnancy and for a few months after. It got more painful so I had botox in 2020.

The botox didn't heal it. Probably helped a little. It also made it so I couldn't hold my BMs for more than about 10 seconds. I had a few embarrassed accidents during the months after botox. After that I pretty much gave up any medical intervention and figured I'll just take milk of mag and hope one day it goes away.

Had another baby in 2022. Again the fissure was there but not too painful during pregnancy. Became much more painful soon after my son was born. I dealt with it and things were manageable until late 2023. Things got super painful for some reason, even though my BMs were soft as usual.

January 2024 I decided I need help. Made an appointment with a CRS. She gave me nifedipine and sent me on my way. Things were up and down after that. At my follow-up 6 weeks later I was offered botox. I scheduled it but knew I would probably cancel. They do it with no anesthesia which I don't like. When I had it in 2020 I was knocked out. Also I really don't want the incontinence issues I had last time, I didn't really like this doctor and I'm concerned about any complications that could make my problem worse than it already is.

I have an appointment with a different CRS in about a week. My pain level is generally really bad now, with a decent day here and there.

So that's my story so far. Just wanted to share with my fellow fissure sufferers. It's a very painful and embarrassing condition, so I'm glad to have a place where others understand. I will update soon.

I want to add a few more details about myself. I'm a 39 year old woman. I have IBS, mainly the diahrrea version. I'm an anxious, nervous person. I don't handle stress well and I'm sure that has contributed to the chronic fissure issue.

I have hypothyroidism and chronic migraine. I take synthroid for the thyroid and Gabapentin, Sumatriptan for the migraines. I'm also on zoloft since 2022 because of ppd after having my youngest child.

My 2 kids were both born via c-section. I tried for a vaginal birth with my first, but had "arrested descent" after several hours of pushing. Perhaps my pelvic floor is weak? Not sure.

I think I have some form of stenosis from having the fissure for so long and from using laxatives for so long. I've sometimes gone a few months with no pain in the past several years, but always needed to take milk of magnesia to keep the fissure from retearing. I basically can't pass a BM wider than an index finger, and it has to be very soft, even when I'm doing well. Currently even super small and soft poops are very painful during and for many hours after.

Just wanted to share these relevant details. I have my appointment with a new CRS on June 6. I will update after that.

So I had my appointment yesterday with a new CRS. It went well. She prescribed me diltiazem ointment and oral valium (5mg to take nightly to help relax the muscle spasms).
I have a follow up in a month. If I'm still not doing well, we'll schedule botox. This doctor does it with anesthesia, so I'm happy about that. I'm still concerned about having incontinence issues with the botox like I did last time, but I can't keep going on as I am now.
Today my pain is really bad. Earlier I was laying on the floor whimpering because the pain was so intense. I'm stuck in a place where I have to take a lot of laxatives so it will be really soft coming out, but then I have to go many times per day. If I take less laxatives, I go with less frequency, but tear really badly and the pain is even worse. Neither is good.

Hey I’m glad you saw a new CRS and got some new medication. Interesting you have valium? I wonder how that feels - I would imagine it works well to relax the spasms and pain generally. Let us know how this goes. Good luck with the diltiazem I was allergic to it sadly. I can totally relate to needing the laxative but then going several times a day which is really traumatic and hurts too. But then not going makes you anxious as you know it will hurt also. I found that taking a half dose of Movicol/miralax was the sweet spot for me. I’d make up a dose then drink half after dinner and leave half in the fridge for the following day. This way it softened just enough but doesn’t lead to repeated trips to the toilet. I also eat a lot of fruit and include magnesium citrate powder mixed into fruit juice. This helps keep things soft. I’ve recently stopped the Movicol after reducing it literally sip by sip and I’m kind of ok. Also I don’t eat anything too fibrous/bulky as this makes the BM hard to pass. I used to eat bran. Big mistake… and any form of fibre supplement made things so much worse for me. I hope the horrible pain subsides for you soon.

Thanks for your reply, it's comforting to know someone can relate!

I honestly don't feel any effect from the valium. I take it at night, an hour or 2 before going to bed, which is my most relaxing time of day anyway so maybe I just don't notice. I've been taking it for a little over a week and feeling about the same as before.

I also haven't noticed any effect from the diltiazem other than a burning, stinging, itching feeling for about 15 minutes after I apply it. I wouldn't mind dealing with that if it helped the fissure heal. So far my pain is about the same.

I think I will probably call the CRS next week and just schedule the botox. I really don't want to, but my pain is impacting my quality of life a lot.

Hi, reading your experience reminded me very much of my experience. I too had LIS surgery a year after you, in 2012. My LIS in 2012 did not work, still had fissure pain and just kept using nitro ointment, was also prescribed valium like you (but just for a month), used miralax and kept a very clean diet. After about 3 years I finally felt no fissure pain. Had 2 fissures. Lived many years after that with no pain. Just kept using Miralax and stool softners all these years with very minor set backs occasionally. Mostly my set backs had to do with having a hard stool and not even. For years like you I've passed index finger like poo and anything bigger than that would create a minor set back. Have lived on Miralax and stool softner everyday for 12 years to prevent the fissure hell. Well fast forward to June 19, 2024 I trqveled to México and got the worst stomach bug ever. Diarrea for 12 days. The fissures are back and extremely painful for hours if not all day. Went to GP antibiotics prescribed and I told him about my re-tear of fissures and with lots of back and forth he prescribed nitro/lidocane ointment Now I am suffering with that old familiar pain I had over 10 years ago, spasms, hot feeling in the anus and swollen tissue feeling down there. I cry everyday from the anxiety and haven't slept in days. Last time this happened I had to stop working. This time I can't stop working. I care for my parents and need to work, they live with me now and are getting up in age.i also need to work to keep my health insurance.I'm on vacation now , I'm a teacher assistant but I go back to work Aug 12. I hope and pray I'm better by then because all I do is lie in bed from the pain, cry , walk a little. A vicious cycle. Been experiencing incomplete poos too, what a nightmare or more than 1 BM a day. Since you had LIS in the past, is your CRS willing to do a Second LIS? I go to a new CRS July 24, I wonder if he would be willing. Maybe they never cut enough muscle the 1st time. My first CRS 12 years ago did not want to do a 2nd LIs for fear of incontinence.But the pain of fissures are so intense I would be willing to go through it again. What a difficult situation we are all in. Your in our thoughts and please now you are not alone. My situation is similar to yours. Please keep us posted if the CRS does the Botox procedure or if he offers you the possibility of another LIS. Your in my thoughts and prayers.

Thanks for your reply, Fern. I can really relate to your story and what you're going through currently.
I understand how hard it is to work or do anything with the intense fissure pain. I'm very lucky to work from home. I worked in an office during my 2010-11 fissure episode and I had to stop for awhile. With my current job I used to commute an hour to the office a few times per week but had to tell my boss I needed to stop because of the fissure. It was embarrassing but now I wfh. Maybe you could work something out with your employer if you tell them what's going on.
I hope your appointment with the CRS goes well. They will most likely want to try more conservative treatments first before considering a second LIS. Since I've had this second fissure issue (2017), I've seen 3 different CRS. They all have said they would be reluctant to do LIS a second time. I think your CRS will suggest botox if the ointments don't help enough.
I think the botox did help a bit when I had it in 2020, but not enough to heal. I was still taking laxatives during that time, because I needed them to be able to poop without too much pain. The laxatives combined with the botox made my BMs super urgent, and I wasn't always able to make it to the toilet. That gave me a ton of anxiety, especially if I wasn't right near a toilet. That's the main thing I'm worried about with doing botox again.
I'm planning to do it though. I have my next appointment on July 11, so I'll talk to the doctor about it then and probably schedule it.
I tried the valium for 3 weeks, taking one pill at night. I didn't feel like it was helping, and was reading on the internet how addictive it is, so I decided to stop. I've been weaning off of it.
I've been doing slightly better the past couple weeks. I'm still having a lot of pain but I'm just grateful it's not as bad as it could be. I've been on this roller-coaster long enough to know that I'm just one imperfect poop away from being back in severe pain.
Anyway, I'm really sorry for what you're going through and have gone through. I will keep you in my thoughts as well. We'll get better somehow.

Thank you so much for responding to me. I can totally see how the incontinencia could be an issue. Wishing you the best for July 11th. Keep us posted here in the Forum.

I had my follow up appointment yesterday with the CRS. I'm feeling a little better than I was last time I was there a month ago, but still having a lot of pain. I know this thing isn't going to heal with just ointment and sitz baths. I've had it for so long. It gets better sometimes never goes away and always gets painful again.

We scheduled botox for August 2, with a possible fissurectomy and/or skin tag removal depending on what she thinks is needed.

I'm a little terrified at the fact that I don't know what to expect in terms of pain after the surgery. It could be just botox and I'll feel fine after. Or it could be more and I'll be in tons of pain for who knows how long.

I talked to the doctor about how I had issues with incontinence last time I did botox. She usually does 100 units, which is what I had last time. So we decided to do 75 units. I also told her I think I'll need more than one round of botox to heal. She said we can repeat it after a few months if I'm not healed.

I've been in a mood pretty much since my appointment. I'm just feeling down and wishing I didn't have to deal with any of this. I know in reality everyone has their struggles and mine is really not that bad. I'm just cranky right now though.

Please feel free to be cranky. I had a massive pity party for myself yesterday. My anal pain has become worse than it already was lately (a 9 1/2), and my opioid painkillers are no longer constipating me enough to allow me a day or two off between bowel movement days. I noticed that you are very much like me in that I also have IBS-d, hypothyroidism, have anxiety and was on Zoloft. I also had my two children via c-section, because my first never dropped and I wanted another section with my second, to give him the best chance of a healthy delivery, like my first. I don't have stenosis, but believe that I've done damage on the motility front by taking so many opioids to slow my bowel down and only allowing movements every three days. I will be having a "hail Mary" appointment with my CRS this week, but am not overly optimistic because he has found no reason for my pain. I'm having an up day today on the mental health front, and hope that your pity party ends soon. Anal issues are so bloody depressing!