I'm seeing a doctor this week about my fissure. It's been about 2 years since I've consulted a health professional about this as last time was when I was pregnant, I guess the fissure was acute then, seemed to heal, blood but minimal pain. Now it's very painful and I'm doing my research. Seems pretty unlikely at this point that I can get over this without surgery, but thought scares me a LOT. The potential incontinence. Anyways, just curious as to how long people try to manage with conservative methods before going down the surgical route? Is it likely to get worse and harder to cure with surgery if it's left for too long?
I'm in Australia and have no idea what the waiting time would be here to go public but as it'll be considered a pre-existing condition if we sign up for health insurance right now I'd still have a year to wait.
Thanks :D

Hi there, I waited for just over 2 years for my surgery, during that time I was misdiagnosed, given the wrong treatment, had hemmorhoids injected then banded, saw about 5 different CRS that basically didn't have a clue, tried all the creams and ointments then finally got LIS.

I waited 4 years. If I had to do over with I would have had surgery after about a year. After a fissure becomes chronic you start forming a lot of scar tissue which make it more difficult to heal - at least that is the way my first fissure was.
Also, the incontinence is the main reason I didn't seek surgery sooner. I think if you have a well qualified CRS this isn't an issue.
Best of luck.

I've had a fissure on and off for nearly five years. (Actually I first had a problem in 1986 but it 'cured itself' after 8 weeks of pain!)
I'm as scared as you are about the surgery. And as I'm in my late 50s I think that that adds a little bit to the worry of potential leakage after the op (and maybe longer healing times)
- I even read one clinical trial where they excluded the over 50s from the results to improve their success ratio! (wasn't done in the US or Europe though.)
I've used all the usual non medical methods plus GTN/NTG (Rectogesic in UK), Diltiazem, and Botox.
I'm now going to see a second CRS shortly to get more advice.
As PaulsPain says I would guess that the longer you leave it the more scar tissue forms from constant opening of the wound and also it can get deeper so the internal sphincter muscle fibres are exposed. You get fibrotic edges, skin tag etc
To me that means eventually that you may not be just looking at the LIS but possibly at a fissurectomy as well.
From the little I've read, combining the two in one operation results in a longer recovery time and more pain.
Hopefully a few people will come along right away and contradict me!
I know of some CRS who will only do fissurectomy with botox, with great success, and extremely rarely do LIS.
However I'd like to know the recurrence rate after long term follow up.
But if you're relatively young and in a lot of pain then you can get huge relief from LIS, as I've read on this forum.
I think most people, unless in extreme pain, will opt to go the medical route for as long as possible like me. That may not be the wisest course, but we are always hoping to heal!

i got my fissure summer of 2004.
i got my LIS (+skin tag excision + destruction of condyloma acuminata (and these condylomas were tiny, flat and all over that i had lots of skin taken out all over my anus)) on january 19, 2011.
so a bit under 7 years it took me.
i almost did it in 2008 but somehow my butt improved and the CRS then cancelled the LIS. i had a colonoscopy instead.
between 2004 and december 13, 2010, i was never prescribed the NTG, diltiazem, nitro, etc. i wonder if my first CRS ever would have given me the diltiazem in 2006, if that would have helped me heal this. maybe not since i probably was already in a chronic fissure state.
i had my first taste of diltiazem on december 27, 2010. it was a wonder drug for me when i went on my trip to japan.
**
i was so scared in when i joined this board in 2006 of getting LIS and that colonoscopy. i am a big big chicken!!!!
and now i am rather confident and calmer if i should need either one again, i'll be OK to do so again.
it's really a lot worse in our minds what these procedures - the LIS or colonoscopy - may make us feel.

I had LIS and Fissurectomy and the recovery has been pure hell, almost 7 months later and I'm still not healed properly, the post-op pain in the first few months was horrific (for me anyway) and with no prescribed pain killers the pain was simply unbearable at times, I have no idea how I've carried on..
Life goes on though!

capnap i just read this post,
with private health you may wait months to see crs but surgery can be done within days.
I waited 6 weeks for my 1st crs appointment and called back to see when surgery could be done on the monday and he said he could do it the next monday. So private health insurance in aus is great!

I waited almost a year to have LIS and I am now at a week and a few days out. I saw my Dr. pretty quickly into this as I was scheduled to see him for my annual physical on a day when it really started acting up. His exam was not the best and seemed to make it worse. He started me on the Nifedipine ointment right away(in a Cortisone base) and it did help some over the next few weeks, but I knew it wasn't really helping like it should. Almost exactly a year before was when this first started with a terribly hard and large BM. I used Colace and A and D ointment on my own and it went away in about 6 weeks. So I knew from that experience that they can go away much quicker. I saw the Dr. again in June and he recommended a colonoscopy so the GI doc could "get a better look" and make sure nothing else was going on. I put that off for two months, trying several different things, always soaking, using lots of different stool softeners, tried drinking cider vinegar, used Wheatgrass cream (which initially seemed to help, but really didn't make it go away in the end), continuing the cream on his instructions all this time. Finally had the conolonscopy in July- I was convinced it would make things worse and ironically it was no big deal and in a way seemed to make me turn a corner toward being better. However, through the GI doc my primary care physician sent me to the general surgeon in their network. I saw his PA in August and by then I had not had pain or bleeding in a week or so. I continued to be better all through September, only to have things resurface when I was on a trip in October visiting my sister. She convinced me to seek out a specialist on returning home, which I did. I had to wait about 3 weeks to see him- he was highly recommended in the area. I was all ready to just do the surgery at that point, but he was more conservative and recommended we try Botox first. Did that early in November and things were pretty much up, down, up down, although some better. Saw him again Dec. 22 and he thought things should be better. Once again, I was prepared for surgery and he said, let's try a second round of botox and we did that Jan. 4th. Finally, he called me about a month later and even though I was quite a bit better, with a pattern of about 2-3 bad days every two weeks, then he recommended LIS. When he was in there, he saw that my muscle was "very spastic" and that the fissure was not really healed. So if I had it to do over again, I would have started the process much sooner- back in June I would have just not have been so scared and initiated the whole process because it just takes time. And from what I understand, in other countries, you guys have a much longer wait time sometimes so I feel lucky with that.
Hope that helps.
Bambi
P.S. I feel like I waited so long and put myself through more than I should have. It makes me less patient now with my normal recovery process from the surgery.

I waited 8 months to have my Lis and if I had it to do all over again, I would do it as soon as possible! I could kick myself for not doing it as soon as my fissure became chronic (6 weeks). It was unnecessary to suffer when it was so easily fixed in my opinion.
I can't believe people live years with these things. It seriously baffles me, Lol