First of all - thank you to everyone who has been sharing their stories like this about something so personal yet painful. No person who has not had a AF understands the weight of the words "pain in the ass".
I want to tell you my story as I feel it needs to be shared to get your advice and thoughts. In December of 2010, I developed a pretty nasty fissure (2 actually). They were the "broken lightbulb coming out" type of fissures with plenty of blood. As a 28 year old male, I have never cried like this in the arms of my wife. It was the most emotional period of my life. I switched to a high fiber, fruit mostly diet - drank tons of water and started on the road to recovery. My fissures were so bad - my CRS (one of the best, practices at Cedars S in LA) told me I had to wait a WEEK before apply the diplitzim ointment because of how "raw" my skin was. The cause of the fissure was a bit unclear but we narrowed it down to purutis ani - or anal itching which I believe I had actually torn my own skin open and gave myself a fissure by scratching. The cause of the purutis ani? Coffee? Nope, Spices? Nope, believe it or not... Cottonelle wipes. They have alcohol in them and I had used 2-3 a day after every BM (for 6 months!) and essentially they "wore down" my skin and caused purtuis ani which led to my AF.
So that week was the week from hell, the week of Christmas (Dec 21 it started). One thing I did apply while I waited to start on the ointment was "H Bleeding Hemorrhoids" oil because I thought that's what I actually had... turns out that oil, plus the diet and liquids helped my skin heal a lot... I want to credit the "immortelle" essential oil which has been linked to tissue regeneration ability. Either way, I applied it 3x a day for a week during that week from hell. Week two, I was still sore but the "passing glass" had faded to soreness and stinging 1 hour after the BM for about 2-4 hours. Into the second week, I tried to start the diltiazem ointment but it gave heart palpitations and crazy dry mouth like I needed to drink a tub full of water. So I stopped that and continued with the "healing oil" route. Enter the 3rd week.. my fissures had healed. I still have some minor irritation but they were almost back to normal before any of this happened.
Fourth week, I went to see the CRS as a checkup and she said "you're back to normal, see ya when you're 50 for your colon test". From that mid January period till late March, I was back to normal - ate and drank as I always did, still continued my benefiber at night but "lived a normal life."
That's until last week. I came home from a business trip on Thursday evening, hadn't drank much water that day and sat for 4 hours on a plane. Grabbed taco bell for dinner and had little water the next day and ended up going out to dinner and gorging on Pizza with family - lots of cheese. The day after, I had probably one of the hardest stools of my life and tore open an anal fissure.
I spent the last week in healing mode, picked up my oil application again, and finally went to see a CRS two days ago. As things were getting better, i decided to take a Zyrtec tablet before bed with my benefiber for allergies. Bad idea - HORRIBLE constipation and another hard stool = retore my fissure and back to square one.
So i'm here now, this time I did get nitroglycerin cream due to the effect of diltiazem last time around on me... and the NG cream actually doesn't give me a headache... so I'm going to try this plus the healing oils (rotate them through the day) on the path to recovery.
The last thing I noticed is that last night, I took a colace plus some ionic fizz and my stool this morning was still rough (not the usual "fluff" post colace). I'm hoping this is the Zyrtec still in my system being worked out... I'm going to try to hit myself with 150mg of Colace (1x 100, 1x 50) tonight to see if that helps.
I just wanted to share this long story of what I've gone through. it's horrible that it's back and now I'm wondering if it doesn't heal this time around (2nd time = chronic)? If I should opt for LIS?
Thanks

ss,
Welcome. I'd try taking Miralax to keep your stools soft until you are fully healed to prevent any more hard stools, which, as you know, are very BAD for a fissure. If you healed once b/4, I think you can do it again. Just my 2 cents worth.

I'm going to go buy some Miralax today. Just did a search on it and read a lot of your posts on how great it is... I'll start with say 3/4 capful though, I don't want to have constant BMs, I'm down to 1 every morning.
Regarding Nitroglycerin ointment, does it matter how often it's applied? 1x after morning BM, 1x before bed?

Hi and welcome! Sorry that what brings us here is agony! I would laugh if it wasn't such pain! You are very lucky not to have got a headache with the Nitroglycerin. I am using Nifedipine, which so far has not done anything though I am hoping. Could you possibly give a little more info about the oils you used? I have not tried Mirilax; just struggled along with Milk of Mag and Peri-Colace. My pain is in straining to get rid of the heavy feeling in the rectum, that comes on hours after my morning visit to the loo. A lot of pain for very little "success". Those wipes are dreadful. Never use more than wet toilet tissue (tho that is cottonelle...) and dry with same. Will watch to see how you are doing. I am sure that others will be able to tell you about how often to use the nitro ointment. WELCOME!!!!!

The Oils are from "Healing Natural Oils":
http://www.amoils.com/ They have one specifically for Fissures, I'm using the H-Bleeding Hemorrhoid one, as it's pretty close in formula to the Fissure's oil.
I think is the essential oil of "Immortelle" or also known as Helichrysum oil is the one that helps healing. Here is another great link for you on why that oil might have healed my AF first time around:
http://www.anandaapothecary.com/articles/helichrysum.html.
Note I'm not here trying to sell anyone any oil, I have nothing to do with this company but just sharing what I used... the oils were the only thing I used last time with the AF and it healed. I'm hoping it can happen a second time!

I am only too happy to get the links !! Anything that helps one person heal is worth mentioning to another. I am also going to get Dr Wheatgrass. Just for extra help. The only thing I have taken is Serrapeptase and don't think it has done much at all. Maybe keep bleeding at bay. Another thing someone mentioned is Flaxceed oil as fissures may be caused by a lack of Omega-3. So, I am going for that too. Pain is always out there, looking for solutions.

I bought dr wheatgrass too. The guy is making a fortune off that stuff. But for whatever it's worth. I think it did me good, it soothes the area and if you are in pain it stills it and makes BM easier.

I am all for people making a fortune, if it works. Desperation for relief from pain takes us along many roads. I have not found anything yet that has helped me, so pretty much at the end of my tether. I spend every day in pain so if I could find just one thing to take it away for just a few hours in the day, I would be happy. The only real relief I get is when I am asleep, and first thing in the morning. I have never had such a lousy time as I have had with this.

Have both of you considered LIS? I want to know more about it... does it work?

Welcome ss616-
A fissure will take a long time to heal 100%. Even after you feel "Normal" you need to keep a healthy diet and soft stools for a long time to baby that area. I think the consensus around here is a year+ before things can be deemed completely healed. Unfortunately with fissures one bad BM sends you back to the start....... very frustrating.
I have used NG paste on two separate occasions - years apart. It didn't do a lot for me. The second time I used it I got a cardiac reaction(heart racing) - so that ended using it that round.
A fissure is deemed chronic after 6 weeks. I would think you are still in the acute stage, since it sounds like it healed closed before. Hopefully, since you had something that worked before that you are able to heal it again and then continue to pamper your rear for awhile(year) to prevent another event.
A LIS is used to treat fissures by cutting part of the sphincter muscle to relax the muscle to aid in healing. It has a very high success rate - in the 90's%. You will find a lot of stories on the board to give you a sense of what to expect. I had one done in Jan 2010. It helped me immensely overall but I am still battling with one area that causes me grief off and on. I found out I have Crohn's last fall so that is root cause of my peri-anal disease.
Good luck. I hope you can heal it fast.