Hi Everybody,
I am a Crohn's disease patient. I was diagnosed with Crohn's in '99, but I'm sure I had it at least since I was 18. I was diagnosed with Psoriasis at 11, and then Uveitis in '94. I finally figured out that all these problems were related, and resulted from some type of auto-immune problem. The first thing to get me into the gastroenterologist was a fissure (which I had never even heard of, thought I had hemorrhoids.) I remember the doc gave me proctofoam which did nothing and actually burned, but then he gave me nitroglycerin and cortifoam, and that helped. The fissure healed; later we did a colonoscopy and found out that I had Crohn's. I started on several drugs, and finally ended up on Remicade infusions which helped the fissures that seemed to reoccur and also helped the diarrhea. Eventually I went on Cimzia injections which were easier and faster than the infusions, and also seemed to work.
Still, somehow I managed to get a terrible fissure 7 weeks ago. I have never had one take this long to heal, and I cannot stand the thought of the doc trying to check it out in the office again this week. He checked it three weeks ago, and I thought I was going to die. Plus the pain was sooooo much worse for days after the exam. He gave me lidocaine with hydrocortizone to try; he really thought it would work better than the Cortifoam. And he gave me Diltiazem to try instead of the nitroglycerin because he thought it would not give me a headache. The lidocaine burned so badly that I thought I was going to die, as did the Diltiazem, which did not give me a headache, but also did not stop the spasming. In the case of the Diltiazem, I question the base of the compound (as this had to be compounded by a pharmacist - not an easy to task to find one around here who does that anymore.) The foams seem to do so much better for me and not burn as badly except that I think the praxomine in the proctofoam burns.
I am taking sitz baths after every bowel movement. It has taken some time, but I think I finally got my BM's to the right consitency after trying Benefiber and Miralax. Stool softeners seemed to give me gas, so I stopped them, as the gas actually hurts! I am still using the nitroglycerin, but I swear it doesn't seem to help as much, and the fissure just seems to ache like an open wound. I can't see it; my husband can't see it, but it's somewhere around the 6:00 position, I believe. Believe it or not, the Cortifoam feels better than anything else, but I know that typically hydrocortizone does little to help fissures. I just don't know what else to do. I have been eating things I know don't set my Crohn's off, but that doesn't seem to be helping any. I just ache all day long. I work, so I can't just lay around all day, although I have been all this weekend, and I've missed two days a week for the past couple weeks, just hoping that extra time off my feet would help.
Was hoping someone would have a miracle cure here on these pages, but I guess at least I can talk to others who understand. Hope we can all help each other.
God bless you.

O you poor thing! Welcome to the best place for advice you'll ever find! First off, u need a heating pad/ magic bag to sit on, helps relax the spasms when u have to function. Also a combo of ibuprofen and generic robaxacet takes the edge off, and Valium helps alot too, my doc gave me a less addictive version of Valium called oxazepam. Yes it causes drowsiness but u get past that after a few days. I don't have crohns but I started like you, with hemmeroids, but once I got the fissure I tried it all... Nifedipine, Botox, and finally, last Thursday, LIS. So far, no burning.... This is the longest I've gone in a year. I hope for your sake you've caught it early and the creams will work but until they do, the ppl here will get you through. Trust me... They got me through. Good luck and I hope we can help!

Ow,
Firstly, welcome to our little group. My son also has CD. He takes the Humira injections every other week. You'll find a lot of support here.

Hi Ow - welcome! You are definitely dealing with an awful lot! Everybody here understands the pain of a fissure, so you'll get lots of support, sympathy and advice here. I am currently using Diltiazem myself and it did burn when I first started it, but it doesn't so much anymore. Elphie is right about the robaxecet and ibuprofen. I mostly use the robaxecet to help calm the spasms. Has your GI talked to you about surgical options if the ointments don't work?
I really hope you get some relief soon and that you heal very soon!

Saw nurse practitioner and doc both today. He basically said that fissures take a long time to heal. She said she would like me to try the first medicine they gave me because it has been like a wonder drug for all their other fissure patients. She felt that I had not been using enough of it. (When I tried it before, it burned, so I am a bit apprehensive about trying it again, but I will.) She gave me a pain killer, Tramadol, non-narcotic so hopefully it won't cause constipation. She told me to continue to use the Benefiber and the Miralax religiously. She also gave me Flagyl, a nasty antibiotic that works well on intestinal infections. We don't know that I have an infection, but just in case, that could be why the fissure isn't healing. (Antibiotics can cause constipation too.) So, now I'm scared of not getting the right amount of Benefiber and Miralax, eating the right things and not the wrong things, taking these drugs together and causing myself more pain. This fissure hurts sooo much worse than any I've ever had. It is just about paralyzing me with fear of it getting worse. Oh, and I asked about surgery, and both the doc and the nurse practitioner said it is a very bad idea for someone with Crohn's disease because they will have trouble healing. So, I guess I'm just waiting.

Hi there, owwwwww (I counted the "w"s):
Like most people on these forums (at least, I'm betting on it), I learned about fissures and treatments mostly on my own by exploring the mighty INTERWEBS. When I went in for a consultation preceding a colonoscopy, I basically finished most of my consultants sentences -- she even learned a few things about fissures and treatments. I would encourage you to discover more information that shares the topics of fissures and CD -- you may be able to find enough information about other people with CD who had some kind of fissure surgery and came through just fine. Also, get a second opinion -- I mean, hell, half the doctors I went to just LOVED prescribing useless ointments and creams that just aggravated the *$&^ out of my fissure, and did nothing to heal it. Sometimes, the "practitioners" need a little schooling.
I'll tell you what I have told others -- I tried Dr. Wheatgrass Skin Recovery Cream, and I firmly believe that it helped alleviate the symptoms of my fissure. You may want to give it a whirl. It's a bit pricey, but I figured it was worth the gamble. My fissure was so big, it could never quite heal it, but it sure helped relieve the pain. I wish you the best.

Hi again owww - I am really sorry you have to suffer through this. I'm pretty sure we've had some folks here with Crohn's, and if I recall correctly, they did experience some difficulties healing after an LIS, so I understand why your docs are trying to avoid surgery. The ointments do work for some people, so please don't give up hope. Get aggressive (or determined may be a better word) with this course of treatment - you may very well beat this fissure after all. I know that's easier said than done - but you strike me a a very strong person, so I'm sure you can do this.
I also think Matt's advice is exactly right - if you can, try to get a second or even third doc's opinion and keep looking for more support forums. The folks here will offer you their best advice, and you'll definitely get moral support and encouragement from us, so do keep posting here! but it would also be really great for you if you could talk to people with Crohn's who have had to deal with fissures too. And, if you do find such a forum, would you mind sharing what you learn with us, in case other people with Crohn's need help from this forum in the future? I really hope you are not is so much pain today - I'm wishing you good healing!

Hi ow, poor you!
I don't have Crohn's either, but I have been through fissure hell like most people around here. And I agree, it would be good to get a second opinion from a CRS.
If your Crohn's is under control/in remission, and yet you still have a fissure, then it just might mean that your sphincter is too tight. Sometimes it takes surgery to fix that, Chrohn's or no Crohn's. People with Chrohn's get other surgeries...like bowel resections and fistula surgery, so I can't believe an LIS would be totally out of the question. We do have a member here, Paulspain, who's been through the surgery and has Crohn's. You might search for his threads. I believe his main struggle now is with a fistula.
I wish you the best of luck in finding the support and care that you need!

Hi Owwww - I just spent some time googling and came across a Crohn's support forum that I thought was pretty impressive. The people seem very knowledgeable, supportive and friendly. The forum actually reminded me a bit of this one - and this forum is pretty special, I think!
Since you've been dealing with Crohns for quite a while now, you probably already know every internet resource there is, so I'm sorry if you already know about this forum. I know how irritating it is to get information and advice that you already know about! But I thought I'd note this site for you on the off-chance that you haven't encountered it yet: http://www.crohnsforum.com/forumdisplay.php?f=2

Thanks to all of you for your encouragement. I had a good day yesterday, but not so much today.I have missed every day of work this week. Today I was going to go in, but the pain set in, and I decided to wait another day. Now the pain has continued so I'm glad I stayed home. Just weird that it wasn't as bad yesterday, and I have not had a BM this morning.
Tried a new version of Diltiazem, new base. The pharmacist used a "dermabase" cream rather than the petroleum base they used before that burned the dickens out of me. This one doesn't burn, but I swear nitro works better to stop the throbbing. It doesn't seem to "heal" the fissure, but at least it stops the throbbing a little. The Diltiazem gives me just as bad a headache as the nitro, maybe even worse.
Just wish there was something to put on the fissure itself to make it heal, like neosporin and a band-aid. Someone at work said I should try silver sulfadiazine on my bottom because it is used on bad chemical burns and it doesn't burn the person. I tried it, and it seemed a little soothing, but I'm scared to use too much because I do have an allergy to oral sulfa antibiotics. The nurse practitioner said it was more like just a band-aid, and I said I wouldn't mind a band-aid down there. I really don't know if it does anything to help.
I will try that Dr. Wheatgrass Skin Recovery Cream, hope I can find it locally. I will literally try anything. If you told me to go eat some doggy poop because it will definitely help, I would.
Thank again guys.
And so you don't have to count the w's, you can just call me Lisa.