Hi all,
I was so happy to stumble upon this board. Well, not happy to see so many others suffering, but glad to see there is a place where we can support each other. To give you a brief overview of my history, I am 32 years old and have struggled with hemmorhoids/constipation my whole life, but have basically had it under control for the last 10 years by taking a ton of fiber every day. Nevertheless, two years ago, I must have pushed a bit too hard one day and I was diagnosed with my first AF. The doc gave me Nitro cream and told me to increase my fiber, take sitz baths, and use baby wipes instead of TP. I would say that the major pain was gone within the first week and I was totally healed within 4-6 weeks. However, almost exactly a year later, the same thing happened. I went back to the doctor, who gave me a painful exam only to tell me what I already knew: I had another AF. This time, he gave me diltiazem 2% cream and the same instructions as before. Luckily, once again, the major pain was gone within a week, and a few more weeks later I was in pretty good shape.
It's been a year since then. You would think I would have learned something from these two experiences, but ten days ago, I did something IDIOTIC. I pushed hard. And sure enough I ripped my fissure. I still had one refill left on my diltiazem cream, so I filled that and started using it. After all, I am 99% sure it is an AF, and I really don't need the doctor to do a painful probe me to tell me that.
I have been applying the cream around (not in) the anus twice a day, as the doctor had instructed me. I have been using a lot, though, definitely more than a pea size. I have also been taking lots of sitz baths, and have increased my fiber. My BM's are relatively soft, but still very painful.
The reason I write now is because it has been 10 days and I have seen little improvement. My mornings are still incredibly painful, while afternoons are a bit better. Also, it seems like the area around the anus is incredibly sensitive now. I am not sure if I am putting too much cream on or what. I have tried to get the cream inside the anus (since others on here swear by that), but it is so tight that I have been unable to do so.
So here are my questions:
1) Am I being stupid not going to see a doctor? I just really don't want to go through a painful probe just to hear what I already know.
2) Is it abnormal to see no real improvement by 10 days?
3) Is it possible I am putting on too much cream and irritating the skin around the anus?
Any suggestions are greatly appreciated. Thank you so much for your time. I know this is not a short post, so I really appreciate your help.

Hi Inpain
Sorry you are going through the repeated rip, tear process. I have been doing it for a couple of years myself. It is a horrible pain!! I love this forum, it has giving me my sanity back. My doc doesn't do anything painful no probes, he gently spreads things and looks, even though it hurts like hell. I think if it is the same pain you were feeling before and I think most of us know when our AF has shown it's ugly head again, they use your cream and do what you did last time. I am on day 10 as well and not much improvement either. I think my fissure is a little better but I have a skin tag that is sending me through the roof most of the day. It actually feels better when I walk and don't sit much, but still in the shower and sitz bath several times a day along with 600mg of Ibuprofen and an occasional xanax when I am home. I had been using Nifedipine for months and now when I apply it It burns and my O feels very irritated so I stopped and am going to try pure aloe vera. I walk all day at work which helps with the spasms but not the burn. I come home at lunch and sit in the water take more advil and go back. Uggg, I was hoping I would be feeling better by now but, this time is gonna take longer. It will heal eventually, it's just getting to that point. I actually have an appt for surgery consult. I can't live like this anymore. Hope you feel better soon

Hi there, I m sorry that u r suffering. If I m not wrong, the longer ur fissure has been ard, the longer it will take to heal. Mind my words, I don't mind it will certainly not heal, just that it will take longer. I have retorn my fissure a few times and I finally calmed down the fissure after 5months. So urs is 10days, and u still c little improvement, u can choose to either cont to stick to ur healing regime or go ahead with LIS. U will know when u can't take it anymore.
U may read "my success story" for some ideas

hi inpain, i dont think that 10 is really long enough for the fissure to heal, i had mine for about 4 months and it did heal with the help of the nitro creme but it took 2 months and i am sure that mine is still healing at this point. my skin tag bothers me the most now. it takes forever to heal these fissures and you just have to do the baths, diet, creme and keep your bms soft so that you dont have a retear along the way.

Hey InPain,
Your fissure sounds a lot like mine...except I got mine from childbirth. But anyway I got it to heal up at first (just with fiber and colace) and it would go for a year or six months or some random length of time where I'd basically forget all about it, and then BAM! one bad BM and I'm back in hell. Until eventually it wouldn't heal, ever, I would tear every day, even though I was using nitro ointment at this point.
My theory is that what can happen is the muscle works itself tighter and tighter every time you tear until you literally have such a tiny opening left that you can barely go at all. That may not happen to everyone but it's what happened to me. The cycle went on for five years for me. In the end there was no way out except for surgery 7 months ago, which has helped tremendously although it hasn't (yet) been a total cure.
Are you seeing a CRS or just a general practitioner? Because it seems like by now a CRS would have suggested surgery. I know the surgery seems scary, but let me tell you, I'm the biggest chicken and it was NOT a big deal. This is coming from someone who lived on/off with a fissure for five years because they were scared of the possibility of incontinence. If you look around this board--no one has complained of incontinence that I've seen.
Maybe a second opinion is in order if this doctor seems too conservative? Meanwhile, DON'T take too much fiber, it'll create big, frequent poops and that will aggravate the fissure for sure. You need the right amount of fiber. Metamucil is too bulk-forming for most of us on here, but I've had good luck with Citrucel. Some people like Benefiber and it won't make bigger poops, but I just didn't feel like it worked well for me. Also Miralax, Miralax, Miralax. That will help you heal faster than any ointment.
Good luck! These f***ers are hard to heal but with the right balance of fiber and Miralax, I bet you can get it back under control. If not, you'll know when you're ready to do the surgery.

InPain wrote:So here are my questions:
1) Am I being stupid not going to see a doctor? I just really don't want to go through a painful probe just to hear what I already know.
2) Is it abnormal to see no real improvement by 10 days?
3) Is it possible I am putting on too much cream and irritating the skin around the anus?
Any suggestions are greatly appreciated. Thank you so much for your time. I know this is not a short post, so I really appreciate your help.

(1) I would definitely see a GP and get a referral to see a CRS.
(2) It's not unusual to see little or no improvement, many of us have tried the same route with no success.
(3) I would apply the Diltiazem internally as it is well known for irritating the skin around the anus, I developed an allergic reaction for applying around the anus

Thanks all for everyone's help. I really appreciate it. It's been two weeks now with little improvement, so I am going to see the Doc on Monday. Thanks again.

little improvement are very important! We all started to heal with baby steps! COntinue with ur fissure diet and caring regime, with diligence, u can beat this thing!
if all else fails, u can still get back ur life with LIS

Hi there
My story is a lot like yours. My fissure would dissappear and then resurface just when I thought I was safe home. I had managed in the past to get the pain to vanish after a couple of weeks of my regime, but unfortunately for me this time around its not been the case. In answer to your questions:
1) Am I being stupid not going to see a doctor? I just really don't want to go through a painful probe just to hear what I already know.
I would suggest going to see a good CRS (colorectal surgeon) at this stage. In my experience you can spend months not really making headway with GPs suggestions.
2) Is it abnormal to see no real improvement by 10 days?
No I don't think this is abnormal, I went a couple of months before I saw an improvement once. Only thing is though, sounds like your fissure is chronic, once it keeps tearing, like alpinestrawberry has said it I too think it makes the sphincter tighter each time. This can make fixing things harder each time. It might be worth considering an LIS, I've not had one so I can't talk of personal experience but others here have had good results.
3) Is it possible I am putting on too much cream and irritating the skin around the anus?
Yes this is possible with diltiazem cream it can cause irritation for a some (not all) people. It caused burning and bleeding for me so I had to stop using it. The CRS said this sometimes happens. If you get irritation using it on the outside I think it probably best not to use it on the inside.
Hope that helps!

Thanks again all. I saw my GP, and he basically said to just keep doing what I am doing (diltiazem outside, sitz baths, baby wipes, continued high fiber). He didn't even raise the issue of seeing a CRS or surgery, which I found interesting. He said that he sincerely thinks it will heal, although it may take a while.
It has now been three weeks since the tear and I have seen some definite improvement. Most notably, whereas mornings used to be a 8/10 painwise, they are usually more like a 5/10. Nevertheless, the first two times I had an AF, I was feeling much much better by this point, so it is a bit discouraging to still have so much discomfort.
I am not ready to see an CRS at this point. If I am still feeling like this after another month, I might change my mind.
Thanks again all -- I wish all of you the best.