Hey all!
I joined this site over 5 months ago. I am 25 yrs old and was diagnosed with internal hemrroids and an anal fissure back in August. It actually began in July 2011 but I was leaving the country for 2 weeks and didn't have time to treat it. I just thought the blood I saw was from a hemorroid since I never had this issue before. I workout and eat fairly well.
Well i finally got it looked at in August and the proctologist told me to up the fiber in my diet, and to use these hydrocortisone suppositories, with this antifungal cream. I saw him 4 more times. I would have alittle bit of bleeding in b/t visits but only noticeable on the toliet paper. Sometimes I really had to look for it to see it. On the 4th visit he said the fissure has healed and that I didnt need to see him again.
Well every once or twice a month since then I would have a bowel movement that didnt feel comfortable and it was usually follow with a little bit of blood. It feels like a scraping motion as the stools exit, but it was never painful although it did hurt a few times. So i recently decided to see another protologist. I saw him today and he definitely saw the fissure. It's about a quarter inch facing the front of my body. He said that since I had it so long I will prob need LIS, which I am afraid of. But he did prescribe Diltiazem 2% ointment to see if it helps. He said if I would have used this cream when I first got the fissure it prob would have fully taken care of it. Now Im angry because I wish my previous doctor would have prescribed it instead of just telling me to up my fiber and to use suppositories, which are really for the hemrroids.
I really hope the diltiazem works. Any advice or tips? I will try drinking some miralax the next few nights since I have been slightly constipated lately. I just dont want my body depending on it since I'm only 25! I feel like I'm falling apart.
On one hand I want this to heal on it's own but then I am depressed thinking about having to constantly make sure my fiber is at a perfect amount. I have had weeks of perfect BM and it jsut takes that 1 off day to retear. So I gotta live the rest of my life being weary of my BM everyday. On the other hand, the LIS is supposed to help solve it but the recovery sounds rough from what I read. And that makes sense because they're cutting into you. There are also some potential side effects of this procedure which may be the same or worst than what I am going through now. :(

I have been suffering since March 2011, and my fissure wasn't diagnosed until May 2011. Similar to you, I don't think I got the cream in time really. I used the cream for 4 months, had botox in November 2011 which hasn't really improved and now awaiting my follow up appointment in May (!). Yep thats my 6 week follow up. I am back on the rectogesic. Could you try the ointment for a period of 6-8 weeks and see if it improves it? Maybe ask about the possibility of botox injections? It hasn't worked for me so I suppose I am not a great advert! But if you are hesitant about the surgery then it may be worth a try as it is not permanent. I must admit I am not really up for trying botox again as I had a reaction to it but I haven't heard of anyone else who has. I am seriously considering getting a second opinion and pushing for surgery as I want my life back. I think surgery is a risk, but any surgery has risks. You need to work out if you are ready to go for it or try some alternatives first. I would put a time limit on it though, then speak to your CRS again.
Only advice I can give is from my own experience so far so just my opinion but stick to a good diet, drink plenty of water. Some people use magnesium tablets (I had a funny reaction to this as I have IBS) but others say it is good. Stick to the miralax, I also take docusate sodium (one a day to help). I am 28, and know what you mean about taking so much medicine, I hate it too and feel like I am falling apart. Try to stay positive, hope you feel better soon :)

Thanks Sue27uk. Ughh....I went a full month in December without needing creams, just metamucil with no pain/blood/issues...but now i'm back to the 1st step. I hope it can heal again now that i have even better ointment than what i got before.
This is so depressing. It's funny how someone can be fairly healthy and then have a small injury such as this dominate his/her life. I hope you get well also.

Hey Jax,
It's a pain having to watch what you eat and drink tons of fluids. But it is what you need to do to heal. Don't worry about taking the miralax for a long time. You can always slowly wean yourself off it when you are good and healed.
I wouldn't blame the first doc too much. Sometimes hemmies and fissures are related and one begets the other.
You're just going to have to be diligent. It is still possible to heal with just the cream and fiber and water. In fact this is crucial! Glad miralax works for you.
There are other things that work for some people, but each of us is different. SO you kinda need to look around this board and read up.
Don't worry, if it does come to LIS, it's not that bad as far as surgery goes. Pretty quick, and very low risk of complications.
It sucks, but you will recover and this will just be a nasty memory. But it will take time and that's the hardest part.
My mom took months to heal with just a cream and an oral calcium blocker. But she did. She has been fissure free for 2 years now and doesn't worry about it anymore.
-Tanya

workingonit wrote:Hey Jax,
It's a pain having to watch what you eat and drink tons of fluids. But it is what you need to do to heal. Don't worry about taking the miralax for a long time. You can always slowly wean yourself off it when you are good and healed.
I wouldn't blame the first doc too much. Sometimes hemmies and fissures are related and one begets the other.
You're just going to have to be diligent. It is still possible to heal with just the cream and fiber and water. In fact this is crucial! Glad miralax works for you.
There are other things that work for some people, but each of us is different. SO you kinda need to look around this board and read up.
Don't worry, if it does come to LIS, it's not that bad as far as surgery goes. Pretty quick, and very low risk of complications.
It sucks, but you will recover and this will just be a nasty memory. But it will take time and that's the hardest part.
My mom took months to heal with just a cream and an oral calcium blocker. But she did. She has been fissure free for 2 years now and doesn't worry about it anymore.
-Tanya

Thanks for the encouraging words. It's definitely depressed me a little. I never know what to expect at each BM. I know I'm lucky because my fissure hasnt caused me much pain, yet. But it's just very annoying and scary to know that everytime I have a BM, im probably splitting it more and more. It's been running my life for the last 7 months. If it heals than great, but I don't know how long it will be before I can go have a BM without that worrying feeling. If it heals, how long should I continue with my Miralax/fiber supplements?
If it comes to a point where I'll need LIS I'm afraid of the recovery period. It will probably hurt more than what I feel now since my case isn't too bad. I know it will be painful during BM for atleast a week. And even with LIS, the current fissure still needs to heal on it's own, as well as the cut that was just made. I guess I find it hard to understand how making another larger cut will help my fissure heal. My fissure was considered healed in December, but it must of gotten retorn. What's to keep that from happening after LIS? I'm soo overwhelmed.
BTW, anyone on here use the Diltiazem 2% ointment? Was it successful? My ointment seems so gritty, is that normal?

Jax,
If you look directly under the surgery section of the forum, there is information on LIS. It makes sense when you know more about it.
I'm like you though and it is more a general discomfort with a bit of pain now and then. So it does seem rather drastic to do LIS. But it has been used to help people who don't get spasms as well as those with spasms.
You should do fine with the topical and healing the non-surgical route. But you need to be good about fiber and water for up to year or more afterwards. The skin takes a long time to get to it's original strength and resiliency. I plan to take metamucil for life. I figure it's a small price to pay for peace of mind and a healthy rear end! :D
-Tanya

Tanya, I really appreciate all your responses. They really do help me. I hope you are receiving good advice from ppl in this forum as well. Sorry if im not able to help you as much since this is new to me even though i have been dealing with this on and off for 7 months.
So I called the nurse just to get more info about my diagnosis. She said my fissure was like a small cut at the rim of the sphincter muscle facing my scrotum. i then proceded to ask if its normal for the diltiazem ointment to be gritty and she said yes I don't know if its the ointment or the grittiness but it itches inside right after I apply it for a few min and subsides.

Oh i have learned lots the last few months.
in fact, much more than i ever wanted to know! Lol :)
so your fissure is anterior? So is mine.
just keep up the routine. There may be setbacks, but there will also be gradual improvement.
it sucks, but what can you do?
-Tanya

Yea I guess it is. It's funny how one common problem can unite people from everywhere haha. Any idea if this location is worse, better, or it doesn't matter lol?
My BM last night and today at noon were fairly smooth. Although it took a while becasue I think mentally im afraid to push at all. No blood and no pain (knock on wood). I take one full dose of Miralax at night and I drink one packet of KONSYL fiber that my doc gave me for free. My stools today came out relatively easy although they are still pretty formed and bulky. They were about a 1"-1.25" in diameter. So i'm not sure if I should up the Miralax dosage to soften it more, or let it be since it didn't hurt?

Hi here Jax,
I had the problem with the 'gritty' Diltiazem, and actually posted about it one here and got some good responses.
http://anal-fissure.org/t2705-diltiazem-with-grit-in-it-please-help?highlight=Grit
I had a pharmacy compound the one I use now, in Boston, and it has no grit. I got the gel.
All The best
Sav