I have been on and off .3% Nifedipine 3 times per day for about 4 months for anal fissure. It worked great for the first month and then I got a stomach virus and was back to square one. Started it again but then started getting bad sphincter cramps that would re-rip the fissure. Laid off it again and was back in agony. Figured maybe give it one last try...this time being more aggressive applying first thing in morning, after BM and THEN 3 times a day. No side effects and after three weeks feel great except for some small twinges,a slight sharp feeling, if I move a certain way or after a BM.
Questions...how do I know when to stop taking the Nifedipine? If I feel no pain, not even the slight sharp feeling, should I still stay on it for a period of time after that? I'm athletic and want to get back to cycling and running but don't want to re-rip. Also, how long can one safely take Nifedipine? I have no side effects except maybe some light headedness occasionally.
Doc says if this doesn't work next step is botox, which from what I hear isn't much better than the Nifedipine or LIS (he said good luck in trying to get a CRS to perform that today--most don't want to do it because of the incontinence issue and fear of being sued for it. I just want this over with so I can be active again! Can anyone chime in with their nifedipine experiences and answer the questions? Thank you in advance. Rich

I'm not sure about the nifedipine part because I stopped after a week because it did absolutely nothing. I'm not sure which procedure your dr said good luck finding someone to do because mostly everyone on this forum actively has had at least one of those procedures done with in the last couple years. I don't think you will have a hard time finding someone to perform any of those options. But the wait to get in may be a bit further down the road then expected.

If your doctor said 'good luck with finding a CRS to perform that today', sorry, but they are talking through their hat. A LIS is the gold standard for this ailment, much as not all of us have had it. Botox is the one that is not as regularly done, I would say, and perhaps your doctor meant that. 
Here is a link to statistics on incontinence after LIS posted by Davo: 
http://anal-fissure.org/t4456-nhs-05-incontinence-statistics-after-lis-surgery
Welcome to the board!! There is a lot of information here, and we will always go out of our way to answer questions.

Nifedipine is not a fast acting cream, it took me 4 months to get the full benefits of it, I had to stop when it gave me itching and developed a rash.
I think you can use it on and off when needed but like everything we tend to become used to it and then it will not work.
If you decide to get LIS make sure you have a very experience colorectal doctor that you can trust, remember fissures can be healed, slowly on their own, sometimes they don't and surgery is the only way to go, just make sure you shop for a good surgeon.

It seems around here (Connecticut) LIS is the last resort despite the success rate. I heard that from two CRSs...in two separate practices. They'd rather do botox (which the results don't seem much better than the nifedipine I'm on) or botox with the fissurectomy (which they claim has excellent results) and LIS as a last resort.
More concerned immediately about how long I should stay on the nifedipine as I'd rather not have surgery. I had hemmeroidectomy using the THD treatment last year. It worked out great. I probably had the fissure prior to that but no one could see it and I certainly couldnt feel the difference.

Rich...
No worries on the nifedipine. There are people who use it for years. (keep in mind people take it orally for blood pressure their whole lives, and that dosage is far higher than what you are using locally on the anal area). The thing is, the wound heals in stages. Even after the pain is gone the wound area is still like tissue paper, very fragile and prone to retears. The remodeling of the wound will occur over the course of months, but it needs a good solid block of time without retearing in order to keep gaining strength. There isn't really an exact amount of time to recommend in using it, but if you can get a good couple to few months of no recurrences at all, that would be a good benchmark to think about.

Thank you so much Jr2. Clearest thing I've heard--even from Drs.
Can you or someone else maybe point me to an article or information here on that process of "remodeling of the wound"...the stages of healing and what to expect. I have no problem being on Nefidipine for 2 months or more as long as it actually heals and the more I know about the stages and what to expect...some people say a skin tag may form to protect the healing. Some say if it's chronic a fistula might form. I've heard people say don't expect a chronic fissure that's been on going like mine for 2 years to ever heal without surgery. These seem more anecdotal than medical and I'm having trouble finding the medical information.

Rich...
Here are a couple of links. There are others, but these give as good an overview picture as any.
http://www.curad.com/firstaid/stages.asp
http://en.wikipedia.org/wiki/Wound_healing
There are no absolutes in medicine. Anyone who says something isn't at all possible is just plain wrong. Sure, there are statistics and probabilities, but no absolutes. Is it true that the longer a fissure has been chronic the less likely it is to heal without surgical intervention? Yes. Is it possible for a longer standing chronic fissure to heal without surgical intervention? Yes. (I even knew of a lady whose 17-year-old chronic fissure finally healed for no apparent reason.)
Generally speaking, the research indicates that conservative measures such as nifedipine, nitroglycerin, or Botox have anywhere from a 50% to 65% healing success rate with chronic fissures.

Thank you jr2. Sounds like I've got a ways to go. It's been only 2 weeks of feeling good. Going to my GP today so he can take a look and see if I should stay on Nifedipine or refer me to another specialist. I've been on it since October 1 and just starting to feel somewhat normal. At some point during the day I feel twinges of discomfort but much better than just a few weeks ago with that "ring of fire" and those horrible rectal 'charlie horses.' I'm going to remain aggressive with the nifedipine at the very least.

Saw the doc today. He said at least the part he could see was healed (without a scope). He didn't want to use the anascope because I was feeling good. He agreed with everyone here that 2-3 months without a re-tear is ideal and that if I wanted to go longer on the Nifedipine there'd be no harm done. He said 6 months more on Nifedipine might be good to shoot for as long as I don't get any side effects. He said recurrence drops after 1 year and after 2 years the odd of ever getting one again drops as long as I stick to a good high fiber diet. he also told me to really way on the side of conservative eating for the next few months--high fiber, small portions, no spicy food or food that would cause say diarrhea or the opposite.