Hi. I'm fairly new to the forum - just one post old. First off, I want to thank each one of you for all your sharing. I've learned a lot from your posts, most importantly that I'm not alone. So thanks very much.
Now for my question. But first I guess I should explain my situation.... for several years now I've been dealing with an AF. The diagnosis was confirmed by a surgeon about 2 years ago. Actually he didn't do a complete examination. He only examined the anal verge and announced he could see a fissure. When he tried to insert his finger in further, I started spasming so he stopped and suggested that he would use local anaesthesia to continue. But, before he could do so, I shamefully confess, I chickened out.
I decided to give alternative therapies (homeopathy and ayurveda) a try. These worked really well for a while. I would very quickly recover from an episode and remain symptom-free for months together. But, end of last year, probably as a result of a lot of sudden stress in my life, I had a really bad episode. This kept me bed-ridden for practically 3 months. I went back to my homeopath and with his help I started healing again in January this year. For over a month I was pain-free and even re-started my evening walks - two miles a day. Then a couple of weeks back, I had a setback. I don't know what caused it. It could have been anything - maybe I wiped too hard, maybe my periods triggered off something, maybe too much walking - who knows? Anyway, this time round, because I've kept my BMs under total control (I have no constipation at all), the pain hasn't built up too much and I can feel myself healing again. But this relapse was so unexpected that it's totally shaken my confidence. I feel my life is on hold. I'm so exhausted!
My family is urging me to see a CRS again, just to figure out how bad things are, and, if necessary, to go through surgery. Surgery would be a drastic option for someone like me who's tried to avoid allopathy as much as possible until now - no Miralax, no painkillers, no nitro, nothing. But it's not the surgery bit that's worrying me, it's the internal examination that the CRS will, I guess, insist on doing.
So here's the question - can the internal exam trigger a re-tear/relapse? In that case (since I'm healing again) should I wait to become completely pain-free before going to the CRS? I ask this because I don't think I have the physical/mental strength to deal with more months of pain and suffering. I'm editing this post to add one more question - should I see a CRS at all or go ahead with alternatives - after all I found this forum only about a month ago and with all the tips and advice I've found here, I'm certainly managing my AF better.
- So, should I see a CRS at all?
- Could the internal trigger a re-tear/relapse?
- Should I wait to heal first before I go to the CRS?
Please do advise. Many thanks in advance for your time and advice.

Several people here have reported that they felt like their CRS's exam hurt their fissure. Most of them came back a day or two later and said it was a false alarm and that they are actually healing well. A good CRS will not force his/her finger in when you are too tight to do so safely. If you've ever had this happen, don't go back! Find someone new.
If you heal, why would you go to the CRS after healing? Its not like its fun in there. Make sure there is a second person in the room when you get your rectal exam, especially if you are working with a male doctor. Again, a good CRS will put a gloved finger on your anus to test for pressure, but if the sphincter is tight, they aren't going to force it in for a full rectal exam.
Only you can decide when its time to stop with the home remedies and alternative medicine. For most people, those things work, but there are some of us for whom it is not going to work. No amount of belief or being good is going to change that. I say this as an alternative medical provider who is going in for surgery tomorrow. Its really humiliating to admit that I can't heal this myself, but I can't. And I'm not willing to keep trying for years and years when western medicine has a solution that will let me get my life back sooner. Yes, there are consequences to using surgery. My chi will be all unbalanced after tomorrow. Bother. I'll deal with it. For me, a big part of why this is happening is that I happen to be really small down there, congenitally. I've had problems pooping since I was a wee little thing. No amount of herbs is going to correct that about me, so I'm grateful to live in a society that has another answer, too.

coconut, thank you very much for responding. I'm not going back to the same CRS - found someone else who has the reputation of being good...not knife-happy. And I won't go alone - thanks for that tip!
To answer your question, even though I'm now getting back on the healing track, I feel I should go to a CRS because I don't know when the next relapse will occur and throw my life out of gear. So, maybe a proper diagnosis will at least help me take a balanced decision about what my next step should be - nitro, surgery whatever. But I'm afraid that the internal itself might set me back by another month or more. So I was wondering whether I should heal completely and then go for a checkup or do so right away since perhaps just knowing what's going on down there and discussing the alternatives with a CRS might give some hope. At the moment I feel disempowered and helpless. It's taken a huge toll on my husband as well. He's been like a rock of support through all this but I feel I should also take his well-being, anxieties and capacity to cope into account.
Thanks for sharing your story. I'm so sorry to hear that alternatives aren't working any more for you. It must be very very frustrating. I understand because I feel so down and out with these repeated relapses. The surgery is a well-considered decision, I'm sure. Take care and do keep us posted on how it goes. Good luck and hope you heal very soon!

IMO, go now. The doctor needs to see you when the symptoms are there to be seen.

Called crs today and asked two questions.
1)I haven't bled in a month with miralax and after exam I had a bm and blood, why?
2)I called another crs and he said he prescribes nifedipine, why didn't he give me cream?
Answer 1) exam probably opened it a little.
Answer 2)if miralax and diet don't work then nifedipine won't work. He also said he had patients referred to him from other surgeons that had already been started on nifedipine and he has never had any one that cream really helped.
I told him that if I'm not at least a little better than I am now when I get back from Maine next month then he is going to do Botox or lis or something! He said call me if it doesn't get better with miralax and diet.i said oh I will!...
BS-my exam was mostly external and definitely tore fissure.

delasama wrote:Called crs today and asked two questions.
1)I haven't bled in a month with miralax and after exam I had a bm and blood, why?
2)I called another crs and he said he prescribes nifedipine, why didn't he give me cream?
Answer 1) exam probably opened it a little.
Answer 2)if miralax and diet don't work then nifedipine won't work. He also said he had patients referred to him from other surgeons that had already been started on nifedipine and he has never had any one that cream really helped.
I told him that if I'm not at least a little better than I am now when I get back from Maine next month then he is going to do Botox or lis or something! He said call me if it doesn't get better with miralax and diet.i said oh I will!...
BS-my exam was mostly external and definitely tore fissure.

From my own experience, and from reading about other folks' experiences here on these boards, and reading actual scientific literature studying the subject, your doctor is completely and fully full of sh#t. Was he trying to push the surgery? A good CRS wouldn't stick his finger in there once he/she discovered that you have a high sphincter pressure in the first place. A quick google of nifedipine research will show you that it does indeed have a significantly higher success rate than diet alone.

He just barely pryed my cheeks just enough to see tag on fissure...he said miralax was the main thing to keep doing.
I guess at little bit of prying and sitting in car was cause of blood. He would probably prescribe nifedipine if I asked him too. I guess I'm going to give the miralax another month first. I just worry about putting anything down there that's not natural. And yes I know miralax isn't natural lol

delasama, I am so sorry to hear of your experience. This kind of a setback is the last thing one needs. I hope with the miralax you'll heal fast. My best wishes to you, my dear, do get well really really soon!
I have a similar dread of using non-natural stuff but coconut is right. It's a tradeoff. Natural is great but, often, even when you think you're doing everything right, something goes wrong. I believe that's because there are too many external influences, some totally beyond one's control - changes in weather (which definitely affect digestion), hormonal fluctuations (more so if you're peri-menopausal/menopausal), unexpected changes in the daily routine, and so on.
My appointment is scheduled for Tuesday next week. I agree, coconut, I should go while symptoms are all there. I'll just have to deal with what happens. If it's a re-tear, then I'll just take a few deep breaths and prepare to welcome AF, my (unwanted) guest. I've got myself a few language learning tapes. AF and I are going to learn a new language!

That's good you are going to get looked at!
If I had more money then I would go ahead and see another crs for more opinions...

BS wrote:delasama, I am so sorry to hear of your experience. This kind of a setback is the last thing one needs. I hope with the miralax you'll heal fast. My best wishes to you, my dear, do get well really really soon!
I have a similar dread of using non-natural stuff but coconut is right. It's a tradeoff. Natural is great but, often, even when you think you're doing everything right, something goes wrong. I believe that's because there are too many external influences, some totally beyond one's control - changes in weather (which definitely affect digestion), hormonal fluctuations (more so if you're peri-menopausal/menopausal), unexpected changes in the daily routine, and so on.
My appointment is scheduled for Tuesday next week. I agree, coconut, I should go while symptoms are all there. I'll just have to deal with what happens. If it's a re-tear, then I'll just take a few deep breaths and prepare to welcome AF, my (unwanted) guest. I've got myself a few language learning tapes. AF and I are going to learn a new language!

Come back when you are done and teach us how to say "my a$$ hurts" in a dozen languages!