I've been suffering on and off with fissure for probably 3 or 4 years now.
Latest fissure occurrence started about 8 months ago and has taken longer than previously to heal which prompted my first visit to the doc a month or so ago. He referred me onto a consultant who I had assumed to be a crs - first visit today.
In the meantime I have been continuing to look after myself as best I know how - good diet of soluble and insoluble fibre, regular soaking, good hygiene etc etc. Progress has been ever so slow, but finally in the last week or so I feel like I am getting close to healing. No spasms, rare sights of blood, less pain from bm. I can bend over and drive pain free for first time in some months.
So I went to todays appointment in high spirits, expecting a visual examination, confirmation that I have a fissure and congratulations on the progress made and encouragement to carry on the good work towards healing.
It's not what happened at all. First off it turns out the consultant is a general surgery specialist rather than a crs. Then I go some scary questions about fammily history of bowel cancer and Crohns. Did I feel generally unwell in any way? Physcial examination of stomach and abdomen (not sure what he was checking for there?) then attempted digital examination of my bum which didn't get far because I am very nervous of anything in that area and clench up and shout "ow" immediately.
then I got another prescription for nitro, some kind of laxative and a painkilling gel. and told quite strictly to use them religiously for six weeks. will reassess in six weeks with view to some kind of camera examination if things not better.
all in all I left feeling thoroughly scared, stressed and depressed.
not sure what to do next. go back to gp and ask for crs? follow the consultants nitro plan for 6 weeks? any thoughts and advice welcome....

Hi there,
Even though the examination was not pleasant (been there, got the t-shirt) the doctor seems to have come up with the right suggestions.
Was the laxative the English version of Miralax (has that name in the US)? If so, that is a good thing.
Six weeks with the nitro is usually enough to see whether it helps/heals, and it is true what he said about being strict in its use. Three to four years is a chronic fissure, however, and more than likely has healed and come back and healed and come back, leaving scar tissue behind.
I had exactly the same situation, in that a CRS tried to examine me, couldn't, but went ahead anyway. Not nice, and not the way to do it. Far better if necessary to have the examination under what they call conscious sedation. This is what I had.
Don't be scared and depressed over this, and definitely don't be stressed. That will just give you more pain when you want to heal.
I would suggest going with the six weeks, and trying for a CRS if you are not happy, in the meanwhile. It can sometimes take time to sort this out.

We hear you owowow:
Sorry that your Docs bedside manners were not to comforting. I was waiting to hear some terrible news from the visit but glad I didn't see any.
Its ok buddy, your continued progress of no spasm and less blood and pain should be enough to help bolster your spirit in the future.
Everyone hear gives you a big pat on the back for that. Now don't go letting Mr. stress wreak havok on your digestion as that can very well happen.
GL HTH

thanks both - few kind words help a lot and I am feeling a little better 24 hours later :)
yes the laxative is called Movicol which seems to be our version of Miralax - I have been taking Lactalose on and off up til now. Not sure what the difference is...?
I think I was mostly stressed out cos I felt like I was being kept in the dark about what was going on. I know folk are different but personally I would like to be informed of the possible different causes and what the likelihood is. If he had just said well it could be a symptom of Crohns, or uc but we would need to do a colonscopy to find out. Let's just see if it goes away first I would have felt much more comfortable. But no I asked him what the camera scan would be looking for and he just said "we don't talk about that yet" . My paranoia thrives in a vacuum and I'm left thinking oh my god he thinks it anal cancer but he doesn't want to tell me yet....

I used to use lactulose... But I found I had to keep upping it every few weeks as my body just got used to it. I switched to movicol and it is sooo much better.
If you are feeling unsure about the consultant you saw, you could always go back to the dr and request to be seen by a proper crs.
I agree with Sav, in that it sounds like pretty standart treatment with the nitro etc for 6weeks.
I think some consultants can be very blunt and not very good at being tactful or explaining things in a reassuring manner... Which always leaves us with unanswered questions and what ifs.... But you have to try not to jump to the worst conclusion.... Because stressing about things just makes the fissure worse!!...(I should know.. I'm my own worst enemy on that one!)
OMB x

Try not to sweat the dark stuff (Crohn's, cancer). Remember that those illnesses usually entail a host of other symptoms that you haven't described yourself as having! Soldier on... You'll get through this!

I just know how much I struggle with the emotional/stress part of all this, and I haven't been dealing with it as long as you have. It is so hard when you take the risk to go in for an exam and the provider is clumsy!!! I've had four exams so far and so, I guess I have the T-shirt, too!. The last one seemed like a waste. The PA (CRS assistant) could only tell me I still had the fissure (which I obviously knew from the daily pain) and he couldn't tell me if I was getting better (or not). It's so frustrating! It definitely messes with your mind, even if you have the best specialist on the planet!! I agree, it's important to not think the worst. Chronic fissures tend to re-tear and are hard to heal without significant intervention (based on my reading of the literature and the aforementioned exams). Work the program (regimen), educate yourself, and get second/third opinions until you feel confident that your situation is adequately assessed and treated. And sorry you are going through it all, again!!!!!!

Hi owowow,
I'm so sorry you're going through this. I also have had a fissure that has acted up maybe 2 times over the past 4 years. This latest episode is the worst by far. I just can't seem to shake it. Have you tried vaseline or coconut oil before a BM? I just started coconut oil and it seems to help. I'm going to try vaseline starting tomorrow.
Also, I have an appointment with a general surgeon who specializes in colorectal later this week. (So I guess I get my T-shirt then). I'm 4 weeks in on nitro and honestly I can't tell if it's helping or not. But I'll be going the full 6 weeks so lets keep our fingers crossed together!
Hang in there!

thanks again to everyone for the good vibes. i have to say i'm struggling more with the psychological side of this since I went to the consultant than before. it makes everything seem a little more serious somehow...
anyhow good news is that progress seems to be steady. bms uncomfortable rather than agonising. no spasms. largely pain free for most of the day :)
since the pain subsided it is much less stressful applying the various creams and potions i've been prescribed. although now i am spending more time at it i have noticed quite a selection of lumps and bumps inside there. god only knows what they all are.
Hope - I haven't tried coconut oil, but the consultant fella did give something called intelligel which seems to be rather good. its seems to an anasthetic, antiseptic and lubricant gel which comes with a syringe type applicator. enough said. but i highly recommend it :)

Yea, we're all learning WAY more about our anatomy than we could have imagined! The lumps can be different things. The naturopath/hemorrhoid specialist I went to told me I have hypertrophic papilla or some such, along with the sentinel pile outside (which feels like an external lump). Those basically go along with the (chronic) AF pathology. I always thought they were hemorrhoids! Glad you are experiencing some relief! :)