When people say that it takes them months to heal a fissure, I wonder if it means that the fissure keeps coming back but with less and less bleeding, or does it mean it takes a long time to heal even after it had stopped bleeding?
 
I just wonder, in general, how long should I expect a fissure to heal once it has stopped bleeding, and what kind of pain should I expect? I knew I had fissures 4 months ago when I felt sharp pain and saw blood during and after BMs. I went to the doctor, and started being very careful on my diet. Since then, my motion has been on the soft side (not totally easily to pass though), and I haven’t see blood for 2 months. However, the pain hasn’t gone away!
 
The type of pain seems to have changed. I have some discomfort during BM, but the pain usually comes when I have been sitting for a while or when I walk. So these days, I can’t even walk normally and sit still. It is not a kind of intense pain, but it feel as if something is pulling..  it is not throbbing, and there is no spasm. It feels tender, and maybe swollen(?). When I apply Rectogesic, I don’t feel any lump though. However, I feel that the surface is not totally smooth (but then I have no idea how it should feel like!)
 
So I just wonder if this is normal? 
Or do you think it is becoming worse (e.g. abscess, fistula) even though there is no blood?

Hi East,
I never ever bled with my fissure but I certainly experienced the severity of pain that accompanied it.
The fact that you are no longer bleeding is good but from what I've researched, it's the level of pain you are getting that it a more accurate indicator of how the fissure is progressing rather than the bleeding.
The fact that you are not getting that sheer knife-like intensity is a good sign because it could be an indication that your fissure is healing but unfortunately, once these things become chronic, they take a long time to heal completely. The fissure is always there - it "doesn't go away" as such, but from my own experience, the healing does goes through stages with different symptoms at different stages. It's hard to say exactly what could be going on with you right now - It could simply be that your fissure is indeed healing up and you are beginning to feel scar tissue in the area forming - I know that this gave me a kind of "pulling/ twinging" sensation for a few weeks......
You could have an internal Sentinel pile or hem in there which will give you an internal "swollen" type feeling?
Of course, not meaning to scare you at all, it may well be something else, but probably not - It's always sensible you check with your CRS - Can you give them a call? If you're getting no major pain/ discharging/ symptoms of infection etc...then I'd guess it's still pretty normal stuff.
As our bottoms go through this stuff and the manipulation that goes with it all, the CRS examinations/ EUAs etc...it seems that some of the side effects do tend to be hems & skin tags sometimes, so it's not unusual to feel a lumpy mass of skin on your bump or a pimple or two - It's actually quite a good idea to get to know your bottom a little just by having a peek now & again.....
I really wouldn't put yourself under more stress by self-diagnosing or fearing the worst, it makes things so much worse! and even if you did have an abscess or a simple fistula, trust me, they are a lot easier (and a lot less painful) to deal with than a chronic fissure!!......An abscess would be obviously sore, visually red, inflammed and "lumpy" and a fistula generally oozes pus and can be accompanied by infection/ bad odour. I've had both & you know when you have them......
Do chat to your CRS if you are worried in any way because it will really help put your mind at rest and hopefully, you really don't have anything to worry about anyway.
All the very best to you....

Hi Ever the Optimist,
Thank you so much for your reply and for your kind words:)
I went to the GP for the 4th time yesterday, and she finally agreed to refer me to the CRS. but it sounds like it will be a long wait (I will get a letter in a week, and then I will need to call a number to arrange an appt with the CRS). I am really nervous about it - as you said, all the manipulations (e.g. CRS examination/ EUAs) can potentially cause problem or make it worse.. but I should really get it looked at properly!

Hi East! I have an appointment with a CRS in 2 days (or tomorrow if someone backs out, I get their slot), and I share your anxiety about things becoming worse because of the checkup!
The first time I got my checkup it was done by a general surgeon/plastic surgeon, and he was manipulating my poor anus without lube! Thank god he didn't try to put a finger inside, I would have screamed bloody murder and kicked him where it hurts. >.>
Anyway I think that Ever the Optimist is right and that the pain you feel is an indicator of your healing. I hope that you continue on the path to a pain-free butt! :)Also, the first time I had a fissure it healed within a month, or a month and a half at most. This is my second bout with them and the worst I've ever been, it has now been 4 months and little progress. I think your progress and healing time depends on your body and your general health as well as what you do in order to help healing along. :)The first time that I started healing I did feel kind of like scar tissue and it was definitely bumpier. I also got a skin tag that never went away.

east_123, I was the opposite of Ever the Optimist I bled with my fissure on and off, when I bleed it would get painful, but as the bleeding got over and the pain started to be less a soreness took over.
Finally the pain and spams were nothing but a mild discomfort or irritation after a BM, just like Ever the Optimist I agree that as the fissure heals the pain will be less and less until you notice that is not as severe as it was when your fissure was fresh.
Now bleeding can also happens from internal hems but usually unless thrombosis internal hems do not hurt.
Depending on your CRS he may or may not manipulate the area unless  he thinks you need a more deeper examination.
My CRS never did an internal examination until I told him that the pain was no there anymore.
He would just look at the area and gently touch to see if I it was sensitive he also could see part of fissure, and I can tell you that it really can make you cry if the fissure is still raw.
I hope you visit to the CRS will give you the answers you need.
I wish you best.

East,
Sorry..... I didn't mean to imply that all the manipulating necessarily makes things worse for you - Gosh, sorry didn't mean it to quite come across that way at all!
A good CRS will make sure they are not causing you any undue stress and pain and try not to create any further damage to that area. Unfortunately, there are a few who are rougher and more clinical. I had one experience with a female, who I actually stopped from examining me pretty much from the start because she hurt me and I expressed I never wanted to see her again too. My regular CRS was totally the opposite. He is extremely professional, gentle and told me to shout the minute I got any discomfort during my internal - He was pretty great actually and I found out later that the woman I had seen previously, had received so many complaints that she was no longer part of the team!!
A good professional CRS will never hurt you intentionally.
There are unfortunate stories of the rare few that do incur damage after examinations, but these are not common - The biggest "side effects" so to speak seem to come in the form of piles or some swelling or bruising, where they position you whilst examining/ operating! It's normal to feel a little uncomfortable and raw after an internal (particularly so, under anaesthetic) but it only lasts a few days and calms down very quickly. I've not had any lasting damage or increased pain from any of my many examinations...but I did get an external hem (which went as quickly as it appeared) and some swelling & bruising after surgery (also totally normal).....
You will be absolutely fine so don't worry in any way and you simply tell them to stop if you feel any pain or discomfort at all. It's far better to go get it sorted honestly.

Thanks for all the replies and reassurance  
I can endure some pain as long as it doesn’t cause any lasting damage. I wish all the CRSs could be gentle and understanding!
Actually, I have only had it looked at twice at the GP office. The first time external only (which was quite painful), and the second time a very quick digital examination which lasted about one second. The later concluded that it is anal fissure based on the fact that she couldn’t feel any lump.
 
When I had the external examination, he was really rushed (and had a medical student with him without asking if I’d mind, not to mention that I initially asked for a female GP!), and he parted me (in my opinion) more than necessary. Since it is only external, it wouldn't have cause any damage, but I am kind of worrying that the CRS would be the same (with the anoscope/ proctoscope)!! Ever the Optimist, are you in the UK, and are you seeing NHS or private CRSs?
 
My fissure (if it is really just a fissure) is not visible from outside. It is totally internal – that is why I had problem applying Rectogesic because it doesn’t always open up at will(?!).
 
Actually, I am not even sure if it is an anal fissure, because it is quite high up. (when you insert a suppository you have to keep pushing it through the very tight tunnel until it kind of get sucked into the other side, which is the rectum – am I right? So the entire tight tunnel is still classified as ‘anal’ right? Sorry for my ignorance but the Google images always show an unrealistic ‘relaxed’ representation of the structure.. which does not tie in with how I feel it should look like!) 
I feel that my pain is within the tight tunnel. 
 
Tornihell, how was your examination yesterday? I hope it went okay!! 

I was under the impression that you kind of hold a suppository in place until it melts. Some websites recommend tightening your sphincter muscles to do this.

Hi East,
Yes I'm from the Midlands, UK. I booked my first appointment privately because of the intensity of pain I was in from the fissure and that was a great thing to do as the CRS I saw also works for the NHS, so I remained under his care for the duration of my treatments.
Most CRS' are generally far better than a normal GP in their examinations because they understand a lot more about a fissure because it is their specialist area and arguably, because they have a better understanding of pain a fissure inflicts, they handle you more gently. Fingers crossed you have one of the more understanding ones and I was lucky that my CRS was the top guy there too, as he was really good.
It does sound to me like you have a fissure, especially if you are suffering with all that horrible pain and yes, they can be pretty much anywhere in that anal tract, some higher positioned, others lower. Mine was also quite deep internally and I have never been able to see it, hence all the EUA's to diagnose it and assess it's healing. That's also why (in my opinion but there are conflicting) that it's better to insert the cream as internally as you can, so it reaches the fissure area.
Yes, suppositories are kind of "swallowed" up through your anus  and into the rectum (lower bowel) If they are not inserted up past the sphincter muscle and sucked into the rectum, they can quite easily pop back out again! I remember the first time using these and the fun & games I had!...They then dissolve at body temperature and get absorbed into the blood stream.
Hoping you find a very kind & gentle CRS soon :)

Be up front with the CRS. Mine only did a quick visual exam, said to do a rectal exam would be torture. but he saw external evidence of chronic fissures, as well as my rather large external hems that were really more like internal/external all combined. 
My surgery included Exam under anesthesia, colonoscopy (because I had rectal bleeding intermittently, LIS for the fissure spasms (and greater chance of healing fissure, and the hem'ectomies). The first 5 days weren't too terrible, the local anesthetics were long lasting...then I had some external stitches tear, but even that got better rather quickly then the other external stitches began to dissolve.
My bleeding was from my hems, I dont think my fissure ever bled...just caused spasms that made me want to dies.
I hope you get relief soon.