What does it mean when you've had a fissure for awhile, in the lateral position, and endured rather intense pain, but then the pain subsides quite a bit, but there is more blood spotting? Is that a sign it's healing maybe? I don't know where to turn anymore. I have had this fissure since October & I am sick of it. This is no way to live. I can't take much more. It's ruining my life. I already have anxiety & bipolar disorder, plus HIV, but this takes the cake. I spent a month trying to heal without meds, then I tried Nifedipine/Lidocaine cream for 4 weeks. Didn't seem to help much. I had quite a bit of pain, with little spotting. Now, in the last few days, the pain is much less intense, hardly noticeable at all, so maybe that's a good sign? But with almost every bowel movement the last couple days I have spotting of blood which scares the hell out of me.

I saw my CRS the other day, he scoped me. He said I have a lateral fissure at 3oclock. He said since my numbers are good & labs are good, it's probably due to HIV since it's in an atypical position. He said surgery would be more trouble potentially than leaving it alone, that it could recur if he excised it. He said I do NOT have cancer, which is a relief, but I am sick of sitting around scared to death to have a bowel movement for fear of seeing blood on tissue.

I can only see the one CRS for now because I barely have insurance as it is, and I can't afford to see another one unless the clinic where I go would pay for it. I think my CRS is a good guy and competent, but I'd like another opinion.

After my appointment the other day he told me to stop the Nifed/Lidocaine cream, and gave me some Lidocaine ointment USP 5% with peppermint oil. He just said basically I have to wait it out, & keep eating fiber, etc. But how much longer will this take to heal?

It's so damn embarrassing so I can't exactly tell many people about it, I am ashamed to even go to the ER, and I'm not sure they'd do much anyways. Maybe I could go to the ER and ask them to operate on me and remove the fissure, but they probably wouldn't unless they thought it was bad enough?

I called my primary doctor's office today to ask for a different type of ointment to try like Nitro, but they didn't get back to me. I've called so much lately due to this problem that I'm embarrassed to bother them anymore. So I guess all I can do is just go to the ER and tell them this is about to send me into a mental breakdown. Maybe then someone will help me. I'd just like to take my chances & have this removed if it's not going to heal itself. Like I said, the last few days, the pain is much less intense, so maybe that means it's healing, but I am having bright red blood spotting about every bowel movement. Probably will go to the ER in a day or two and demand action if this doesn't stop soon. Maybe they'd listen to me.

This is ruining my life, I am hoping to go back to school soon to further my education but now I'm so mentally drained that I feel like I am about to have a total breakdown.

Hi Alex,

The layers of complexity you are dealing with are definitely going to make your situation really difficult to cope with. Are you under the current care of a therapist for your bipolar disorder, who can help you navigate the mental coping part? It's really important to have support with the stress levels because the stress will only work against you with the fissure problem.

as far as the bleeding goes, it is very very common for fissures to bleed, and for there to be different amounts of blood at different times. Though it is disconcerting, it is very very typical. The fact that you are experiencing a reduction in your pain is a very very good sign. So try as best as you can to be reassured by that, especially when the anxiety rises about the bleeding. You've actually received some really good advice from your CRS. With your HIV status, surgery would be a risky undertaking when it comes to healing and there is the potential for you to end up in a worse situation than you are now. That being said, second opinions are always worthwhile and if you can at all swing it, it might help to get a second pair of eyes on you by another CRS for another opinion.

You could also consider consulting with a wound care specialist, particularly one who has experience with wounds in HIV patients. Some fissure sufferers have had success, for example, in hyperbaric oxygen therapy when surgery was not an option for them. Someone who specializes in wound care might have other ideas as well.

The ER is not likely to be the most useful place for treating you. You likely will just be sent home with the same instructions that your current CRS has already provided for you. You would be better off seeking a second opinion from another CRS and also trying to get in touch with a wound specialist (you could call your GP or your current CRS to see if they know of any referrals).

I am seeing a therapist, he has been very helpful to me. But of course this fissure thing is so embarrassing & humiliating, I don't really feel comfortable telling many about that. I'm just not dealing with this very well I was told I have Bipolar in August and now the fissure, on top of having HIV. It's a lot to handle.

I will ask about the wound specialist thing. I think the CRS I've seen knows what he's talking about because he deals with several HIV patients. I just hope this won't kill me. HIV is totally treatable today, & I have been doing great luckily, and have been on meds for several years, but you always hear about the secondary, opportunistic things that end up killing people. I sure hope this fissure won't be the death of me. I'm scared

I'm trying to see the lesser pain as a good sign. Still a little there, but much less worse than it was. If only the spotting would stop now. I called an Infectious Disease doc, he told me spotting is normal & not to be worried about.

But I had surgery back earlier this year to remove an inflammatory polyp from my rectum (not related to the current fissure) and I did great with that. And the CRS who did that surgery didn't think twice about it, and I healed fine. So maybe that would be an option in future if this fissure doesn't heal. Hopefully it will. For now I'm glad to not be in as much pain, the CRS told me to stop the sitz baths & Nifed/Lido, he didn't seem to think they'd do much good.

I'll ask my doctor about my options. Guess I should be glad I don't have cancer at least. It seemed like when I used Nifed/lido it actually got worse in terms of the pain, but who knows.

Just confusing. The CRS just wants me to use Lidocaine ointment & fiber, stool softeners, etc.

It's totally understandable that you would have increased anxiety with all you've got on your plate. It IS a lot for you to deal with. But you're doing everything exactly right, you've got your therapist on board, it sounds like you've got a good CRS in your corner who is giving you really good advice, as you've mentioned before your HIV numbers are looking really good, so it's all really really good news. Try to keep all those positives in the forefront of your thinking as that itself will go a long way toward supporting your body's healing capabilities, which are obviously already very strong, since, as you mention, you healed fine from the polyp removal..

Fissures, though painful physically (and emotionally) aren't dangerous, which is why the CRS isn't in any rush to put you at risk with performing surgery.

Hang in there. We all know how maddening this affliction is. Keep up with the good diet habits, etc., and definitely it is encouraging that you are having less pain. Less pain is always a good thing. :)