Hi everyone,

I'm sad to say that I have been struggling with anal fissures for a few months now..it just seems to be feeling better - no pain during the day and little to no pain during bowel movements - and then something happens and I feel like I'm back to the beginning of healing. I have had some slight bleeding, but not in the last few months. This last set back happened about 6 weeks ago. It's been harder to heal this time. It's so frustrating, I feel like I'm working so hard on drinking water and eating lots of fiber. For the most part, my stools are soft and the last few times I've been set back it has actually been because stools are too soft. I try to focus on the fact that I can control the water I drink and my diet, but it's so damn frustrating when things start to hurt again.

I've been using nefidipine for about four months now. I feel like I have a confirmed fissure on the left posterior but I feel like I have another on the right side. My doc has scheduled a colonoscopy for next month, just to be sure it is only a fissure (no reason to think otherwise, symptoms are consistent with fissure). On a good day, I don't feel it at all. Then, other days it feels like I'm sitting on something (irritated and sore). And then after a bad BM, it is a sharp pain that is quite localized. I'd like to think that it's not too severe but it just doesn't seem to be healing! I'm frustrated.

Anybody have any words of advice? How bad is this. Is there hope after a few months that if I'm persistant this will get better. It seems too, and then it feels like it will never get better. How long do I give the nefidipine to work... Just be persisitant. Botox and surgery seem like options that I want to avoid... But this frustration is really starting to wear me down... I just can't believe that there is not more that can be done to heal this little problem...

Thanks so much for your advice. Take care everyone,

Hi Bailey,
This is really normal. Getting better, then suffering set-backs is very common. It took me months of healing and set-backs to finally feel completely healed. The set backs got fewer and fewer and less and less severe.
But it sounds in your case, as though you are not making overall progress.
It sounds as though you've got the diet part sorted. That's great - it's a really important part of healing.
You've been using nifedipine for four months, and it's not helping. Four months is long enough to know it's not working. So switch to a different ointment. Try diltiazem or nitroglycerine. If you look at my thread
a-one-person-experiment-on-af-drugs-t7231.html
you'll see that I also started with nifedipine, and tried all three drugs before finding relief with nitroglycerine. If one doesn't work, another may, so tell your doctor you need to switch.
In the meantime, have you tried heat? As in, sit on a warm hot water bottle or heat pad? I found that very comforting and healing. I used a hot water bottle for well over a year, and find it the best way to soothe pain.
Good luck, and please let us know how you get on.

Thanks so much for your response. I have an appointment to see my doctor on Monday.

This has been a terrible week. I have good days and bad, moments during the day when it feels good and them moments when it is quite sore. Am I correct to understand that these moments are times when the sphincter is in spasm? Bowel movements have been a little harder than usual this week - for no particular reason. Today was a good day, almost no pain. But, felt the urge to have a bowel movement on the way home from work, that pinching feeling that the fissure was sore, and after BM have lots of pain. I'm so frustrated and so unhappy. Don't mean to vent, just fighting tears again today because this has been a really bad week. Thanks for listening and for your kind words.

Don't worry about venting. That's what this place is for. I'm so sorry you are having a bad day. Oh dear, I remember that so so well. The good news is, I'm past that now, and you will be too. Hang in there. I know it's awful now but it won't be forever.

Yes, it seems that the sore feelings are the muscle in spasm. As I understand it, the pain and trauma of the fissure causes the muscles to spasm, and the nifedipine (or dilt or NTG) are muscle relaxants. Easing the pain, and/or using the ointments should relax the muscles and prevent the spasms, but in my experience, only lessens the spasms. I took a lot of ibuprofen, every day for months.

Let us know how the doctors appointment goes.

Thank you.

And may I say, thank you for the reminder to try heat again. I had forgotten about this when I started feeling better... It has been a lifesaver this week.

I so appreciate your kind words of support and encouragement...

All the best to you,
Bailey

So, after a rather miserable week last week, my weekend was wonderful. A soft BM Saturday, mild pain for a few hours Sunday morning, and another good day today. I do not understand how it can be so sore one day and not so much the next. Anyway, I added some prunes to my diet this weekend thinking that it may help with the slightly harder BM's last week. Fingers crossed that it helps!

Also saw my doctor today who did not see any evidence of an external fissure. (Last time she looked, she did see a small external fissure). So, that's a good thing, I guess. However, based on my description she is thinking there is an internal fissure and I am scheduled for a colonoscopy in a few weeks. She says that the doctor will look at it and let us know what he sees - if he thinks there is a need for a repair. (I really hope not!). In the meantime, she has suggested that I switch from nefidipine to nitro - to see how that helps. Fingers crossed:).

Thanks again for listening... I hit my end last week and took the weekend as a "mental health" break. The ups and down of this journey are frustrating and the pain really wears you out after a while. Thanks again.

This is great news!
By the way - try using really small amounts of nitro to begins with. If you were told a pea-sized amount, start with a lentil-sized amount, ie tiny smear. Build up over a few days. If you do this, you may avoid the headaches which are a common side effect of nitro. I get a bit of a head rush when I use it, but it's over in a few minutes. Definitely worth it, if it works for you.

Thanks for the tip! Appreciated more than you know...

Just a quick update and a quick question. Much better week than last week. Today, not so great. But, some fairly pain free days that I've been trying to celebrate because I'm tired of having a sore bum:). Have been diligent with my diet, water, and walking this week. No side effects from Nitro - thank goodness. If you don't mind my asking Scientist, and I know everyone is different, how long until you felt the nitro was helping?

I was really relieved earlier this week that external fissure had healed. The symptoms of pain just before and during BM still very consistent with fissure. Is it common to have no identifiable external fissure but have an internal fissure? Hopefully, will get answer from colonoscopy later this month.

Healing a fissure takes the patience of a saint! It really starts to mess with your mind, the way it comes and goes... I hope things are moving in a good way this week.

Thanks for listening.

Things don't seem to be moving in a good way. Again, a few really good days and now another really not good day. BM is soft, but was a little more formed yesterday and I think that was enough to set me back. It doesn't seem to take much to cause the spasm - the pinching/burning pain and shards or glass feeling.

Only one week on nitro - thankfully no headaches but I can't say it's really helping yet.

Looking toward the colonoscopy in two weeks - hoping to get some answers. It's being done by a general surgeon - with lots of experience and recommendations. My doctor said he will give us his recommendation of whether a surgical repair is necessary. My questions - is there any way that he may be able to do the surgery while I'm in hospital for the colonoscopy? And then, does it really need to be a CRS if this surgeon has lots of experience? I've searched and I'm not even sure there are many CRS in my city. I also don't want to be referred, and have to wait for the consult, then the surgery... After I've already been dealing with this for 5 months. Does that make sense? I don't want the surgery but with each setback, I'm starting to feel like this is really never going to heal.

I've got the trip of a lifetime planned this summer - a month in Europe - and I can't imagine traveling for that long right now. I don't want to cancel my trip for a stupid fissure. I'm not even sure I want to risk surgery and complications before my trip. I'm stressed and sad tonight...