Hi Michael, we are here for you. Please do not give up. If you are not getting help from your doctors, try new doctors (if you can). Try to get a better diagnosis.
Please consider anti depressants. Several people here have taken them to tide themselves over the worst times. It is nothing to be ashamed of. If you are having destructive, obsessive thoughts, medication can help you deal with them and allow you to focus on healing.

Can you tell us more about your situation? Do you have a good diet? Are your stools soft and formed or are they hard and dry? Or do you get diarrhoea? You say you do sitz baths. What else do you do? eg, exercise, relaxation, painkillers like ibuprofen or lidocaine? Are you using creams or ointments such as nifedipine, diltiazem or nitroglycerine? Do you feel your doctors are taking good care of you?

Do you have family to turn to? The terrible irony of this disease is that it's so hard to talk to people about it. You tend to suffer in silence. With other injuries or diseases you get sympathy and support, but with anal fissures you tend to isolate yourself. Even one friend to talk to can make a big difference. If you haven't anyone like that, please keep posting here. We are here for you and we want to help.

I've been to so many doctors. They tested me for hep c, aids and I had a colonoscopy, and they said I did not have chrones diseas or anything like that. I had my LIS last month and she said it should have worked. I do not know much about muscle relaxants at all, and do not believe I have taken any. I am located on the west coast of the US. My doctor said it was normal to have the urine sensation because the sphincter and the peeing are together. I don't really know if I have diarhia, I have 3-4 bowl movements, and they seem reasonably solid to me. It would be impossible for me to have and std or anything.

I have not exercised in awhile because I just never feel well. I always take
A bath after every bowl movement.
Lidocaine does not seem to work at all for me I don't receive any RELIEF from that ointment. I have not been taking any pain killers because I do not know if that will help with my burning. My bowl movements are kind of random sometimes they are soft and sometimes they are hard. When they are soft I have horrible burning.
Before I had my LIS hard
Bowl movements did not make me have any burning after a bowel movement but now I have the burning even if it is soft or hard. I really have faith in my doctor but 4 surgeries later there is still no improvement and it is really hard to get a second opinion because they cannot really see the fissure unless they are under the operating table. So I don't know why I would switch specialists.

Michael,

Is there swelling after the burning sensation? If you were re-opening your fissure, you would feel the inflammation within 30m.

Have you seen a dermatologist? They can do a biopsy of the skin that burns after BMs and see if there is anything weird about it. In my case they saw something in my skin cells that suggested an allergic reaction, and they eventually found out that I was allergic to fragrance in most products and the blue dye in my underwear. This would leave my anal skin in a permanently sensitive condition that would flare up during BMs.

How can you tell if there is swelling? I am really not sure.

Swelling in the anal area would feel like if the skin is enlarged. The best way I can describe it is if you feel like there is still poop stuck in there but you know there's nothing.

If there is no swelling then you're not re-tearing your fissure and something else is causing your skin to get irritated. Once again, have you seen a dermatologist?

Well I feel irritation inside. No I have not seen one. I am currently working with a gastroenterologist and a colorectal surgeon.

Are you sure it's in the "inside". The rectum (the inside) has no pain receptors so it's unlikely you're feeling that burning there.

The irritation can only occur on the anal opening or the perianal area where there's very sensitive skin that can feel pain. I also made the assumption that my burning was on the inside, but it was the skin outside the anal hole.

Once again, burning sounds like a skin problem and I would strongly suggest seeing a dermatologist or allergist.

Burning can also be due to nerve pain. Does it burn all around or in a specific location? It could also be occurring if your incision site has not healed yet. Has your CRS told you if it has healed? It can definitely take longer to heal from LIS (including the fissure) than a month. That is not unusual. You say your BMs are unpredictable...have you tried a stool softener? People on here really like Miralax.

Since your pain could be due to another reason, I would think that re-evaluation would be quite valuable. You could have an exam under sedation or anesthesia. In many cases, people's fissures have actually healed but then have pain after, such as nerve pain or muscle pain. This can then be sorted out with physiotherapy and/or medication. Do you have bleeding?

A vote for Miralex... I struggled for months with a fissure and Miralex was a lifesaver for me. BM's that are too hard will hurt and could cause reinjury. BM's that are too soft irritated my skin and caused horrible burning. Miralex made my BM's consistently soft and easy to pass... Took away my anxiety every morning.

I hear you about the burning - it hurts and after a length of time, it steals your strength. But, it does get better! For me, the most helpful things were to drink lots of water and a heating pad. The heat really helped to relax the muscle.

I too would suggest you get a second opinion and possibly see a dermatologist or urologist. It sounds like you may have more than just a fissure... Keep pushing! You will feel better. Don't give up!