Hi all, I have been battling fissure(s) for over a year now and have had many ups and downs.
I went back to my CRS amazingly a year to the day (in July) I first saw him mainly because a) I knew I had a fissure that was bothering me and b) the skin around my anus was very raw, irritated and would bleed if I wiped more than once. And by bleed I mean not from the fissure, from the raw skin.
He took a look with his night vision goggles (that's what they look like) for a minute and said "yep, you have a fissure that is irritated as all get out". He told me I had a second one but it wasn't much of a problem, very small, but the bigger one was the reason for all my issues.
He told me the usual -- take sitz baths as often as you can, eat more fiber, drink a lot of water, soften things up (he knows I take Miralax) and that's that. But he did give me a cream called Calmoseptine to use (it is orange and smells like menthol) for when I "feel I just have to tear it apart" mainly from itching, etc. He said to come back in a month.
After a couple weeks of little progress, I started using the Calmoseptine daily after each BM or tub and it felt great. The rawness went away which was excellent so no more mass amounts of blood when I wiped and I was feeling better back there. I had a setback before I went back to see him where I was fighting dehydration (four days outside in 100 degree heat and humidity led to some diarrhea) and I think that hurt things back there.
So I went back to see him a month later knowing my butt felt a little better but I certainly wasn't healed or on the right path. He took a look again, said "we are winning" but said I now have three fissures instead of two. But he said they are all "superficial" and "if I asked him to operate on them right now he'd tell me no" so he gave me same instructions -- sitz baths, fiber, lots of water, miralax, soften things up, etc -- and come back in three months.
Two odd things (to me at least). I told him I was using the Calmoseptine daily and it was making things feel better back there (it has a cooling sensation and I have read online it is used to heal raw skin and even help heal fissures, it is a moisture blocker with healing elements) but he told me to only use it when needed and emergent. He said the Calmoseptine could trap fecal matter or whatever else in the fissure and impair healing.
The second thing he said was "let's try to heal this without the Diltiazem, because if it worked last time for you then you're the first person I've ever met it worked for". I found that odd. I used Diltiazem last year and off and on throughout this past year and while I clearly didn't heal, it seemed to help. His comment seemed odd.
So my questions are -- has anyone used Calmoseptine to aid in the healing of a fissure?
And can anyone think of why he would say Diltiazem would not work or hasn't worked for people? Should I use it again now? I recently had a hard BM (three days ago) and re-tore one of them because it hurt, there was a little blood in the bowl and I have been in pain after going each time since.
Any advice or help would be greatly appreciated. I'm drinking water like crazy, taking my full cap full of Miralax nightly and trying to keep things soft but I'd like to start getting ahead of this. It has me very depressed.

Hi there,
Sorry you are suffering.
I really can't think of a good reason why your CRS would say not to use the diltiazem again. I'm not sure how many people actually heal a chronic fissure with it, but if it makes your pain more manageable and there are statistics that say it has worked for some.
I used the calmoseptine and the diltiazem for months.I didn't heal my fissure but I didn't get any infections from the calmoseptine either.
There are folks who heal with the diltiazem , but I've noticed that most started using it in that crucial time- before their fissures became chronic (older than 6 weeks).

I have found diltiazem has helped me immensely. I have only just stopped using it after 5/6 months as it had started to make me itch. I wonder if you should increase your miralax/movicol as you shouldn't be having any harder bm's. Last thing you need is another fissure. I find using vaseline around o before ur bm help alot too! All else fails change CRS??

I don't really think you could heal a chronic fissure with the creams, but then anything's possible!
He might just have meant that he personally has never had anyone heal with diltiazem,that doesn't mean no-one ever has! And it does help a lot with spasms.

So is surgery the only way for a chronic fissure even if doc says it's superficial?

lurker53 wrote:So is surgery the only way for a chronic fissure even if doc says it's superficial?

No! Surgery is not the only way to heal a chronic fissure. I had a chronic fissure (15 months) and am now healed by Botox. I got better using the nifedipine ointment along with taking psyllium fiber, Miralax, stool softeners and doing sitz baths, but could not fully heal. I ended up developing a superficial fistula from the fissure and had that taken care of at the same time as getting Botox. I just had my 4 week follow-up and my fissure is now healed, he still wants the skin to get tougher, but it is healed. I have to go back in 8 weeks to follow-up again just to make sure it is still looking good. The Botox has really helped me heal. I just have to be careful as does anyone who has healed to not tear it open again.

But it sounds like you had surgery anyhow right? They took care of a fistula. Was your botox and fistula fix under anesthesia or was it a local?

itpainsme wrote:No! Surgery is not the only way to heal a chronic fissure.

Well, the word "surgery" possibly means different things to different people! When we say it won't heal by conservative methods, it means once a fissure has become chronic, and all other methods have been exhausted, then surgical intervention, ie, LIS, botox or even anal dilation, is going to be necessary.
"Surgery" doesn't necessarily mean major surgery! An ingrowing toenail is "surgically" removed by a chiropodist!!

Here Here!! For me, I just know that I need the surgery. 6 months of this and if that don't say it all nothing does. Am so glad I found this forum or I might of been the unlucky ones who waited years....

lurker53 wrote:But it sounds like you had surgery anyhow right? They took care of a fistula. Was your botox and fistula fix under anesthesia or was it a local?

I only had surgery for a superficial fistula (only skin, no muscle) and had the Botox at the same time since I was already numb. The fistula was more external, at the external end of the fissure. My CRS believes the fistula played a role in me not being able to heal. I was not sedated at all, I was given local in the area to numb it. I didn't feel a thing after the injections to numb the area. It was done in the CRS's office, not at a hospital. I would do it again in a heartbeat. I can still tell a difference from the Botox, it is still working for me. I have no idea what it will be like for me when it wears off, but I plan to be extra careful to stay hydrated and I will always take my fiber supplement.