Hi,
I'm new here, but the fissure is not new. Last May I had a routine colonoscopy, they found no polyps but I woke up with a fissure. I didn't know what it was at first since I had never had anything like it before, when I went to the doctor for the follow-up to the colonoscopy, he did a digital exam and said I had a fissure. About 12 hours after the doctor appointment, I had an abscess from the fissure. I went to emergency to get it treated and was prescribed broad antibiotics which healed the abscess but caused me to develop C-Difficile colitis, which majorly compromised fissure healing. By then it was June and I already had a sentinel pile by the time the colitis was healed. I was finally referred to a colorectal surgeon and he prescribed nitro-paste which I have been using since August. The fissure seemed to be healing slowly until Dec., but now it seems to stay the same and I have good days and bad days. I don't have much pain when passing stools but I have tenderness and itching throughout the day (on bad days at least.) It doesn't really bleed and I also don't think I have the kind of spasms that some have mentioned here, I did at first though. The itching is worst when I am exercising or walking alot. My colorectal surgeon released me as a patient in Dec.--he phoned and I told him I thought it was improving but now I wish I hadn't allowed myself to be released. I guess my question is, should I get a referral and try botox at this point? I have never been constipated and I am just 30 years old, so I don't really want to go the surgical route. I never knew that I could get something like this from a colonoscopy, I wish I had been warned since the procedure was probably not necessary in my case. It seems like the fissure should heal on its own, but its been 10 months and it still hasn't healed. I'm so tired of having to baby my bum, the soaking and the nitro paste make traveling a pain. Any suggestions, I really feel like I'm at the end of my rope? I just keep soldiering on because there are good days when I hardly feel it, but then a week like this where I am aware of it constantly. Is Botox my best bet or should I just keep soldiering on?
Thanks for any suggestions you can offer!
Susie

hello welcome to these find boards hun
am no expert on fissure as ive nly had mine since 12/08
i got stuff call anoheal, but then i got other crs stuff to deal with
my 2 fissures are till there, but other stuff has made them less in my thoughts lately, i had a flare up around aweek ago, it was like sitting on a beehive to me, but thankful settled dwn again.
there a lots of people here though that id say no more about fissure than those so called doctors etc,
eachone on here will give you great advice, everyones fissure affect them different, and different things help,
i am sure ull find ome great help here
welcome to the boards xx

Welcome aboard Susie! It sure sounds like you may have chronic AF, and if you tolerate the side effects of the nitro paste, that's good, keep using it. Since tenderness and itching seem to be your primary annoyances at the time, I wouldn't think you'd be a candidate for surgery at all.
I think it may be safe to slightly increase the nitro dose over time for more effectiveness, but ask your CRS.
Are you taking multiple daily hot soaking baths? If not, please start as they do aid in at least temporarily bringing extra blood flow to the fissure site...it's probably not healing because your sphincter is too tight and the blood flow to the wound is not sufficient.
As long as tenderness and itching are your main symptoms, I think I would definitely avoid botox, as the anecdotal evidence from this board over time is that the success rate is no better than the nitro, or diltiazem/nefedipine creams.
And do try to keep your stools soft, using some type of stool softener, and there are many options in that category.
Wishing you a speedy recovery!
Kim

That's the same way I got mine. It hurt after The colonoscopy, but the first bm was hard and that really did a job on my bottom. I used nitro and and cocoa butter with vit. E along with Colon Cleanse from Swanson's for fiber. It took 6 months to start getting better but it's been 2 years now with only a couple of set backs if I ate wrong. Good luck and hope you can get over this. There is a lot of good people here to quide you along. I learned alot on this board. MLS

Hi there and welcome! Sorry you have to be here!!!
As you dont have spasms theres no point in rushing into surgery, especially as you dont want to go down that route, but seeing as the nitro helps and the LIS is like a permanent form of nitro, it might be worth thinking about in the future if it doesnt heal on its own ( I hope it does!) In the meantime, as everyone says - hot soaks, drink lots of water, up the nitro and keep things soft with lots of fibre and/or stool softeners.
Best of luck!

That is just horrible to get fissure that way :( - I mean it is horrible "any way" but I would just go berserk knowing that somebody else "gave it to me " I had colonoscopy done while I HAD a fissure and CRS was so gentle that I felt actually better AFTER the procedure since he left small tube inside until I woke up and it made my sphincter actually relax. But now , what happened -happened . Just try to be very vigilant with high fiber diet, soaks, creams etc. and find a very good CRS who will follow your progress and take good care of you.
I wish you best of luck and may you heal completely very soon

Hi all,
Thanks for your sympathy and suggestions. My stools have always been very soft, I'm a vegetarian, in fact, after the C-Difficile it took months for them to solidify at all. I have been soaking with epsom salts ever since I got it. Its so maddening because I can't seem to do anything to make it better. I can see the fissure, its a slit on the pile and I have recently been applying pure vitamin E oil to it with a q-tip, but that doesn't seem to be doing anything either. I have also tried aloe and vaseline. As I said, it seems to have stopped improving a couple of months ago and I don't know why. I wonder if I have become immune to the nitro paste? Is that even possible? Could scar tissure be keeping it from healing? I guess I just wonder what my options are. The main reason I don't want surgery is because I got the fissure from the colonoscopy and I never had one before. I thought that surgery was mostly for recurrent fissures, but maybe I'm wrong about that?
Thanks for being there!
Susie

How tight is your anal canal? That surely may be the main question. If it is too tight for a lubed, gloved finger, or too painful and tight, then the nitro isn't doing enough. It's not that you're immune to it, it sounds like you tolerate it well, it just doesn't work for everyone.
The vitamin E and aloe, while they are good for your membranes, aren't going to heal you.
If you had surgery, chances are you wouldn't get a second fissure from that, and even if you did, the surgery itself would set you up for healing, but getting rid of the tightness that (surely) is currently constricting healing blood flow to your fissure site may be the key.
As a vegetarian, do make sure you are getting complete protein each day, and in sufficient quantities because that would be a barrier to healing, too!
Good luck, Susie!!

Hi Suise
I am very sorry to read how you got you fissure, that is just awful
Your thoughts about the botox is kind of the next step up from the creams, in saying that all the research I have done on botox vs creams i found the healing stats were very similar, I had one botox shot and it helped me for a short time but as the effects wore off that tightness came back so for me I needed a more pernamant fix, like Kim says what is really important is the feeling of the anal canal whether it feels tight or in spasm...
This cycle totally sucks Susie but don’t ever be afraid of the surgery many of us have had the surgery and it is no where near as bad as you imagine !
Surgery for anal fissure is not reserved only for recurrent fissures though in that situation surgery would be the only way !
I am sure you will find this forum a great support !

Hi,
I'm not sure if my muscles are always tight or not. When I apply the nitro I do it with my finger (wearing a cot over it), sometimes it does feel tighter than other times and sometimes it hurts more than others, like when the fissure is more irritated and the pile swollen. Sometimes it feels better after the nitro kicks in and other times I can tell no difference. I'm sure it must be tight at least part of the time or otherwise this fissure would have healed. The swelling sometimes feels so extensive, I can see the pile and when I insert my finger, I can feel it on the inside too.
I have a few questions about the nitro paste. Do you know how long does the nitro affects the muscle? I guess my thoughts are that botox would be more constant without reapplying. How long does the botox treatment last? Another question, when I put on the nitro before passing a stool, sometimes it takes a while to pass it and then its like gravity just brings it all out at once. Is that because the muscle is paralyzed? Is that normal? How long can I use the nitro paste? I have been using it since August. Since the doctor released me, I'll have to get another referral to get a refill. The expiry date on my current bottle is May. Does it go bad after that or can I keep using it until its gone?
My other worry is that I have knee surgery coming up later this spring. I'm afraid it will be hard to apply nitro and the pain meds are supposed to be constipating. I guess my thought is that if I have botox before that, I might be in better shape to weather that experience.
Your thoughts?
Thanks for all your insights, these board are really helpful.
Susie