Welcome Twenben! I’m sorry you have to be here, but you’ve come to the right place. We all understand your pain and the psychological trauma. Fissures really mess up your life and can be physically and mentally debilitating!
I agree with all of Val’s advice – good stool softeners (Miralax/Movicol/Restoralax – the name depends on where you live – is the favourite here). And definitely find a good Colorectal Surgeon (CRS). S/he will likely start you on some kind of ointment, like nitro or Diltiazem, which promote blood flow to the butt to help with the healing. The reason fissures become chronic and fail to heal is usually because the sphincter is too tight and/or spasms, which prevents blood flow, which in turn prevents healing. Warm baths also help stimulate blood flow. If the ointments don’t work after a few weeks to a few months (depending on the timeframe you and your CRS decide upon), then surgery is usually indicated.
The surgery is a Lateral Internal Sphincterotomy. It involves making a small cut to the internal sphincter to loosen then muscle and stop the spasms. It is not unusual to not feel spasms, and sometimes they are hard to recognize (you know you have spasms if there is a throbbing/burning feeling). I didn’t have spasms that I felt until my fissure was almost two months old, and then I really felt them! Some boardies here didn’t ever feel spasms, but their CRSs told them that their sphincters were too tight and/or that their sphincters were spasming, but they just didn’t feel it. The LIS is considered the gold standard treatment. The cure rates are very high (like around 95-98%) and the complication rates are quite low.
One thing to note while you do your research is that many websites don’t distinguish clearly between incontinence to formed stool, incontinence to liquid stool and incontinence to gas. Incontinence to formed stool is pretty much unheard of. The most common form of incontinence is to gas – so you may f@rt a bit more. Some boardies here have had some minor leakage after the LIS, which is annoying and can irritate the bum; but, this usually gets better over time, and none of the boardies who experienced this regretted getting the surgery.
Another complication of an LIS is infection. I had an LIS in May. It healed my fissure in about two weeks. About a month after surgery, just as I was getting completely better, I developed a small abscess at the incision site. The incision wound healed too quickly in the wrong way and an abscess formed, which eventually turned into a superficial fistula. I had a minor surgical procedure to fix that on June 27th and now I am about 97% fully healed. Even though I had a complication, I still don’t regret the LIS. Fissures can get infected and/or form fistulas without surgery too, so I figured may as well be healing if something like that might happen! The LIS was scary as hell, but it gave me my life back.
Now for the most important thing: If you find a good CRS asap, then you have a very good chance of healing sooner rather than later. A CRS can tell you if your sphincter is too tight, and the pros and cons of different treatments, and especially the implications for anal sex. I will say this: you do not have to suffer for the rest of your life. There are treatments and the surgery, if it comes to that, with a good surgeon will not leave you with fecal incontinence. You will get your life back, and you will have an active, happy sex life again. There is definitely hope! Just go get yourself a good CRS. We are here to help and support you.