A:
Diltiazem is a calcium channel blocker, Nitro is a vasodilator. I would call around and compare prices- availability and not rely on the doctor or pharmacy especially if you need it now.

I had LIS in october and my fissure finally healed but the area still can be tender at times.
I tried the diltiazem and I find it burns and irritates the most. I’ve used nirto and nifedipine and I think the nifedipine is the least irritating and works the best but that’s just my opinion.
I had other issues besides the fissure, scar tissue from an old hemorrhoid surgery and ibs and some pelvic floor problems so I think the area where the fissure was and some of the old skin tags stay tender for quite a while. The only thing that seems to help me when things do get tender are sitz baths. Of course eating more fiber and keeping bms strain free are a must. If the diltiazem is irritating you tell your doctor and see if you can try something else.
If you have a health food store close by try pure aloe vera, you have to store it in the fridge but that’s even better. It feels cool and soothes the irritated skin.

A:
The pain and discomfort from my butt problems has certainly affected the libido and has from time to time seen ED rearing its ugly head!

However, many health problems have the potential to affect the little fellow’s ability and performance . You should speak with a doctor to ensure there isn’t any other health problem that could be the root cause of the erectile dysfunction e.g. kidney, heart problems, vascular disease, etc.

It is important to be checked out by a doctor to ensure the blue pill isn’t going to cause you any problems.

The doctor has seen this all before and should be reassuring that a normal life can be resumed! Don’t allow any embarassment put you off going along to one. Goodness, if you’ve been along with the AF to a doctor then you should hopefully be through the embarassment stage with any doctor and “down there” problems.

A:
I had my fissure for about a year.
I too thought I was healing and almost canceled my LIS surgery twice but thank god I didn’t back out. I had the surgery and when I woke up the CRS told me my fissure was very big and deep, it was highly unlikely it would have healed on it’s own.
The reason I was experiencing less pain was because I kept my stools relatively soft and easy to move. I can’t tell you how many things go through your mind when you decide to have surgery.
First and foremost the incontinence issue sticks in your mind. I had tried everything else first though, I did all the ointments, I had the colonoscopy and that tore the fissure a little more (but they told me up front that might happen).
My doctor didn’t recommend botox for me because it was only temporary and because I’ve had spasms for a long time and the sphincter was very tight.
The chance of retearing was greater. As for the sensitivity of the area, it remains.
I don’t have the terrible pain of the fissure but if I have too many bms in a row the area where the fissure was gets a little irritated. If you don’t clean thoroughly after a bm (because of the skin tags) that can irritate it too.
I can tell you the one thing that sticks with you after an experience with a fissure is the thought that it could happen again. That fear remains. I’m hoping in time it will go away, but it’s hard to forget being in pain for almost a year.

A:
Most LIS procedures today will not cause incontinence. In the “olde days” they cut the entire length of the muscle so you would be incontinent. They now only cut a portion so you still have some muscle to hold the poopies.

Botox has worked for some. It is always worth a try, but it only works for a few months, then you need another shot if you haven’t healed.

Have you tried any ofo the topicals? Talk to your doc about getting Nifedipine that may help you too.

I’m surprised your doctor removed your skin tag with an active fissure. The tag is formed by the fissure to protect it. My doctor said he wouldn’t remove a skin tag unless the fissure was healed because the chance it will grow back is pretty good.

I had LIS and an injection of some kind of steroid into the fissure and it healed in about 8 weeks.
The LIS relaxes the sphincter muscle so things can heal down there. It doesn’t treat any other bowel problem though. I was very afraid of incontinence but my CRS told me the chance of that was very low.
Sometimes people experience a little loss of control when they have gas and that usually goes away in a few weeks. I had my fissure for about a year and just couldn’t stand the pain anymore so I chose the surgery. The area remains tender for a long time but it’s nothing like the pain of a fissure. I wish I hadn’t been so afraid to begin with and had the surgery sooner but it’s a scary decision to make. Just remember even after the surgery it’s important to keep your stools soft and strain free. We all have our own methods for doing that, some take benefiber or MOM or miralax and eat higher fiber diets. If you need some
suggestions just ask.

A:

Have you tried different brands of wipes? Or of TP? (I only use Charmin soft)
Are you using ones that don’t have alcolhol in them?
Do you pat dry or use hair dryer to dry off after wipes or wet TP?
Do you apply anything after wiping? Like lanolin or vaseline? Are you using any prescription creams?
Did you discuss possible causes such as yeast issues?
Try sticking to one brand of tp and wet it for a month and see if anything changes.
If no changes, try wipes – the same brand- for a month.

I used to use wipes a few years ago, but I didn’t like using chemicals.
So I use a spray bottle to moisten TP with water now. I use Charmin soft TP. I occasionally use zinc oxide or yeast creams after, but that’s when I feel the rash flare up. It occurs after BMs and after sitting.

The problem can be even not related to the wipes themselves – it’s just that you need to dry the area after you use them. I just use a hair dryer set on low. It’s fast, easy and dries the area really good.

A:
Fiber acts kind of like a colon cleanser. It moves the food you eat through your digestive tract quicker and the bulk of it is what pushes against the wall of the colon on it’s way out to clean it out. It doesn’t thicken anything but your stool. I don’t understand what your nutritionist means by thickens your digestive tract. The main ingredient there is wheat dextrin.
I think metamucil is more of a bulking fiber than benefiber. Too much bulking up of your stool like you get with metamucil isn’t really helpful to a person that suffers from anal fissures because your back side has to stretch too much to pass it, that’s why a lot of us like benefiber. When you have fissures you need a consistently soft, strain free stool so if you only took it every 2nd week how would that help you in the first week.

I am a HUGE proponent of Benefiber as it really softens things better than any other product I’ve tried. This (on top of Miralax & lots of water) was the only thing that finally helped me heal my fissure after 7 months of debilitating pain & after trying so many different things including botox, LIS, aloe vera, wheatgrass cream, Metamucil, Nifedipine, Nitroglcerin ointment, etc.

I literally felt the tear (glass-passing sensation) every single BM (even 3 months after LIS) until I added Benefiber to my regiment.
I take 3 Tablespoons of Benefiber throughtout the day & Miralax at night. I make sure to drink 64 oz of water a day. When I get to work, I put 2 Tablespoons of Benefiber into 32 oz of water & sip on it all day. Then, with dinner I have 1 Tablespoon of Benefiber with 16 oz of water. Then, before bed, I take a quarter dose (17 gms is regular dose) of Miralax with 16 more oz of water. I was taking 1-1.5 x a full dose plus the 3 Tablespoons of Benefiber when my fissure was at it’s worst & finally began to heal.
I’ve found it’s easier to use a 32 oz water bottle to make sure I get the 64 oz of water & stick to my schedule.
I can pretty much eat what I want, but I do tend to have a spinach salad & fruit everyday. I usually add peas or chickpeas to my salad for a little more fiber but not always. I think I have a more constipated system than most so don’t know if others would need both Benefiber & Miralax.

At any rate, I wanted to relay my story again & what worked in hopes that it may help someone else. I cannot stress enough about stool consistency! I did not get this & no one stressed to me. I thought things were soft enough for the longest time as it was so much easier to go than what I was used to before the fissure. However, things were not nearly soft enough . . .
need to be the consistency of pudding/soft-serve ice cream in order to heal those suckers! I do recommend shortly after you’ve healed (maybe month) firming things back up though b/c I did experience burning for a while after healing & none of the docs nor I could figure out why since fissure was healed. I am a lifer on the Benefiber & maybe Miralax too

I found it interesting the info having to do with Chinese medicine. There is no doubt that Eastern medicine, Ayurveda, and herbal remedies can help, but I would not go so far as to judge those of us that have this chronic condition. It is something many of us deal with regularly and not from choice. I am going to be seeing a Chinese MD as a health consultant for various things. One of which is a zinc deficiency that I experienced recently. I am wondering if it has anything to do with the oils.

I had the misfortune of having repeted tears after fissurectomy.
Then, I consulted reputed gastro surgeon – he did a digital exmanination of my anus. He suggested me to udnergo surgery again.
 
I took the decision not to undergo surgery and to make life style modifications like walking, taking more vegetables/greens, timely food, regular sitz bath….etc
 
Now I am free from retears / burning senssation in anus.
 
From my experience, I strongly feel that a holistic approach by the sufferer can tackle fissures.
 
You can take cue from my experience and avoid the mistakes I comitted.

A:
These remedies are merely band-aids on something that will not go away. Unless you have a medical condition that will not allow you to have the surgery – go for it. You won’t be sorry. The horror stories that you will here – don’t believe it. Find a good CRS and have the surgery. I suffered for years and was scared to death to have the surgery and when the pain and bleeding became too much, I cried “uncle” and had the surgery (three years ago), and I have not had one problem since.
I have had two botox shots in the past year and they seem to have helped. I thought after the first botox all was healed (still using baths and nifedipine) but then developed an odd mass that also made the fissure retear so i did another botox with removal of the mass. Still healing from that using same diet and bath regiment.
Seems to be coming along but one thing i’ve learned over the years – healing is an extremely slow process – give yourself years before you can say you are in the clear and in all likelihood – i’ll have to be vigilant about diet the rest
of my life -but the fissure can be healed or at least reduced to nothing more than an occasional nuisance.