I have now been dealing with this fissure issue since September 08.
Although I think that I have healed(to be confirmed with my sigmoidoscopy coming up)it still gets sore at the site when I sit for extended periods of time and I still get tailbone spasms from time to time but this is usually later on in the day, again if I have been sitting for long periods of time.
How long before these residual annoyances subside and I can feel normal again(relatively speaking)?

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.

Benefiber/Metamucil thickening digestive tract?

I spoke with a nutritionist and he mentioned that taking psyllium products consistently such as Benefiber/Metamucil can cause your digestive tract to thicken. He said the best way to avoid this problem is to take psyllium every other 2 week.
I googled to verify this information but got no results.
Anyone have any idea?

Metamucil

A:

The difference between Benefiber & Metamucil

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.

How I use Benefiber & Miralax

I take 3 Tablespoons of Benefiber throughout 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

If you have a fissure, just get these products here: Benefiber - Miralax - Metamucil

A fistula generally starts as an abcess and it tunnels to the outside to release the pus. It can tunnel from inside the bowel to the vagina, to another section of bowel or to the outside beside the anus or other areas. You can have one and not know it but they do eventually become very painful. They are usually treated with anti-biotics first and if that doesn’t heal it, surgery is next.

A pocket of infection that tunnels its way to the outside. I had one and we think that it came from one of the Botox injections. It was in the anal canal and tunneled over into my buttock and then continued on to the outside. There was a tiny hole next to my anus about 1/2 inch over, beside it and it drained yellow pus. It had a foul odor. I never ran any fever or felt bad. It was just annoying and smelled. My CRS tried Cipro and Flagyll. Neither worked and I had
to have it surgically fixed. Any drainage should be investigated to see where it is coming from. Also once you have a fistula, they can spread and make more and then you really have a mess.

I  had surgery on the first fistula that I had. A fistulotomy (I think that is what they called it) and when she was in there she cut into the rectum muscle a tiny bit to try to relieve the pressure on the fissure. It worked ……both for the fistula and the fissure (no fissure pain since 2004). About a year after the surgery I got another abscess and that developed into another fistula. My surgeon suggested that if I thought I could live with the fistula then I might want to consider that instead of more surgery. Because the surgeries are so invasive I chose to keep my fistula for the time being. Since the fissure was not bothering me anymore I was inclined to leave well enough alone!!!!!

The problem with the existing fistula is that it has a pocket in it and over time (about twice a year lately) the pocket seems to fill up with fluid and then needs to drain. Everytime this happens I get an abcess and then I go through that whole process (daily trips to the hospital to change packing), it then heals and eventually the fistula stops draining
and then about six months later I get another abscess.

I saw a new colo rectal guy in Feb and he told me I had to come back when I have an abscess so next time I get an abscess I will go and see him to see if he has any new ideas.

All of this seemed minor to my fissure and because it hadn’t bothered me since my surgery (2004) I was ok to just leave everything be, but my fissure has come back to life since my visit to the colo rectal guy in Feb so right now I am trying really hard not to aggrivate the fissure if at all possible. I have actually been off work for the last two weeks
as a result of the abscess and then the awakening of the fissure.

I have been suffering with chronic anal fissure for about 3-4 years. My story reads like many: a nasty bout of constipation is the likely start; was misdiagnosed by GP for hemorrhoids. I cant even remember all the prescriptions we tried over time, but i do remember they never worked. Finally the pain was so bad I went to a gastroenterologist and he diagnosed a fissure. He gave me diltiazem and 8 weeks later i was fine. For 10 months i thought it was a thing of the past. I was grateful everyday that the pain was gone. Then, out of nowhere, it came back with a vengeance. Eight more weeks of diltiazem and i was in the clear again, but it lasted only a month. So now this thing has completely dominated my life for the last 6 months. Over this period i managed to function by willing my BMs from their normal AM time to PM. (not easy) For me, just walking after the BM brought on intense debilitating spasms, making daily function impossible. So, by having the BM at night, i could soak in the tub, then go to bed, not aggravating it. This was really an amazing breakthrough for me and allowed me to have a semi-normal life. (I hope someone else may benefit
from this seemingly simple adjustment.) All this time i was on diltiazem and analpram, waiting for it to work again. But after so many weeks it became apparent that it wasnt going to work. I was switched to Nifedipine and for the first 4 days it appeared to be working. Then it was all down hill. Its hard to believe the pain could get worse, but it did. WOW! Now i have such intense spasms that i am up all night. I was given lidocaine for the pain, but it does nothing, in fact it seems to aggravate the situation. My MD said he didnt want to give me narcotic painkillers because they would constipate me. So, i have found in my years of dealing with this pain that only two things have brought me quick relief. The first, of course, is the sitz bath. Even this doesnt always help me. The second i have never seen anyone talk  about. I am (or was-not these days!) a yoga practioner and i found that shoulderstand drains the blood out of the lower regions and reduces the overall blood pressure in the area. So, when i am having a wave of spasms i lay down and get my legs up on the wall, the more inverted the better, and the majority of the time, i feel the pressure and the edge of the pain drain away. (Hope this helps someone else too!) I hold it for several minutes, as long as i can and then carry on. This has been my #1 source of relief, as silly as it seems, it really works. But, not all the time. Not recently. I am now so miserable i am forced to consider that which i never wanted to do: surgery. I havent slept in days, cant work, cant do much of anything- i am at my wits end and i need a solution.
So, i finally get to my point: what would you, fellow sufferers do in my position? Botox? LIS?

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.

a reply received:

I understand your frustration- I saw 3 different gastro Drs for my Crohn’s and terrible anal pain. The first one told me i was wiping too hard and said to use baby wipes. The second one kept giving me suppositories- which just aggravated things trying to insert them. The third one listened to me, then examined me and said I had a fissure and referred me to a CRS.
See if the next Dr will give you nifedipine- most of us here seem to feel it works better then the nirto or diltiazem, another cream often prescribed. Actually, my 1st CRS refused to give me a script for it- she said she only gives nitro , Botox or surgery. She also told me because I have Crohn’s, she didn’t feel I was a good candidate for surgery but told me I’d eventually get soo bad I’d beg her for it. I didn’t like that attitude, so I asked to have a 2nd opinion from her higher up, and have been with him ever since. Actually, my gastro DR gave the script for the nifedipine when the 1st CRS refused to give it – bless him! The 2nd CRS now refills it. Hope you can find some relief!