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.

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.

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!