Everything I know about fissures (Not in any particular order)
1) see a board-certified colorectal doctor (not a gastro or general surgeon)
2) in every medical field there are good doctors, so-so doctors, and bad doctors. If you don't like what your colorectal doctor has to say to you or how he treats you, find another one!!!
3) your doctor does not need to put his finger in your rear to examine but should be able to assess by simply spreading your butt cheeks apart
4) if doctor insists on attempting to put his/her finger in, find a different doctor
5) chronic fissures (ones that keep returning or don't leave after a
short period of time) need treatment
6) if topical treatment is obtained early, surgery can be avoided,
7) topical treatment of fissures would include nitroglycerin (NTG) .2% (can cause headaches), diltiazem cream (2%), nifedipine and other medications
8) the creams can work, but if your injury is extreme then you may need more drastic measures
9) soaking in a warm bath helps
10) a sitz bath (can be purchased for about $10) is nice for
relaxing, and cleaning after a bm
11) suppositories can increase the pain and sometimes can thin the tissue regardless of type (anusol, prep h, glycerine, etc.)
12) overcoming the fear of having a bm is hard to do
13) watch your diet - add fiber and avoid foods that may bother you upon exit. I avoided the following foods: beef, tomato-based foods, spicy foods, nuts, popcorn (also less in is less out)
14) drink LOTS of water (I drink 90-120 ounces a day)
15) do whatever it takes to soften your stools (I try and consume 25 grams of fiber through foods that I eat and I drink about 8 oz. of prune juice right before bed)
16) get treatment asap, if your fissure hasn't cleared up in about 3-4 months it may get worse & even harder to cure
17) if you are having trouble getting help fast, keep trying, there
is no reason to suffer any longer than necessary - also seek out at least TWO opinions before having any surgery
18) the more intense pain hours after a bm are caused by muscle spasms inside your sphincter
19) there are alternate therapies and treatments that have worked for some people like physical therapy for the pelvic floor, acupuncture, dilation, or hyperbaric oxygen therapy (HBOT) - a lot of these things are NOT covered by insurance
20) use surgery as your final option - LIS surgery (sphincterotomy) works well for most people who get it but it does carry the risk (1% or so) of fecal incontinence and it does permanently cut your internal sphincter & it doesn't cure all people
21) chance of gas incontinence after LIS surgery is about 30%
22) I read somewhere that once a fissure heals it takes 3-4 months for the tissue to regain 40% of its original strength and 2-3 years for the tissue to be back to 80% of its original strength. Have not yet heard if it will ever be back to 100%.
23) fissures are EXTREMELY painful - hang in there you will get better!!!
I know a lot of people say the sphincterotomy is an easy, quick way to heal your fissure but I still don't like the risks that are associated with it. My doctor told me that it appears that I am healing slowly so I will continue to use conservative measures at this point. It is a long process to heal a fissure. Keep things soft and self-moving. Good luck and don't hesitate to ask more questions. Also, read the posts by Purpleladyfish. She has some excellent insight about fissures.