anal fissure

Sorry for the graphic details below but I'm desperate for advice.

I was diagnosed with an anal fissure two years ago.  It comes and goes.  It took about two months to get over it the first time around.  Since then it's reappeared maybe 15 times and been a pain for anywhere from a week to a month each time.  The pain is mostly stinging during and after defecation, sometimes with a streak of blood.  I don't think I have spasms.  Between bowel movements the pain goes away completely, but I have to be very conscious of my diet and my fluid and fiber intake all the time, and even with all the attention I pay to it, I still get a fissure breakout every couple of weeks or months.  It's painful and very annoying but not incapacitating.

I have seen two specialists.  One gave me diltiazem but it gave me a rash and I had to stop.  I got a second opinion from a surgeon who suggests a surgery called lateral internal sphincterotomy.  I've heard that people shouldn't consider that surgery unless they're desperate, because it's risky.  Since I don't have the spasms or the constant pain, I don't know if the risk is worth it.  

During a recent bout of fissure pain, I made an appointment to see a surgeon, but by the time the appointment came, the fissure healed itself.  She said there was nothing there to operate on.  Sure enough, a month later I had another fissure episode.  So, was it really healed?  What does it mean that the fissure keeps coming back, even though it disappears completely from time to time?  

Just wondering if anyone has any experience to share along these lines...

[Matthew007]

wow that is bad.. sure enough that is a anal fissure.. sting pretty good too..I don't have first hand experience I had a tiny bit of a problem like that years ago.. not to that extreme.

anyway I'm not sure if your doctor has ever suggested this but you need total pressure releif off the colon at all costs.. i'm not sure if i'd be doing really any fiber..what i'd do honestly in your situation and it's gonna be lousy but i'd buy some miralax and purposely make your stools almost liquid OR like prep yourself for a colonscopy drink tons of water and magnesium citrate and just empty yourself out.. should take a few days before you have a bowel movement..that way you could give your body some time to repair things down there if you went days without a bowel movement.  Almost fast or go on only liquid diet of soups and jello so that you give your colon a complete break so it can heal down there...

i'm with you I wouldn't want surgery there either.. although that is a possible and probably would fix things I wonder what the long term side effects would be.

Anyway that's my advice at first it's gonna suck going a lot but if you empty out like a colonscopy prep and just do miralax and clear liquid diet for a few days.. it might buy you enough time to heal things down there.. and then ease off miralax over time.. but i'd avoid fiber honestly (Buuuut i'm not an expert..fiber bulks.. you don't need bulking you need small..)

.02

[LIgirly]

Hi PVK,

I am in your exact situation.  I started with a fissure in March 2009, and it became chronic.  I was in severe spasm and opted for Botox as opposed to the surgery.  The botox worked for me and stopped the spasming.  However, now every time I go back to my surgeon with pain, I have a new fissure.  It is about evey 2 weeks when I get a new one.  I don't know what to do, I am emotionally drained, I can't keep living like this.  Have you gotten any more advice? Can anyone else help?

The whole area down there must be so weak that the new fissures keep ripping.