Advice re Chronic Fissure for a 40-year-old Athlete

[ChronicFissure]

Hi, I'm new here. Thanks to everyone who's already posted.

I first developed an anal fissure in 2.5 years ago. I kept thinking it would heal on its own. My surgeon told me continuing to row and bike wouldn't make it worse, but it definitely seemed to prevent it from healing. I finally had surgery in 22 months later. The surgery was a great success. I was finally able to resume rowing, biking, lifting and, best of all, but in January (5 months after the first surgery and 7 weeks ago) and tore the same fissure.

It's nowhere near as bad as the first, but I'm giving up hope that this will heal on its own. Having spent two years of my life dealing with this, my patience is running thin. Crew season starts again in a month and I don't want to waste any more time if this isn't going to heal on its own. Also, with corona virus on the rise, if I'm going to have surgery, I'd just as soon get it over with before the medical system starts to feel real pressure (and hospitals become obvious places for infection).

But before I schedule a second surgery, I wanted to see what advice folks here might have. Of course, I had botox again two weeks ago (I did it twice with the last one). That seemed to work wonders, but earlier this week, I had a bad bowel movement after eating something that disagreed with me, and bled for the first time in weeks.

Here's what I've been doing:

- I take 3-4 psyllium capsules with each meal

- I take two docusate sodium at night

- Going keto seems to have helped. Cutting out grains and all carbs other than veggies (which I actually eat more of now than before) has made my bowel movements easier

- I try to take 3 sitz baths a day but I usually only manage 1-2

I did just realize that I've been doing one important thing wrong: my initial fissure was so bad that actually inserting the ointment into my anus seemed to make things worse, so I just applied it outside -- and then forgot that I was supposed to put it inside. I feel foolish for this now, because my failure to put it inside might explain why my initial fissure never healed on its own, despite two botox injections. (Or maybe I was just too physically active to let it heal.)

So, thoughts? Specifically:

1) If you were me, would you give it more time? If so, how much? My surgeon told me that, as a rough rule of thumb, if the Botox was going to work, we'd know after 2 weeks. I'd like to think that things WERE going well until that one bad bowel movement, and that maybe I just need to give it more time but... thinking that way (and way too much travel and two rescheduled surgery dates) is how I wound up spending an insane 22 months dealing with the first fissure

2) Any speculation as to how much of a difference inserting the nifedipine ointment actually makes over simply applying it onto the anus (but quite regularly)? I've been doing it correctly for a week and I'm not sure it's really made a difference. If anything, the insertion seems to irritate the fissure.

3) My surgeon told me nitroglycerin ointment (Rectiv) is more effective than nifedipine but I haven't tried it yet because, while nifedipine is $50 for a jar that lasts a few months, the nitroglycerin is ~$670. Any experience? Or better yet, data? I've seen conflicting studies. Has anyone succeeded in convincing their insurance company to cover more of the cost? I could try telling them that it would cost them less than another surgery...

4) AM I MISSING ANY TREATMENT OPTIONS? I've read enough to see that some people have had good experiences with dilation and massage. I've also seen some discussion of using antibiotics.

5) I'd love to hear about the experiences of other athletes. It has been very difficult for me to adjust to not being able to bike everywhere, to row (in season), etc. I'm basically limited to upper-body lifting and swimming, which I only recently started again (mainly the breast stroke). That seems not to aggravate the fissure and, if anything, seems to help -- presumably, but getting blood flowing. My surgeon said that being in the pool should not discourage recovery. Basically, right now, I'm fine, as long as I don't break into a run to try to catch a train, go up stairs too fast, or lift anything too heavy. But I can't go on like this.

6) Any experiences with second surgeries? I'm not afraid of the experience, which wasn't that bad. But I do worry about complications from cutting the muscle again.

7) Is there any point in getting a second opinion? My surgeon does excellent work (at least, that's what two other doctors who saw the results said) but he's not a great communicator. I just don't know that anyone else will be able to do or say anything differently.

8) I'd also love to hear from other gay men who've suffered from chronic fissures. Both the initial fissure and the new one resulted from overdoing it while bottoming in January.

(If you're not a gay man, just try to imagine giving up on sex for two years!) I'm particularly afraid about (a) a second surgery affecting my ability to bottom again (honestly, that's the biggest reason I waited 22 months to have the first surgery) and (b) what happens if I have surgery again and then tear the fissure for a third time. After my first surgery, everything seemed to be just fine for three months. I'd like to believe that I would have been fine if I had just been more careful, but I don't know.

9) In predicting the risk of future recurrence, I can't help but wonder if the recurrence might have something to do with the fact that I had just had c. diff. (after an unrelated surgery) and been on antibiotics in the weeks beforehand... If that somehow made me more liable to have a recurrence, I'd be a little less concerned about future recurrence

That's it. I'm sure you all understand how psychologically debilitating this can be. I could really use advice. Feel free to respond to any one of my questions!

[kalecolbe12]

I was wondering if the surgery you had was sphincterotomy

or fissurectomy?I have pelvic floor dysfunction that seemed to be exacerbated by a fissure,but I did use the same compounded ointment as you and my cousin who is a nurse in the UK and has had fissures said that she has used both expensive ointment and the compounded and there is no difference....I am a heterosexual female I have had pain with sex... I had to go to a pelvic floor physical therapist and do stretches and breathing and use medications I'd needed...also thought of doing Botox but with my condition that works for some and not for others ...I started my own chronic pain group and several of the women can absolutely not have sex anymore because their pelvic floor dysfunction so I do understand....this is such a complicated area with all the muscles and nerves and it's very slow to heal and very prone and sensitive to further injury.....if it were me I would go ahead with a second surgery because if you don't you'll always wonder if you should have .... And it may be your answer ...I realize that debilitating feeling and mental anguish it puts you through also... sometimes it helps to speak to a counselor ...most of the people I know with chronic conditions do need a team of doctors for a while at least .....I hope you hear from some other gay males that may be able to enlighten you further

[ChronicFissure in reply to kalecolbe12]

Thanks for your encouragement. Seeing a counselor is probably a good idea!

I had a sphincterotomy. I never discussed a fissurectomy with my surgeon but from what I've read, it's supposed to be less effective on average.

And to be clear, my question isn't so much whether to have the surgery again as whether there's any point in waiting any longer (7 weeks from the new fissure and 2 weeks from the botox).

[kalecolbe12 in reply to ChronicFissure]

Well I wouldn't wait any longer if it were me I would just get it done...but everyone's different...that way you'll have the surgery and then you'll see if it works which it probably and hopefully will ....please keep me posted ...and message me if you need support or to talk more about it

[kalecolbe12 in reply to ChronicFissure]

I want to say I was rethinking my answer to you and since I'm not a gay man I didn't really think about the consequences of the sexual part.... So yeah I might get a second opinion

[kalecolbe12 in reply to ChronicFissure]

I was wondering if you ever got the surgery or what you ended up doing just checking in

[Bolex]

check out my youtube channel m.youtube.com/watch?v=6Oexa...(Not working as expected?) i have finally discovered the cure for anal fissure and haemorrhoids my story is very long ended up with pudential neuralgia do not do any sport as its unnatural in the way it contrically brings tension into the muscle do not have surgery it rarely works ! the pelvic floor is reacting to the prime powerful muscles in the body hence the compression and tension there since starting dct i have stopped bleeding after 5 years fissure healed i can squat like a youngster with no tension like an animal in the wild its truely profound !!!! went from hardly being able to walk to being able to walk miles i have experienced miracles in my body monthly ! my muscles are not only strong now but very light and relaxed the pelvic physio community have got it so wrong breathing exercises or static stretching are going to do piss all. Since when did animals in the wild need to do this the muscles have to be put under load concrentrically and eccentrically and then the build up constriction will start to unwind after yearsvand the pelvic floor will begin to settle.i was about to give up before i started dct its been a life saver and i am so grateful for its discovery . check it out on youtube my anal pelvic pain journey anal fissure and pudential neuralgia and decision to trial dct! i have 5 vids on there charting my journey my whole outlook on the body and whats going on with the pelvic floor has completely changed its no different to when galileo said the earth was not the centre of the universe and he was riduled and yet he was right proven right by newton 60 years later.

[kalecolbe12]

Get diltiazem 2% compounded for $40 from the compounding pharmacy it's the same exact ointment as nifedipine