Painful Fissure and New GI Doc in Tampabay

expensive option, depending upon your insurance, but humira.  i took it for pouchitis, which didn't work, and the doctor said it would help the fissure.  it healed it.  think course of med was only for several months.

in the meantime, stay with the sitz baths.  three a day and warm not hot water.  that's the best.  good luck, janet

You need patience for fissures. If you just stick with the program they'll generally slowly heal, particularly if you manage to keep your stool consistency "just right." Another treatment option is Botox injections; I'm not sure how effective that approach is, but it might be worth a try (by someone who knows what he's doing).

 my experience, from having had a fissure for well over five years, was that it didn't slowly heal.  it got worse, i tried every imaginable treatment--including botox, which lead to incontinence.  i heard horror stories--and of course you can hear those stories about any surgery--but i heard way too many about fissure surgeries.  even the surgeons discouraged me.  i have a very high tolerance for pain and i agree that anal fissures can be nasty, especially when one poops 8-10 times a day, or more because of the fissure pain.

ask your doctor about humira.  it saved me.  i now have a k pouch and don't have to worry about fissures.  but i can recall the pain and empathize with you.

what strength nifedipine?  i went from .02 to .2--i think, it's been some time--and that helped.  at some point you will develop a resistance to it.  but if you have been off of it for awhile--sorry don't know how long--perhaps an increase in strength would help.  another question for the doc.   in the mean time keep doing the sitz baths, 3xs daily if you can them into your routine, and warm, not hot water.  good luck!!

JLH, you know first hand that they sometimes don't get better with the usual treatments. I do wonder, though, how early it's appropriate to bring out the bigger guns. 

How long did you all use Humira before it worked? 

after about six weeks on humira i had a scope, at which time the skin around the fissure had 'granulated', which was a good indicator that it was healing.  because the pouchitis had only responded a small amount the doc doubled the humira dosage, which i continued on for 4-6 weeks.  humira wasn't working for the pouchitis, but the fissure had healed!!  i ended the treatment, which would have been about 3 months, and the fissure never returned for the remaining one year plus.  then i got a k pouch.

maybe humira is not for you--it is expensive--but good to know about it as an option.  google it, just to be sure.

what strength nifedipine are you on and for how long have you been using it?  how often do you do a sitz bath?  my mistake was that i used very hot water, and once i used just warm it was better.  often i would heat up a moist wash cloth and stick on my butt for 10 min or more.  that helped and as it was easier i did it more often.  

interestingly i also had an abrasion that was caused when a nurse, doing some test with a metal object, pulled it out.  the sponge came off and the metal cut my anus.  during the humira treatment the fissure healed, but the abrasion never did.  it was an irregular cut, quite deep--as was the fissure--and apparently at a particularly inconvenient spot.  it became one of the most painful of my problems and a reason, along with the pouchitis, for the k pouch.  i realize how big of a problem the fissure can be.  hope this is helpful.  ask more ?? if not, or if not clear enough.  good luck, janet

JLH posted:

after about six weeks on humira i had a scope, at which time the skin around the fissure had 'granulated', which was a good indicator that it was healing.  because the pouchitis had only responded a small amount the doc doubled the humira dosage, which i continued on for 4-6 weeks.  humira wasn't working for the pouchitis, but the fissure had healed!!  i ended the treatment, which would have been about 3 months, and the fissure never returned for the remaining one year plus.  then i got a k pouch.

maybe humira is not for you--it is expensive--but good to know about it as an option.  google it, just to be sure.

what strength nifedipine are you on and for how long have you been using it?  how often do you do a sitz bath?  my mistake was that i used very hot water, and once i used just warm it was better.  often i would heat up a moist wash cloth and stick on my butt for 10 min or more.  that helped and as it was easier i did it more often.  

interestingly i also had an abrasion that was caused when a nurse, doing some test with a metal object, pulled it out.  the sponge came off and the metal cut my anus.  during the humira treatment the fissure healed, but the abrasion never did.  it was an irregular cut, quite deep--as was the fissure--and apparently at a particularly inconvenient spot.  it became one of the most painful of my problems and a reason, along with the pouchitis, for the k pouch.  i realize how big of a problem the fissure can be.  hope this is helpful.  ask more ?? if not, or if not clear enough.  good luck, janet

Thanks for the info. I'm going to try the humira. Did you or anyone else stay on Loperamide while having the fissure? I have been off of it since I originally got the fissure. Seems right to be off to make the stools easier to pass, but maybe I'm wrong??? 

i stayed on imodium as i was told it slowed down the transit time in my gut and minimize frequency.   slowing down might have also thickened the stool, but when i went off it there wasn't much difference.   try it both ways and see what works for you.  keep at it as this is a situation that if you don't do something it will get worse, and then you are left with surgery, which is not a good option.  janet