Hi there. I think I'm finally getting over one, so I'll share with you the following. Please do not include my name or e-mail address.
My work took me to England 3 years ago for a 2-year stint. As paultry as the American diet's fiber content may be, the British one is worse. After a few months I noticed some pain on defecation and a bit of blood spotting on the toilet paper. But it came and went, so I felt little harm was being done. Also, when I would return to the US for a few weeks at a time the problem would vanish, so I suspected diet to be the cause and that once I moved home my difficulties would cease.
Not so. The pain and bleeding grew more and more bothersome, appearing with every daunting trip to the bathroom. After a couple of months I saw my GP who took a look and merely said that if it kept bothering me to see a proctologist. A few months later I got a new health plan with my work, and so decided to go in for a physical. I took the opportunity to explain my condition, and once again prepared myself for the dreaded anoscope. Diagnosis: proctitis of unknown etiology. He referred me to a proctologic surgeon for an expert opinion (I suppose he rightly knew he was out of his league).
This proctologist cleared the confusion immediately, stating that I had a couple of sizeable fissures and ruling out (through a rather uncomfortable sigmoidoscopy) anything more serious. His treatment was one of high fiber and plenty of fluids. If this didn't work in a couple of months, then he would recommend sugergy (sound of my heart pumping fast and loud in both ears).
After a month of taking two doses per day of Fiber-Con the pain was greatly reduced as was bleeding, though not eliminated. After viewing the Anal Fissures Self-help Page and reading about the nitroglycerin treatment I phoned my doctor. He said I could try some if I like, but that 1/3 of patients get bad headaches. So I went ahead, hoping to be in the majority.
He prescribed a 0.4% nitroglycerin ointment (higher concentration than I saw listed on the Web page), and the first couple of nights I did experience some headaches. They have not shown up in the two weeks since. I believe this stuff has helped greatly, but I can't be sure that it is not simply the continued success of the fiber. In either case, I'm doing much better symptomatically. I cannot be sure that the fissures are actually gone, since I have not been examined. I will probably remain on this high fiber diet for some time; I see no reason for not doing so indefinitely, in fact.
To summarize: use of fiber supplements seems to do great (but give it time!), and nitroglycerin appears to help as well. I probably would have benefitted from using both at the start.
Some further information I got from my doctor concerning surgery: he said that about 1% of patients who get a lateral sphincterotomy cannot control flatus (i.e. embarrass themselves in crowded rooms without warning). He prefers "anoplasty" which I know little about, but I think involves moving some skin from the peri-anal region onto the anus. Since suturing is supposed to do more harm than good, I don't really understand how this procedure works. Perhaps someone can add a few facts?
It's been a few months since my post, and progress has been great.
I haven't had any discomfort or bleeding in two months, and am now off the fiber supplements completely. I have added a great deal of fresh fruit to my diet, however.
There was, I believe, one more important factor in my healing which I should mention: coffee. Soon after abandoning my once-a-day extremely strong and caffeinated cup, my healing sped up. Of course I cannot be certain that this wasn't simply the normal course of recovery, but I think the facts are compelling. First, coffee would often induce a BM. At the same time it functions to constrict your sphinter. Bad combination!
Since shunning coffee (I was a happy consumer for 15 years, and sad to give it up, I might add) I have had essentially no problems. I should also mention that I am much more regular now, even than when I was on fiber supplements with the coffee.
So, at this point I no longer use nitroglycerin ointment or fiber supplements. There is always a bit of trepidation at the trip to the restroom, but now all smiles in the end...