Hi, TJ, I've been dealing with fissures for a while now.
What I call the "acute" ones are the ones that feel like a razor blade is cutting you--with that kind, stool softeners and numbing medication is about all you can do, and hope it heals up.
Right now, I have a "chronic" fissure, have had it for over a year. I never had the "razor blade" pain with this one, it was different. While going to the bathroom doesn't hurt, I develop a terrible ache 20-60 minutes afterward. I think it's the muscle spasming. Immodium helps the ache sometimes; tylenol or ibuprofen always ease the pain.
I had a visit with a colorectal specialist about this several months ago. He suggested surgery, but I didn't want to do that until trying a nonsurgical approach. He gave me some diltiazem ointment to apply topically, to help get the blood flowing to the fissure site to promote healing. Dr. said that the longer you have these, the harder they are to cure without surgery.
I learned there are two things they hope to accomplish with the surgery: cut out the fissured tissue itself so the fissure can heal cleanly, and/or they cut the rectal sphincter to ease or eliminate the spasming.
HTH! 
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Re: anal fissures
