What this experience covers
This experience addresses the situation of a chronic fissure that is not healing despite treatment — what might be contributing, what options exist, and how to think about the decision to escalate. It is a composite drawn from many anonymised accounts.
The pattern
When treatment is not working
People describe reaching a point where they have been doing everything right — creams, diet, sitz baths, stool management — and the fissure is still there. This is not unusual with chronic fissures, and it does not mean they have done anything wrong.
Common reasons a fissure does not heal
- Sphincter spasm: The internal sphincter pressure is too high for topical treatment alone to overcome
- Ongoing re-injury: Hard stools, straining, or inconsistent self-care continuing to re-tear the fissure
- Chronicity: The fissure has developed features (depth, fibrosis, sentinel pile) that resist conservative treatment
- Underlying conditions: Rarely, conditions like Crohn’s disease can prevent healing
- The specific fissure: Some fissures are simply more resistant than others for reasons that are not always clear
The decision to escalate
People describe the decision to move from conservative to more aggressive treatment as significant:
- Acknowledging that creams have had a fair trial
- Having an honest conversation with a clinician about next steps
- Weighing the options — botox, fissurectomy, LIS
- Managing the anxiety that accompanies surgical decisions
The common next steps
- Switching topical treatment: From GTN to diltiazem or vice versa
- Botox injection: A middle ground between creams and surgery
- Fissurectomy: Removing the chronic fissure tissue, often with botox
- LIS surgery: Cutting part of the sphincter to reduce pressure permanently
Each step has its own timeline, risks, and benefits. Your clinician can discuss which is most appropriate for your specific situation.
What people wish they had known
- That some fissures genuinely need more than conservative treatment — this is not a failure
- That escalating treatment sooner, rather than suffering through months of ineffective treatment, is reasonable
- That each treatment step provides useful information even if it does not work
- That asking “what else can we try?” is always appropriate
Everyone’s situation is different. If you want to talk through yours in a private, judgement-free space, our chat is here.
When to contact your doctor
Seek medical attention if you experience:
- No improvement after 4 to 6 weeks of consistent treatment
- Symptoms that are worsening
- Heavy or persistent bleeding
- Pain that is significantly affecting your quality of life
- A desire to discuss treatment escalation