What this experience covers
This experience follows the journey from starting GTN (glyceryl trinitrate) treatment for a chronic anal fissure through to the decision to have lateral internal sphincterotomy (LIS) surgery. It is a composite drawn from many anonymised accounts and represents common patterns, not any single person’s story.
For many people, GTN is the first prescribed treatment they try. When it does not fully resolve the fissure, the path to surgery involves a particular kind of emotional reckoning — accepting that conservative treatment was not enough, managing the side effects along the way, and finding the resolve to take the surgical step.
The pattern
Starting GTN: hope and headaches
People describe starting GTN with cautious optimism. After weeks or months of pain, having a prescription feels like progress. The reality of using it, however, is often harder than expected.
The headaches are the most commonly discussed side effect. People describe them as ranging from mild and manageable to debilitating — the kind that makes you question whether the treatment is worth the side effect. Some people adjust to the headaches over time. Others find them relentless.
Beyond the headaches, people describe the daily routine of application as its own challenge. The awkwardness, the timing around bowel movements, the waiting to see if today’s application will finally be the one that turns things around.
The middle weeks: uncertainty
Weeks three through eight are where the emotional landscape gets most difficult. Some people notice partial improvement — less pain during bowel movements, shorter episodes of burning afterwards. But partial improvement raises its own question: is this enough?
Others notice no improvement at all, which is demoralising after enduring the side effects. The temptation to stop treatment early is strong, but most are told to complete the full course before making any decisions.
People describe this period as a kind of limbo — too early to give up, too late to feel genuinely hopeful.
The turning point
For those who ultimately move to surgery, there is usually a specific moment or accumulation of moments where the decision crystallises. Common descriptions include:
- Realising the fissure has not healed despite weeks of consistent treatment
- The side effects becoming harder to tolerate than the original condition
- A follow-up appointment where the surgeon confirms the fissure is still present
- A particularly bad day that tips the balance from “maybe I should wait longer” to “I need this resolved”
The decision to have surgery is rarely sudden. It builds over weeks of weighing discomfort against risk, convenience against resolution.
The relief of deciding
People consistently describe an unexpected emotion once the surgery date is set: relief. Not about the surgery itself — that still carries anxiety — but about having a plan. The open-ended uncertainty of “will this cream work?” is replaced by a concrete next step with a date and a timeline.
This relief does not eliminate the pre-surgery nerves, but it provides a framework that the weeks of topical treatment could not.
What people wish they had known
- That GTN headaches are real and significant — not a minor inconvenience
- That partial improvement is common and does not always mean the fissure will fully heal
- That needing surgery is not a failure — it means the fissure required more than conservative treatment could offer
- That the emotional toll of weeks of treatment uncertainty is legitimate and worth acknowledging
If something about your treatment journey does not feel right, or you just want reassurance about what is normal, our chat can help you think it through.
When to contact your doctor
Seek medical attention if you experience:
- Heavy or persistent bleeding that does not settle
- Severe pain that is getting worse rather than better
- Fever or signs of infection
- Symptoms that have not improved after 4 to 6 weeks of self-care