Anal Fizzures have plagued me since I had a serious injury 7 years ago. Because of a concussion I started taking Ginko Biloba to keep my brain active and alert, but the side affects are the breakdown of tissue and leaves them subject to tearing.

Ever since, whenever I eat tortilla chips or any corn product(one of my favorite foods) it is so painful I can barely stand it and unfortunately it doesnt heal for weeks. So of course I have to meticulously inspect every menu when I eat at a restaurant.

The only thing that seems to work is hydrocortizone cream with aloe and ibuprofen for pain which only half helps. I went to see a specialist about it(a surgeon of course) and she suggested surgury. But Ive known women who have this surgury and it only makes it worse and they are in agony.

Please, if anyone has anything at all to share to help ease the pain or some relief, I would love to know because it has altered so many plans in my life and really dulls the quality of my life. This evening I had to stay home from a wonderful concert because of it and probably will the whole weekend. It's excruciating.


Thanks in advance!

when you say surgery there's different operations not just one. the operation that would probably be recommended is lateral sphincterotomy. depneding on what treatment you've already had botulinum toxin into the sphincter may also be a possibility

My 7yo daughter has this ALL the time. She suffers from chronic constipation.
I give her mineral oil in chocolate pudding so the stool is loosened up and doesn't hurt her even with the fissures.
You can do it daily (1 tbsp) mineral oil + 1 tbsp pudding, mix & eat. Adjust it to your liking and reduce or increase oil until it is comfortable.
You know you have too much mineral oil when orange oil comes out. (EWWW,gross I know) But it is easy and simple.

mineral oil as a laxative causes a form of lung disease caused lipoid pneumonitis

SAY WHAT? Please enlighten me on the site or book you got this from. I am interested in reading about this, thanks.

edited to add:
I have tried to look this up and I only find that if you aspirate the oil you could get this.

Pediatricians recommend this for children with chronic constipation. My daughter (7yo now) has been doing this since she has been a baby. I know many others who have their children on Mineral Oil Therapy.

[This message has been edited by Want 2 B Well (edited 10-26-2003).]

[This message has been edited by Want 2 B Well (edited 10-26-2003).]

yes, but aspiration of minute droplets of oil is very common so the use of mineral oil has been abandoned in many countries. add in malabsorption of fat-soluble vitamins and incontinence and it doesn't sound good compared with other laxatives

I suppose there is that risk. Unfortutately it works for chronic constipation.

but so do lots of other safer laxatives

Nikkir- I know how painful this condition is. Was the specialist a gastroenterologist? That's the kind of doctor I would go to. (They are all surgeons, but are trained to deal with anal disorders from polyps to hemorrhoids to fissures etc.)

Topical cortisone applied too often or over time can break down tissue even more (it thins the skin), so if you are using over-the counter stuff, (or have been usuing it a long time) I would stop immediately. I suffered from excema on my hands and a big muckity- muck fancy Beverly Hills dermatologist prescribed steroid ointments and insisted I continue using them for TOO LONG, and I got worse.Because the skin was thinning, my hands started to fissure and crack and bleed and then subsequently became open to all kinds of infection to the point where I was hypersensitive to everything that was given to put on them.

Whenever a doctor recommends surgery always get a second opinion from someone not affiliated in any way with the first doctor. If doctor #1 wasn't a gastro person, it would be wise to find one.

Some of the treatments for anal fissures are:
* Stool softeners
* Dietary adjustment (addition of bulk -- substances that absorb water while in the intestinal tract)
* Cleansing more gently
* Petroleum jelly
* Sitz bath
* Anesthetic ointment, if pain interferes with normal bowel movement
* Topical muscle relaxants


These measures generally heal more than 90% of anal fisssures.

A previous poster mentioned BOTOX injection into the anal sphincter, which temporarily paralyzes the anal sphincter muscle and promotes healing. Another option for nonhealing fissures is the surgicial procedure to relax the sphincter.
In your case, it appears that the fissures have become chronic....If all the above measures haven't helped,(or haven't been tried yet) definitely get a second opinion about other treatment options before you consider surgery. There are always risks related to any surgical procedure, but this surgery can be very successful.

zuzu xx

[This message has been edited by zuzu8 (edited 10-27-2003).]

gastroenterologists are physicians not surgeons

What are the safer laxatives that you can use for a child for a chronic condition?

a warm spoon works well so does prune juice and walmart brand stool softner, those are a few of my favorite laxatives.

Hello Nikkir
This answer is a bit long because I had to copy it all out of an older book. They all seemed like great ideas.
So here goes....... http://www.healthboards.com/ubb/idea.gif

Soothing Solutions
The similarities between anal fissures and hemorrhoids are largely superficial. Hemorrhoids are generally swollen veins. In contrast, fissures are ulcers, or breaks in the skin, which just happen to occur in the same general area.

Fissures are very much like those painful tears that sometimes develop in the corners of your mouth, says J. Byron Gathright, Jr., M.D., chairman of the Department of Colon and Rectal Surgery at the Ochsner Clinic in New Orleans, Louisiana, and an associate professor of surgery at Tulane University. Both the oral and anal variety occur where skin meets delicate mucous membrane. In the anus, a common cause of such tears is the passing of a large, hard stool, says Dr. Gathright.

If you have fissures, you know that these little sores can make your life—or at least your sitting life—miserable. They burn, they sting, they often bleed. Below, the experts tell you how to get to the bottom of the problem as quickly as possible.

Ban hard stools with fiber and fluid. The anal opening was never meant to accommodate large, hard stools. Generally a by-product of a Western diet lacking in fiber, rock-hard stools tug and tear at the anal canal, which can result in anal fissures as well as hemorrhoids.

The solution? Adapt yourself to a diet high in fiber and fluids that will produce soft bowel movements. Eating more fruit, vegetables, and whole grains, and drinking six to eight glasses of water a day is "the best remedy and preventive measure," you can use for anal fissures, says Dr. Gathright. Once your stool is soft and pliable, your anal fissures should begin to heal on their own.

Try the petroleum solution. Eating more fiber will soften your stool, but you can also protect your anal canal by lubricating it before each bowel movement. A gob of petroleum jelly inserted about 1/2 inch into the rectum may help the stool pass without causing any further damage, says Edmund Leff, M.D., a proctologist in private practice in Phoenix and Scottsdale, Arizona.

Buff yourself with talcum. Following each shower or bowel movement, brush yourself with baby powder. This will help keep the area dry, which can help to reduce friction throughout the day, says Marvin Schuster, M.D., chief of the Department of Digestive Diseases at Francis Scott Key Medical Center in Baltimore, Maryland, and a professor of medicine and psychiatry at Johns Hopkins University School of Medicine.

Watch out for diarrhea. It may seem odd, but not only can hard, constipated stools worsen anal fissures—so too can diarrhea. Watery stools can soften the tissues around them, and they also contain acid that can burn the raw anal area and give you a form of "diaper rash" to add additional misery to your condition, says Dr. Schuster.

Keep your nails away. Anal fissures may make you want to scratch. Fight the urge. Running sharp fingernails over your tender anus can tear at the already sore tissue, says Dr. Lawder.

Shed those excess pounds. The more weight you carry, the more you're likely to sweat. Perspiration between the cheeks of your rump will only slow your fissures' healing, says Dr. Lawder.

Use a little dab. Nonprescription topical creams containing hydrocortisone can be very helpful in reducing the inflammation that often comes with anal fissures, says Dr. Gathright.

Try a vitamin cream. Particularly helpful for soothing pain and helping to heal fissures are those nonprescription ointments available at the drugstore containing vitamins A and D, says Dr. Schuster.

Jump into a hot tub. Whether you fill your bathtub with hot water or slip into an outdoor hot tub, warm water will help to relax the muscles of the anal sphincter and so reduce much of the discomfort of fissures, says Dr. Leff.

Steer clear of certain foods. While no food will cause fissures, some foods may provide excess irritation and discomfort to the anal canal as they pass through the bowels. Beware of hot, spicy foods and pickled foods, says Dr. Schuster.

:nono: (bassie)

Wipe yourself oh-so-gently. Rough toilet paper and overzealous wiping will impede healing of your fissures. So wipe gently and don't skimp when picking a brand of toilet paper. Be particularly choosy when it comes to color (you want only white) and scent (you don't want one). Perfumes and colorings can provide irritation to the already irritated area, says John O. Lawder, M.D., a family practitioner in Torrance, California, specializing in nutrition and preventive medicine. Dampen each wad of paper under the faucet before wiping to remove most of the scratchiness, says Dr. Lawder.

Treat yourself to the best. The Rolls Royce of toilet paper isn't a toilet paper at all. Facial tissues coated with moisturizing lotion offer the least amount of friction to your fissure-plagued bottom, says Dr. Lawder.
----------------------------------------------
Warning
Fissures are generally not dangerous. "The real caution with fissures is not to put them off forever—an ulcer that doesn't heal may be a cancer," says Lewis R. Townsend, M.D., a clinical instructor of obstetrics and gynecology at Georgetown University Hospital in Washington, D.C.

"If you have fissures that don't heal within four to eight weeks, go get them evaluated," says Dr. Townsend. "Remember that a sore that will not heal is one of the seven classic warning signs of cancer."

In addition, if you notice a mucous discharge from your anus, have it checked out by a doctor. "Abscesses can be very serious in that area," says John O. Lawder, M.D.
----------------------------------------------------

Hope you get better :-)

Hi zuzu8

I realize I overlapped a lot of your post. Didn't mean to. Was too busy typing. http://www.healthboards.com/ubb/redface.gif

DJ- You're right, gastroenterologists are internists who specialize in diseases of the digestive tract. Nowadays, the prerequisite training includes a medical internship and residency in internal medicine.
However, many devote extra years of separate training in areas of subspecialization (liver, gallbladder etc.) and become surgeons .

In Nikkir's case, I believe a gastroenterologist would normally be equipped to perform the procedure required to relax the anal sphincter.

Hi BASSIE- Your post was great...doesn't matter if we overlapped!

zuzu xx



[This message has been edited by zuzu8 (edited 10-28-2003).]

I don't know any gastroenterologists who are also gastrointestinal surgeons

Originally posted by savysac:
a warm spoon works well so does prune juice and walmart brand stool softner, those are a few of my favorite laxatives.

I would take it in a heartbeat, but my 7yo daughter who is already a picky eater (hence the orignal problem) will not.
I am open to suggestions. She has had MEGACOLON since she has been 1. That is 6 years of this crap. (ha-ha)
I need a therapy (drug or laxative) for a child that will last for a year. It may take that long for her colon to shrink back to size.

She always has anal fissures. Blood in her stool is always.

The peds say mineral oil because it does the job w/o any side effects.

Her diet is the problem. How do you fight that?

there is no drug available without side-effects

Originally posted by DJblod:
there is no drug available without side-effects

Well I have to choose something.

well yes (?) but there are laxatives with a much better safety profile than mineral oil. its not used in many countries

this extract is from the British National Formulary:

Cautions: CSM recommends avoid prolonged use, and has
contra-indicated in children less than 3 years of age

Side-effects: anal seepage of paraffin and consequent anal irritation after prolonged use, granulomatous reactions caused by absorption of small quantities of liquid paraffin (especially from the emulsion), lipoid pneumonia, and interference with the absorption of fat-soluble vitamins

Hi DJBLOD- I'm a little confused about your statement tthat you don't know any gastroenterologists who are surgeons.

My own gastroenterologist, whom I have been seeing for years for IBS and who just performed a routine colonoscopy on me, (James H. Sherman @ Cedars Sinai in Los Angeles) not only does routine diagnostics but also colon and rectal surgery.

 Yale University School of Medicine and Memorial Sloane-Kettering in NY has a host of physicians whose specialities are gastrointestinal surgery, many of whom were originally and still are gastroenterologists.

My sister's had a gastroenterologist whose speciality was "surgical gastroenterology".... Among other things, he performed surgical therapy - For example, laparoscopic myotomy for alleviating the symptoms of achelasia. Although minimally invasive, wouldn't this be considered surgery?

What about all the gastroenterologists who do bariatric surgery for morbid obesity or laparoscopic repair of abdominal wall hernias , carcinoid tumors, pancreatitis and neuroendocrine tumors of the pancreas, and peptic ulcer disease ?

zuzu xxx

Originally posted by DJblod:
well yes (?) but there are laxatives with a much better safety profile than mineral oil. its not used in many countries


Like what?

to zuzu8, what's confused you? I don't know any gastroenterologists who are GI surgeons. surgical gastroenterology = GI surgeon. gastroenterologist = physician. surgeons operate. there's no such thing as a (good) part-time surgeon. surgical training takes years

looking at the Yale University site all the biographies I accessed re GI surgeons showed none of them were board certified or trained in internal medicine/gastroenterology
I'm confused

Hi there,

What a lengthy responses you have gotten. I skimmed through them to make sure that what I say will not be a repeat. If it is I'm sorry.

I am 33 years old and have suffered from Crohn's disease since I have been 13 years old. I have been having a problem for the last 2 years without any relief. Having this disease so long I know just about everything about it. Anal fissures are very, I mean very common with Crohn's disease. I don't have them myself.

You also said that you can't eat corn, I have a very hard time with it too. I have a Gastroentronologist, which is a specialist for esophogus (sp) to anus problems. By the way Crohn's disease can affect from the esophogus(sp) to anus. Not to be gross. Sorry.

actually lips to anus

zuzu8 a minimal access myotomy for achalasia would not be laparoscopic!

Hi DJ- I often see the phrase "laparoscopic myotomy" for achelasia. Including something called Heller laparascopic myotomy". So now I'm confused even more.

Why is the word "laparoscopic" used so frequently then?


I thought the laparoscopic approach was introduced not long ago.... and that  studies have shown less pain, earlier return to normal activities and earlier return to work than when an open procedure is done.

Take a look at this link....tell me what you think:
http://www.laparoscopy.net/acha/acha9.htm


zuzu


[This message has been edited by zuzu8 (edited 10-30-2003).]

. there's no such thing as a (good) part-time surgeon. surgical training takes years[/B][/QUOTE]

DJ- Another query for you...Are you saying then that (for instance) an ENT specialist cannot be a "good" surgeon? They see patients every day in their offices and yet also perform surgery.

Originally posted by DJblod:
to zuzu8, what's confused you? I don't know any gastroenterologists who are GI surgeons. surgical gastroenterology = GI surgeon. gastroenterologist = physician. surgeons operate. there's no such thing as a (good) part-time surgeon. surgical training takes years

There's some pretty good surgeons around here who are also in general practice. They have done their training and combine the two.

I was constipated real bad once that I felt an awful pain down there going to the bathroom. Lots of bright blood came out. I was in so much pain for weeks. I got even more constipated, because of the pain. I also couldn't really sit, I had to sit by laying on my side.
I drank metamucil twice a day to help me.
I decided to go to a gastroentologist, found out I had a anal fissure about an inch long, that looked like it was starting to heal, according to the doctor.
I guess using medamucil everyday, putting bag balm on the area, and using a little donut pillow to sit on was helping it heal. And drinking LOTS of water.
The doctor told me to sit in a warm bath for 20-30 min. once or twice a day, spreading my cheeks a bit to help the healing process. And use baby wipes with no scent or alcohol for wiping. It all helped. It's completely healed. It took a month or two, but it works if you dedicate yourself to it.

to zuzu8 and bassie, have either of you had any training in gastroenterology or surgery? if not, how much can you know about the training?

G'Day DJblod

Ahhh you would be surprised what some people can know :D

DJBLOD- No...haven't been trained in either. You presumably have(?)

So I would love your input on the link I posted earlier and my previous questions about laparascopic myotomy.

Also, I don't think one can generalize about physicians being strictly physicians and surgeons= surgery.

My gynecologist is a surgeon.
My ENT physician is a head and neck surgeon. Most otolaryngologists are specialists trained in the diagnosis and treatment of traditional ENT problems, but also are trained to deal surgically with problems of the entire head and neck region, including trauma, tumors, infections, congenital abnormalities, etc.

zuzu xxx

I just happened to be browsing around and saw this thread. I had to take Iron supplements for the year following my Gastric Bypass Surgery (lost 236 pounds!). A BAD side effect of Iron supplements is severe constipation. I think the problem started out as a fissure but eventually grew into a full-blown internal rectal tear. I did the same things mentioned in all the other posts - sitz baths, cortizone foam, stool softener.... for over a YEAR I lived with horrible pain with every bowel movement. One morning, after going to the bathroom, it hurt so bad that I could not walk. All I could do was cry. I was taken to the ER and put on a Moraphine drip! I had surgery the next day. It was day surgery and within a week or so I was all better. I have not had a problem since and it has been almost a year now. Afterwards, I could not believe that I had just lived with the pain for so long because I was too embarassed to have the surgery. Now, surgery is certainly not the best choice for everyone. Mine was obviously a very severe situation. But, just wanted to add my two cents worth that at least for me, the surgery was the best thing ever!

AV

DJBLOD- No...haven't been trained in either. You presumably have(?)

So I would love your input on the link I posted earlier and my previous questions about laparascopic myotomy.

Also, I don't think one can generalize about physicians being strictly physicians and surgeons= surgery.

My gynecologist is a surgeon.
My ENT physician is a head and neck surgeon. Most otolaryngologists are specialists trained in the diagnosis and treatment of traditional ENT problems, but also are trained to deal surgically with problems of the entire head and neck region, including trauma, tumors, infections, congenital abnormalities, etc.

zuzu xxx

zuzu8, I think what DJblod means by surgeon is a specialist in surgery - that is a gynaecologist does some gynaecological surgery but isn't a general surgeon. all surgical specialties do clinics - that is obvious! all patients need diagnosis and follow-up as well as cutting