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Old 01-31-2007, 08:29 PM   #1
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have anal fissures and need help

I have been diagnosed with 2 anal fissures. I have had them since July o6. The doctor put me on conventional procedures: laxative, analpram one percent, and 4 sitz baths a day, and fiber. The fissures go and come but never stay away for long. I have recently had back surgery and the fissures are out of control. I called the doctor today and they can't examine me because of the back surgery. He upped my topical cream to anal pram two and a half percent. When I saw him the first time he said if the conventional procedures didn't work I would have to have surgery. Has anyone else been through this and can give me any advice. I am in the most horrible pain. And it doesn't help that I'm only 24 and just a back fusion. Any advice is appreciated.

 
Old 01-31-2007, 10:13 PM   #2
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Re: have anal fissures and need help

Everything I know about fissures (Not in any particular order)

1) see a board-certified colorectal doctor (not a gastro or general surgeon)
2) in every medical field there are good doctors, so-so doctors, and bad doctors. If you don't like what your colorectal doctor has to say to you or how he treats you, find another one!!!
3) your doctor does not need to put his finger in your rear to examine but should be able to assess by simply spreading your butt cheeks apart
4) if doctor insists on attempting to put his/her finger in, find a different doctor
5) chronic fissures (ones that keep returning or don't leave after a
short period of time) need treatment
6) if topical treatment is obtained early, surgery can be avoided,
7) topical treatment of fissures would include nitroglycerin (NTG) .2% (can cause headaches), diltiazem cream (2%), nifedipine and other medications
8) the creams can work, but if your injury is extreme then you may need more drastic measures
9) soaking in a warm bath helps
10) a sitz bath (can be purchased for about $10) is nice for
relaxing, and cleaning after a bm
11) suppositories can increase the pain and sometimes can thin the tissue regardless of type (anusol, prep h, glycerine, etc.)
12) overcoming the fear of having a bm is hard to do
13) watch your diet - add fiber and avoid foods that may bother you upon exit. I avoided the following foods: beef, tomato-based foods, spicy foods, nuts, popcorn (also less in is less out)
14) drink LOTS of water (I drink 90-120 ounces a day)
15) do whatever it takes to soften your stools (I try and consume 25 grams of fiber through foods that I eat and I drink about 8 oz. of prune juice right before bed)
16) get treatment asap, if your fissure hasn't cleared up in about 3-4 months it may get worse & even harder to cure
17) if you are having trouble getting help fast, keep trying, there
is no reason to suffer any longer than necessary - also seek out at least TWO opinions before having any surgery
18) the more intense pain hours after a bm are caused by muscle spasms inside your sphincter
19) there are alternate therapies and treatments that have worked for some people like physical therapy for the pelvic floor, acupuncture, dilation, or hyperbaric oxygen therapy (HBOT) - a lot of these things are NOT covered by insurance
20) use surgery as your final option - LIS surgery (sphincterotomy) works well for most people who get it but it does carry the risk (1% or so) of fecal incontinence and it does permanently cut your internal sphincter & it doesn't cure all people
21) chance of gas incontinence after LIS surgery is about 30%
22) I read somewhere that once a fissure heals it takes 3-4 months for the tissue to regain 40% of its original strength and 2-3 years for the tissue to be back to 80% of its original strength. Have not yet heard if it will ever be back to 100%.
23) fissures are EXTREMELY painful - hang in there you will get better!!!

I know a lot of people say the sphincterotomy is an easy, quick way to heal your fissure but I still don't like the risks that are associated with it. My doctor told me that it appears that I am healing slowly so I will continue to use conservative measures at this point. It is a long process to heal a fissure. Keep things soft and self-moving. Good luck and don't hesitate to ask more questions. Also, read the posts by Purpleladyfish. She has some excellent insight about fissures.
ericollin

Last edited by ericollin; 09-05-2007 at 04:29 PM.

 
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Old 02-02-2007, 09:54 AM   #3
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Re: have anal fissures and need help

Okay can you tell me exactly what a sitz bath is? I thought it mean just sit in a tub for 10 minutes at a time.

 
Old 02-02-2007, 01:27 PM   #4
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Re: have anal fissures and need help

I was confused about the sitz bath thing too in the beginning. There is a sitz bath that you can buy at the store that you can put on your toilet bowl and fill with water and just sit. If you know that you are going to need to do this often, it is easier to do this than to completely unclothe yourself and sit in your actual tub. However, you can just do a sitz bath in your own bathtub filled with warm water not hot.

 
Old 02-02-2007, 01:55 PM   #5
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Re: have anal fissures and need help

olliedoll,

I am sorry to hear you are so miserable. A sitz bath is a special basin that you can purchase in any drug store. It sits right on top of your toilet seat. You can fill it with water and soak without ever having to use the tub to soak in. Excellent for after having bm's as you can jump right on it afterwards. The sitz bath is used to relax the internal muscle that is spasming and causing the pain as well as preventing the tear from healing. I suffered from a chronic anal fissure last year, too. Eventually it got to where my sphincter was in almost constant spasm, excellent clue that your fissure has gone chronic and probably tearing into the muscle tissue provoking the spasms. It's a viscious cycle. I finally had the LIS surgery in August and feel tremendous. Everything ericollin wrote is true. I tried healing mine all the conservative ways. Unfortunately, the fissure would not heal and stay healed. It would start healing and days would be good then it would reopen and start all over again. I went through this cycle for 7 months then decided I could not take it anymore and had the surgery. I'm not telling you to give up what you are doing and have surgery, that is a personal decision that only you can make. Only you can decide when enough is enough. I will tell you this: the longer you have it and the more it begins to heal then reopen, the more likely it is to become chronic and the spasms become more and more frequent. Chronic fissures do not have a good success rate of completely healing and staying healed forever. That is why the LIS surgery is recommended for chronic fissures. There is also Botox, which I was offered, but did not opt for. Botox only temporarily relaxes the sphincter muscle so it cannot spasm. LIS permanently relaxes the muscle. I chose surgery becasue it was a permanent solution to the problem and not temporary. I did not want to take the chance that the sucker would come back some time down the road or possibly getting a new one. Incontinence is a risk, very low but still a risk, of the surgery. I do not suffer from incontinence and everyone that I have spoke with who has had the surgery says the same. The most important thing to remember through all of this is: you must have a good colon/rectal surgeon who is treating you and more importantly if you decide to have the surgery. You definitely want to keep things soft and self moving. Any straining or pushing will retear you. If your fissures have begun to tear into the sphincter muscle, then they probably will not heal without surgery as surgery relaxes that muscle and loosens things up for you down there making it easier to have a bm and not cause a spasm or have pain. This is why people fear the incontinence. Keep up the high fluid intake and remember that anything with caffeine in it does not count toward your fluid intake as caffeine dehydrates you. Take your fiber supplements, sitz baths and whatever else your doctor has you doing. Do beware of the ointments though, like ericollin said, they thin the skin after awhile which you do not want in that area as the skin is quite thin and delicate to begin with. Also watch pain medications (pills) as they dehydrate and will cause constipation. I wish I could offer you more but it sounds like your doctor has you doing everything mine did and my surgeon is rated one of the top in the field here in Florida. In the end, its a personal decision that only you can make. Bright side: if you opt to have the surgery, its a breeze compared to what you are living with now. I can tell you about my surgical experience if it comes to that and you want to know. Also, I have several posts on here already in regards to my experience with the fissure and LIS surgery if you care to read them. Take care and my prayers are with you.

 
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Old 02-04-2007, 09:18 PM   #6
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Angry Re: have anal fissures and need help

I had surgery for an anal fissure and it has been 5 months. It healed all the way to where the doctor left ragged flaps, and so I have a hole that is small but is wreaking havoc. I have a systemic infection, and all the doctor can say is give it two more weeks.

 
Old 08-29-2007, 07:54 PM   #7
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Re: have anal fissures and need help

thank you for all your info. you didn't say what vitamins to take, you are a good person. Good bless you.

 
Old 09-02-2007, 10:30 PM   #8
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Re: have anal fissures and need help

Hello everybody on this board. I am a new victim to this monster. I call it monster, because it appears every morning after a BM and will torture me for 4 to 5 hours and then will disappear completely, giving me the false hope that it will not come back again , but unfortunately, the monster will come back every day after the BM.
What I don't understand is why the pain from this fissure last for so long, and after 4 to 5 hours, its completely gone and I can go back to normal life.Is this the same routine for everybody with this problem.I was wondering if there is a way to train your body to have a BM at night, that way I can sleep during the painfull hours and lead a normal life during the day.Does any one know if an internal hemorhoid can agravate a fissure and make the situation more painfull

will appreciate any reply to the above.
ROMEO1

 
Old 09-05-2007, 04:40 PM   #9
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Re: have anal fissures and need help

Romeo,
I had an active fissure from about Nov. 2006 until July 2007. It was the worst pain that I have ever had in my whole life. I don't wish that pain on my worst enemy. I am now cured. My cure was two-fold. I began seeing a pelvic floor physical therapist and I started seeing a colorectal surgeon who used silver-nitrate to cauterize my fissure. He cauterized it three times: April, May, and June. Also, I just finished up my last visit with my physical therapist. She was a true healer.

I will try and answer your questions. My answers appear in CAPS:

1) What I don't understand is why the pain from this fissure last for so long, and after 4 to 5 hours, its completely gone and I can go back to normal life.
I AM NOT SURE WHY THE PAIN LASTS SO LONG BUT IT WAS THE SAME FOR ME WHEN MY FISSURE WAS AT ITS WORST.

2)Is this the same routine for everybody with this problem.
FROM READING EVERYWHERE ON THE INTERNET AND THROUGH SOME FISSURE SITES IT SEEMS AS MOST PEOPLE HAVE THIS SAME PROBLEM.

3) I was wondering if there is a way to train your body to have a BM at night, that way I can sleep during the painfull hours and lead a normal life during the day.
I ALWAYS WONDERED THE SAME THING AS I THOUGHT IT WOULD BE BETTER TO HAVE THE WORST OF THE PAIN AT NIGHT. I WAS NEVER ABLE TO TRAIN MY BODY TO DO THIS. I DO STILL DRINK 100% PRUNE JUICE ABOUT 30 MINUTES BEFORE BED AND THIS USUALLY DOES THE TRICK FOR ME TO HAVE A BM FIRST THING IN THE MORNING. FYI: PRUNE JUICE TASTES HORRIBLE!!! TRY DRINKING IT WITH A STRAW SO YOU CAN GET IT TO THE BACK OF YOUR MOUTH AND NOT TASTE IT SO MUCH.

4) Does any one know if an internal hemorhoid can agravate a fissure and make the situation more painfull
I AM NOT SURE. HAVING HEMORRHOID SURGERY WAS WHAT GAVE ME A FISSURE SO I AM SURE THAT THEY CAN EACH AGGRAVATE THE OTHER.

Let me know if you have any more questions and I will try and answer them. Hang in there things will get better.


 
Old 09-05-2007, 10:54 PM   #10
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Re: have anal fissures and need help

ericollin,

how did you find a crs who practice silvernitrate procedure? and what is it? please give us a write up of this procedure. I too have AF for over 4 months due to a side effects of hemmorrhoidectomy and i'm trying to opt out LIS by treating it with the convervative treatments.

medical procedures i have in mind are as follows:
* ditiazem and perapamil (2nd gen of ditilazem) - stopped using because of rash
* botox a (next step)
* partial dilation offered by one of my crs (little worry about this)...but very interested in dr. sohn - a popular bumm dr. who practices in NY, NY.
* LIS

I'm in OC, CA....and i don't know who does silvernitrate procedure.

 
Old 09-06-2007, 10:55 PM   #11
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Re: have anal fissures and need help

allsmiley,
I ended up seeing 4 different doctors regarding my bum. I would recommend continuing to visit with different CRS's until you find one that uses it or call the CRS's nurse ahead of time and ask if the doctor would use it to heal a fissure.

It is just a stick that has silver nitrate on it. When you touch it to skin, it basically burns off the top layer of tissue. I had seen it used before when 2 of my 3 kids couldn't seem to heal their umbilical cord wounds. Each time the pediatrician got out a silver nitrate stick thing and touched it to the unhealing tissue by their umbilical cords and it almost looked like it was burning the tissue. They did heal up soon after.

So the 4th doctor I saw (because the first two doctor's sucked and the 3rd one was so hard to get an appointment with), did this treatment on the second visit to him when he didn't see any improvement in my fissure in two weeks. This 4th doctor really considered the fissure that I had as an unhealed wound left over from my hemorrhoidectomy. The other 3 docs called it a fissure.

Anyway, I have to admit that the silver nitrate did not feel great after he used it on me. It didn't feel good for about 2-3 days and then I would feel some lessening of pain overall and much less blood by day 4. The term my CRS used was that the silver nitrate "cauterized" the wound/fissure. I asked if this caused more scar tissue to form and he said that actually it caused you to have less scar tissue overall.

Through another medical site that deals with the topic of fissures, I have heard about Dr. Sohn and the doctor himself even communicates with us fissure-sufferers if we have questions. He seems to be a very caring man/doctor which is hard to come by these days.

I do recommend trying the physical therapy that I have been doing though. I might be able to help you find the names of some PT's in CA that might be able to help you. These PT's do not touch you rectally AT ALL if that is a concern of yours. There are two awesome PT's that work in the San Diego area but I know that is not that close to you. Let me know if you would like me to assist you in finding a name of a PT.

All I know is that I wanted to try any type of measure that might heal me before having the LIS which was such a permanent thing. I mean if you have a spastic shoulder muscle, you don't cut it to release the tension of it. What would you do? You would massage it to release the tissue/muscle. Anyway that is the type of PT that I had done and it had me feeling so much better in just one session. My whole pelvic floor was as tight as a drum. How can a fissure heal in that type of environment??? Just let me know if you want help in finding a PT.

I hope this info helps.
ericollin

 
Old 09-07-2007, 06:08 AM   #12
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Re: have anal fissures and need help

Quote:
Originally Posted by ericollin View Post
allsmiley,
I ended up seeing 4 different doctors regarding my bum. I would recommend continuing to visit with different CRS's until you find one that uses it or call the CRS's nurse ahead of time and ask if the doctor would use it to heal a fissure.

It is just a stick that has silver nitrate on it. When you touch it to skin, it basically burns off the top layer of tissue. I had seen it used before when 2 of my 3 kids couldn't seem to heal their umbilical cord wounds. Each time the pediatrician got out a silver nitrate stick thing and touched it to the unhealing tissue by their umbilical cords and it almost looked like it was burning the tissue. They did heal up soon after.

So the 4th doctor I saw (because the first two doctor's sucked and the 3rd one was so hard to get an appointment with), did this treatment on the second visit to him when he didn't see any improvement in my fissure in two weeks. This 4th doctor really considered the fissure that I had as an unhealed wound left over from my hemorrhoidectomy. The other 3 docs called it a fissure.

Anyway, I have to admit that the silver nitrate did not feel great after he used it on me. It didn't feel good for about 2-3 days and then I would feel some lessening of pain overall and much less blood by day 4. The term my CRS used was that the silver nitrate "cauterized" the wound/fissure. I asked if this caused more scar tissue to form and he said that actually it caused you to have less scar tissue overall.

Through another medical site that deals with the topic of fissures, I have heard about Dr. Sohn and the doctor himself even communicates with us fissure-sufferers if we have questions. He seems to be a very caring man/doctor which is hard to come by these days.

I do recommend trying the physical therapy that I have been doing though. I might be able to help you find the names of some PT's in CA that might be able to help you. These PT's do not touch you rectally AT ALL if that is a concern of yours. There are two awesome PT's that work in the San Diego area but I know that is not that close to you. Let me know if you would like me to assist you in finding a name of a PT.

All I know is that I wanted to try any type of measure that might heal me before having the LIS which was such a permanent thing. I mean if you have a spastic shoulder muscle, you don't cut it to release the tension of it. What would you do? You would massage it to release the tissue/muscle. Anyway that is the type of PT that I had done and it had me feeling so much better in just one session. My whole pelvic floor was as tight as a drum. How can a fissure heal in that type of environment??? Just let me know if you want help in finding a PT.

I hope this info helps.
ericollin
Thank you for this awesome write-up. Right after writting to you yesterday I visited one of crs and she gave me an examination. Her recommendations are as follows:
1. LIS with a little cutting of the the 'dead' tissues to promote healing
2. botox A injection also with cutting the 'dead tissues' to promote healing
3. Baclofen, a muscle relaxant ointment (since i had a good day after a BM I jumped on this option)

I was concerned about developing anal stricture so she 'poked' me and said there definitely tightness but wasn't sure about the diagnoses unless I get put under anaesthetic with some muscle relaxant. (my poo is a the size of a quarter in diameter, so i do not know what the normal poo scale or for everyone. the poo evidently smaller than before the surgery, but i have consistently have BM each AM and too manage to squeeze it through as smaller the size as possible to minimize the bleeding/pain.

I also asked her about silver nitrate, and whether or not i can use concurrently w/ Baclofen, she said it can be used together but silver nitrate is not useful in my situation (not clear with her reasonings). I currently have an unhealed wound/fissure of a Y-shape. At this stage she is convinced that i need LIS. She also mentioned that 10% of peopel who had incontinence with this LIS procedure are women, female who had a weakening sphincter muscle group to begin with due to the pushing related w/ child birth. She never had incontinence happen with this procedure, especially on male patient. I am a healthy male, 40 yr old, non-drinker/smoker, was in a very good healthy before this. A few time, i can even play in a competitive basketball game without pain. i only feel pain after bm/retearing, lasting for 4/5 hr. So what are my chance? i'm clueless.

Where can I look up for a PT? and the ones who have experience in treating people w/ AF? Please help me. Please provide my the PT who are in San Diego. My employer asked me to be on disability so I am now free and willing to seek help. This problem has taking so much the quality of life and my kids and wife suffer as much as I do. Help, help, help.

I feel that I am 95% healed. My pooing habit is good once each AM. The only thing that I struggle to understand is that my poo is a little harder than the rest when it first came out, which caused the fissure to retear. I am taking benefiber 2 tsp, 3x a day, and that is it. Contemplating in taking MOM to help a falling BM but a little concern with side effects of meds. I honestly feel if I can have falling BM for a week this monster will disappear from my @. I am feeling great as I type you this email right now although I haven't had the urge as yet.

Thank you so much in advance.

Last edited by allsmiley; 09-07-2007 at 06:14 AM.

 
Old 09-28-2007, 10:13 PM   #13
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Re: have anal fissures and need help

ericollin,
thank you and everyone for all the information.
I too have been inflicted with this horrible and painful fissure problem.
After 4 month on Lanolin with .02% Nitroglycerin I am no better off.
There is no pattern when I am fine and when it appears and cause excruciating pain. The relieve does not come with the Lanolin.
I am heading back to the doctor next week, although knowledgable, but internist.
I live in a remote area and am willing to go anywhere where there is a trustworthy doctor that can diagnose and treat me properly and relieve me of this curse.
It appears that you have received successfull results and are relieved of this mysery. Would you be willing to share the name of the person/physician that was able to help you?

 
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