Chronic prolapsed hemorrhoid with fissure - can this heal or am I surgical candidate?
Hi, I'm new to this board and am experiencing a painful anal fissure for the first time, and I wanted to know if anyone else has experienced this on top of a prolapsing internal hemorrhoid (stage 3). The tear is on a prolapsing hemorrhoid that comes out with each bowel movement, so I can plainly see the open wound. I am concerned it will never be able to heal because I have to constantly exert pressure on it to push the internal hemorrhoid back in. I worry I may be making the fissure even larger (my primary care doctor examined me and said it was about 3 mm in length). Over the past 3 days, even though my stools have become softer and more regular (taking citrucel), the hemorrhoids are getting harder to push back in, and the longer it takes, the more swollen they get. Has anyone had a wound heal on a prolapsing hemorrhoid before, or does this require surgical intervention to stop the blood supply?
Some brief history - I haven't had a bowel movement without this hemorrhoid prolapsing since this started for me 12 years ago (I'm 28 now), so it's unlikely that I can really "cure" the internal hemorrhoid first and have it shrink first. Even though they seem to shrink in between BMs while inside, the hemorrhoids swell up immediately every time I go and pop out, even if I have soft stools. I am in the process of getting a new patient appt with a colorectal surgeon to find out my options and to also get treated more regularly, but I think it might be another week before I can see a specialist.
Thanks in advance for listening. I really thought I had this under control and could avoid surgery, but I had no idea it could get worse like this with the tear, so, I am definitely reading the other threads and taking the advice about fiber and diet now!
Re: Chronic prolapsed hemorrhoid with fissure - can this heal or am I surgical candid
Just an update in case this helps anyone... I found a colorectal health center and they had a last minute cancellation, so I saw the specialist today. She did say my internal hemorrhoid was unique in that due to the duration of being prolapsed so long, I've grown tissue around it, which is where the fissure is, so, it couldn't be banded. However, she said we could try reducing the amount of tissue prolapsing, which was the only way to truly shrink by banding higher up where the hemorrhoid starts. Over the past two days, it's been becoming extremely difficult to re-insert, so I'll take what I can get. I now need to lie on my side in bed whereas before I was able to do it in the bathroom standing up, so I'm afraid I won't have any more options other than surgery if this intermediate banding doesn't get it back under control.
She used the O'Regan system, so it was quick and I felt just discomfort from pressure. It was just aggravating for me because I couldn't really distinguish the pressure between wanting to pass gas vs. the urge to have a bowel movement, which I am trying to keep at a minimal of once a day due to the fissure. However, I didn't fully evacuate this morning, so I did go a second time just 3 hours after the banding, but it wasn't any worse than what I've been dealing with. Overall, general pain is similar to menstrual cramps and seems to respond to ibuprofen well. I was told not to sit longer than 2-3 hours, so I've been doing some light walking, standing, and lying on my side.
We'll have to see if this improves, but, lesson learned, go see a CRS (colorectal surgeon) as soon as possible to know your options (I thought surgery was the only one - didn't know about banding until this board!). My primary care doctor had indicated to me that mine were small, but, I think she was only comparing to severe cases that required emergency surgery, and I had put off seeing a specialist until now when the fissure started (which was probably caused from all the irritation of being re-inserted constantly).
Yokel - how are things for you now? Have you been living with the prolapsed hemorrhoids, or did you finally find a procedure that gave you relief?
I've also had the grade 3 internal hemorrhoid that I've been dealing with for almost 10 years. Started off pretty mild, just needed some gently pushing, but now, it has grown so large over the years it grew some tissue over it, and now, I have developed a fissure right on it near the bottom last week. I thought things couldn't get worse, but, all the constant pressure and irritation seems to have come down to this, and an open wound on such a tender spot is pretty painful, which I unfortunately have to put direct pressure on to push the hemorrhoid back in after a bowel movement while it's trying to heal.
I saw a CRS yesterday, and she said she could only try rubber banding the top part of where the hemorrhoid starts so that there will be less tissue prolapsing each time, and then go from there to see what my options are (which may be nothing but surgery). So, she did apply one band, and I just felt discomfort from the pressure and some mild cramping. Today I don't feel anything (I hope it didn't fall off preemptively), but my fissure seems to be giving me more pain today, and it wasn't any easier to push my hemorrhoid back in today than previous days.
So, if anyone is still living with these prolapsed internal hemorrhoids, apparently it can get worse if you develop a fissure right on it. In hindsight, I see now there are things I could have been better prepared and possibly prevented the wound on the prolapsed hemorrhoid, such as take the fiber diet more seriously (I was a bit constipated and not eating enough veggies right before the inflammation happened), use a daily fiber supplement, use tucks wipes to clean more thoroughly, and use more lubrication (such as vaseline) when pushing back up. Sometimes if I walked too long, my hemorrhoid would come out on its own, and sometimes I couldn't always find a restroom and put it back in right away, and they would only get larger... Well, lesson learned, my doctor explained that the internal hemorrhoids can never truly shrink - so once stretched out, they will only get bigger. So, make sure you can push back in, and I've found that the prep h suppositories helped keep it from coming back out (it probably just pushed them higher up the canal rather than truly shrinking them).
I have no experience with the fissure but as far as the hemmerhoids are concerned, go get the surgery! Do it now, and your recovery will be over that much sooner.
I had 3 large external and 3 very large internal hemmi's and I tried everything to avoid the surgery. Infrared, banding, stapled hemmerhoidectomy ... all were just a waste of time for me. I had the surgery a year and a half ago and it was worth every bit of suffering for that week or two of recovery!!
I have no idea how you can use suppositories or vaseline and get your hemmi's to stay in. Any sort of lubricant like that and mine would pop right back out again. Miserable!! I lived that way for 5 years or so, very painful.
Recovery from the surgery is bad, can't sugar coat that... life after the surgery is 1000% better! Totally worth it!
Thanks Excavator. That's reassuring to hear you have had positive results from your surgery. Did you end up changing your diet (e.g. fiber supplements) after the surgery? You did the stapled procedure before doing the full hemorrhoidectomy? Was the post-op pain and recovery for the full surgery about the same as the stapled surgery?
I think my underlying cause is my digestive system (IBS-like symptoms), and I've only started taking Citrucel daily, so, I'd hate to have surgery and trigger the hemorrhoids to come back. Before I did have some issues keeping my hemorrhoids in before, but I think due to the fissure, it creates spasms that keep them in there (and making them so hard to put back in).
I don't want to scare you off from considering the surgery but the stapled procedure was little or no pain at all. If you get the real hemerrhoidectomy, be prepared for a couple weeks of painful recovery (scroll back through this thread for some graphic descriptions from myself and others who have gone through it). It is also a very good fix for this problem so, pain or not, I'm convinced it was totally worth it.
I did not change my diet, I've always eaten healthy.
Re: Chronic prolapsed hemorrhoid with fissure - can this heal or am I surgical candid
I'm suffering so much from my hemorrhoids. It's so painful when I have to go. at the end of this month my G.I. is doing the banding because I can't take it much longer. Please keep us posted on your progress. I'm glad you don't feel much. My doctor told me I will not be put under that it is a quick procedure.
Re: Chronic prolapsed hemorrhoid with fissure - can this heal or am I surgical candid
Well, here's an update! I'm a bit amazed how much rubber banding has helped treat internally. However, I could not entirely avoid the scalpel. In addition, my doctor had said she would have wanted the fissure to heal first before cutting to make sure it wouldn't turn into a chronic fissure (not sure why that is - both are cuts, right?).
After doing 2 internal bandings on the same hemorrhoid, the fissure FINALLY healed, and it got easier to push back inside. This happened around 7/7, a full 4 weeks after it first appeared. It was hard though because my hemorrhoid was so large, I had spasms and constant throbbing during the healing process. My doctor gave me valium to help relax the muscle and it did ease the spasms, and I only had to use it for a few days.
Then I did my 3rd banding on 7/12, and my hemorrhoid had changed shape. My doctor said it looked so small internally, so she asked me to push just a little like I was having a bowel movement so that it could come out. Then, she banded about half of it that came out, and then pushed it back inside. Man, that was pretty tender, and this time the constant throbbing and spasming was pretty intense that I couldn't sleep at all the first night even with valium. It became more controllable with ibuprofen, but then I had to go on a 4 hour flight 4 days later, and that was quite uncomfortable and needed valium during that time too. By day 5 I noticed some bright blood with a BM - the band had fallen off. Then day 10, everything got so much easier and shrank.. But then I felt my hemorrhoid prolapse, and I kept trying to push it back in, but it was so "small" that it kept falling out, even when I was lying down. Due to my past experience, whenever it was out, it had swelled up to be even larger, so I was pretty desperate to keep it inside but couldn't. It soon sort of shrank and became more deflated but excess tissue that kept hanging outside, but, it no longer irritated me while it was out and I could be active and still run and exercise.
Then on 7/30, I had my follow-up appt since I complained about it. My doctor said all was left now was a skin tag of my hemorrhoid, and that if we banded it, it would probably still fall out and be very painful because it had grown all this tissue over the years I've had it (~12 years). So she recommended to just do a minor surgical procedure in-office with local numbing agents where she would just cut it out, and leave it to heal as an open wound since in her opinions stitches always come apart and be more painful with BMs. She said I could try and live with it, but, since she was going on vacation in the next few weeks, and work right now for me is relatively slow, I decided to go ahead and do the excision so I can heal and be over with it since the skin tag still swelled sometimes and I wouldn't be surprised if it got worse over time. Overall she said it's a lot less painful than a hemorrhoidectomy since we treated everything internally with banding, and, there was nothing left to band for her. Pretty surprising how it exponentially shrank near the end!
So, on 7/31 Tuesday, I went in, and the assistant there kept saying it's minor, don't worry. However, I knew this skin tag was sort of big (1 inch long, half inch wide), but I had prepped myself with TacomaGuy's recovery guide materials, even though my ordeal was not going to be as severe. Actual procedure took about 20 minutes where she used a numbing ointment first and then shot me up with some lidocaine shots. I was afraid of those hurting, but, everything was more like small pinches and very short spurts of pain. I ended up bleeding a lot more than the assistant was used to seeing because after my doctor cut into the skin tag, she saw that there was blood pulsating through since the tissue was so old - apparently most skin tags don't have this issue. She also had to cut partly internally to get all of it out, but told me most of my wound was external. She then cauterized my wound electronically, and I got all wrapped up. I felt pretty tender but thought that was the end of it.
So, apologies if this gets too graphic, but, it's a learning experience, right? I decided to hang around the office for another 30 minutes, getting my prescriptions and waiting for my husband to pick me up. And then, I had to start passing some gas, and each time I did, spurts of blood came rushing out. So, I asked the assistant again if this was normal, and then finally, after I passed gas for the third time, it ran down my leg, and I was like, this is no way normal. By this time, almost an hour had passed since my procedure had ended, and the assistant took me back into the room and kept pressing into my wound to try to stop me from bleeding and had to call the doctor back in. Turned out all that pressure and feeling of wanting to have a bowel movement was solely from all the blood that pooled inside me. I was bleeding from the excision done internally (external was fine), which my doctor said was not bleeding at all when we first did the procedure and never got cauterized. I guess she didn't want to unnecessarily cauterize? By this time I started feeling more faint and light-headed. Unfortunately my doctor couldn't see anything inside me because there was too much blood, and I had to expel it. She first asked me to go to the bathroom and come back, but after trying to sit back upright, I got really dizzy and almost fainted. I drank some water and asked if I could just go into a bowl instead of moving (I guess this is the only downside of doing in-office procedures - less prep?). They had a sitz bath available, and luckily it was enough to catch it all for me to go. It was pretty gruesome - I think I filled up the whole bottom of it. Anyway, my doctor tried cauterizing a few times and then finally got the banding instrument and banded the tissue to make it finally stop bleeding. I felt the familiar internal pressure of the band, but overall, having it banded sort of quickens the healing process for me given my past track records. At this point, my doctor asked for me to stay for another 45 minutes to make sure I didn't pool up with blood again and feel the need to expel. So, I sat and chilled and ate some snacks while they were there, but felt pretty weak. Luckily my husband had arrived by then and kept me company. Everything seemed to be OK by then, so we drove back home.
However, once I got home, I had to expel again, and I felt the similar gushing feeling as before and got worried. By that time I also didn't feel the internal band pressure anymore and was afraid it fell off. I called my doctor, not sure if I should go to the ER to meet her, or back to her office. Finally she said she would wait for me at the office for me to come back (it was around 4:30 pm then), and we arrive 20 minutes later. When I took out my underwear, I saw it had collected a lot of dark red blood, so, luckily that indicated that it was old blood from my previous episode that had collected and ran into my colon when they tilted me in an upward position. My doctor examined me and said the band was still intact but I still had a lot of thin old blood stuck inside. She used a proctoscope to try to drain as much as possible and then applied some silver nitrate to my internal incision as extra insurance. Overall she said she hoped I wouldn't have a BM until the next morning so I wouldn't disturb the band site, and luckily it looked like I had nothing up there since I normally go once a day in the mornings. So, after being prodded again, I was pretty tender and just wanted to go home to take some vicodin.
So here I am on day 4, and overall the pain has been less than feared. I am overall more fatigued than I expected since I think I lost at least a pint of blood, and I am a lightweight person. My first two BMs were very soft and thin (due to Colace), so not that painful, and I just wash off in a bath / small wash basin. However in the mornings I feel pressure and pain from wanting to go, and today I had firmer and thicker stools that throbbed on the way out. I realized I did not take the Milk of Magnesia that my doctor recommended, so, today I started Miralax instead to help keep it soft. I just have to keep some gauze down there to collect constant seepage, but luckily no more crazy episodes of bleeding.
That was a scarier experience than I expected, but lesson learned is if you're not being hospitalized or monitored afterwards, it's worth hanging around the office for about an hour just to test so you don't have to come back far if you suspect something is not normal!
So, banding definitely helped in my situation (we'll see if they reoccur, but I have permanently added Citrucel and flaxseed into my daily diet), but, you may not entirely avoid the scalpel at the end due to pesky residual skin tags. Hopefully your experience will be smooth! Overall, in spite of the wound pain and tenderness I have, I only had to take vicodin twice (1/2 tablets), and am using just ibuprofen 300 mg (I cut the 600 mg in half) every 4-5 hours now, and, it's less incapacitating pain than some of the banding episodes.
Also, now that I am mostly cleared up and don't have a huge hemorrhoid blocking me, BMs are very fast for me now and a huge improvement from the pain before. Keep in mind though I just did one banding at a time - if you do multiple, you may suffer more, but, at least it'll be over sooner instead of being drawn out over the 2 months I've been handling this. Let me know how it goes for you Martha!