have anal fissures and need help

olliedoll · 02-01-2007, 12:29 AM

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.

ericollin · 02-01-2007, 02:13 AM

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

olliedoll · 02-02-2007, 01:54 PM

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.

ericollin · 02-02-2007, 05:27 PM

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.

purpleladyfish · 02-02-2007, 05:55 PM

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.