Post Hemorrhoidectomy - Now having a fissure, what option to take?

[tmnn123]

i had a harmonic scalpel hemorhoidectomy, 4/23/07, for external hemorhoids. The general surgeon removed 3 tags, a pea size, 2 rice size. I NOW have a fissure at the 6 o'clock or unhealed wound, 1/2 inch deep in from the mouth, and 3 tags/roids- double its original size.

for the last 4 weeks, i've using topical ointment, diltiazem/channel blocker with anamantle, 3 or 4 times a day. I feel it's working but not quickly enough and (I think) anamantle is weakening my tissues (also was told by my general surgeon and some web site) 'cause I tend to bleed more when using that so i think i should stop using.

i've been drinking enough water, at least 64 oz, eating healthy - greens, plus 2 stp flax oil, 2 tsp benefiber, and 2 docusate sodium. my stools are good although a little hard when it first come out, and i don't know how to change that, making them all evenly soft, but i guess that it's normal for everyone. when the stool stay at the colon area the colon absorbs a little bit water, which cause the stool to get a little harder than the rest. I am training to have bm twice a day, AM and PM, which means I have to eat more than I should. other than that I am having Bm consistently on every AM but I still bleed only during bm, and the pain and spasm kicked. The pain subsided after 4/5 hr later.

I am seeing 2 colorectal surgeons and 1 general surgeon, and here are my surgeon's recommendations:
1. physical therapy - anal dilation? no clue what she will do!
2. anal advancement flap - re-cut the tissues and staple/stitch back together
3.cutting the tag to reduce pressure for the fissure to heal (suggested by the general surgeon) - most conservative method

i feel good with these drs but after the fiasco I experienced w/ the surgeon who operated on me i have difficulty trusting any dr again. I am going to do it right this time by doing my own research and ask questions with people who had gone through this ordeal. i learn from this healthboard that many drs do not tell their patients the truth, especially the one who operated on me. My goal is to find the RIGHT ONE to operate on me, but i am clueless on how to accomplish this.

so, here my questions:

1. I live in Orange County, CA, and I notice that there are many ABCRS certified surgeons, but what kind of question should I ask them about their work without offending them?
2. Does any one know a referral in Southern California? I plan to join the local colorectal support group so I can get information from them but this will take time which will delay my plan
3. What should I do w/ the recommendations from my surgeons above?
4. in WATCHOUT's thread - all her dr. did was removed a tag/roid that run deep into her fissure, which caused the fissure from healing
5. Should I have the real thing by having fissurectomy, anal advacement flap, a substitution for LIS, where the dr. will have a small incision into the sphincter muscle helping it to relax? or should I have a full LIS procedure? what i fear is the side effects with the LIS. If I have incontinence my career is over!!!!!
6. Should I take the most conservative approach first such as recom #3

Every morning before having a bm I am pain free and didn't even know I have a health problem. In summary, I need to seal this fissure/unhealed wound so that it can no longer retear during bm, causing bleeding, inflamation to the roid/tag. i notice too that the biggest roid, a pea size, is located outside the fissure area. i can honestly say that i can live w/ the roids i have. i want the fissure and the bleeding to stop.


I know that my fissure is 90% healed and if i can stop the bleeding for a week I am confident that the bleeding will be gone. I 'tried to fast' for 3 days by eating only activa yogurt, dried prunes, and drinking water. What a mistake! I had constipation resulted doing that. right now I am clueless on how to make treat the final 10% of my fissure!!!!

I've been taking 1 or 2 docusate sodium daily, plus 2 stp benefiber for the last 3 months, and I stopped taking the DSodium las night because I am worry that my body might get used to stool softener medication, only 2 stp of benefiber yesterday - one at breakfast and dinner. My BM movement as of this morning is OK, still had the same bleeding!!! I am trying very hard to train my colon so i can have 2 bm a day, am and pm.

What are the side effects of taking Colace, docusate sodium, miralax? I took 1 stp for miralax for couple days before bedtime and I felt my body did not like what it is in miralax although it was doing its job, so I stopped.

Before having the 2nd surgery, I plan to try some of these natural/the unpoplar treatments in hopes to heal my AF/unhealed wound.

* Athlete's Foot Cream Tinactine
* Neosporin
* epsoms salt
* BF&C ointment
* Hamamelis and Zinc cream
* Wheat Germ Oil, Gotu Kula & Wheat Grass
* Lansinoh
* vitamin E suppositories and oil
* oil of oregano
* Hamamelis and Zinc cream

Many people healed their AF by using the above mentioned home remedies. but in my situation is different because my problem NOW is cause my mankind, not nature!

Did anyone on this board have success trying these treatments? and what are the results?

What are the best way to train your colon so you can have 2 bm a day? what are the natural foods/fruits/drinks so i can make this happen? should i drink plenty of prune juice?

fyi...i was a healthy person and I didn't need a hemorrhoidectomy because I didn't go through any physical pain and my so-called problem then didn't cause me to have tear on my eyes. The reason I decided to have the hemorrhoidectomy was I am about to turn 40, so i want to take care whatever "problem" i have now and hope for the best in the future. Little that I am causing a BIGGER problem for myself. I can never imagine the situation I put myself in!!!!!

[lodgen]

i have gone all threw that ,get a colonrectal board certified surgeon to do
i fissureomentry on you ,its simple and will solve your problem with the fissure.its time you understand if its chronic you can not fix it ,it will tear
again,miralax will help with the hard stool, take as much to achieve stool
being completely soft.colace is fine also they are not habit forming and i take
this Regine after surgery.life to short get it done and start enjoying it.

good luck

[tmnn123]

Originally Posted by lodgen

i have gone all threw that ,get a colonrectal board certified surgeon to do
i fissureomentry on you ,its simple and will solve your problem with the fissure.its time you understand if its chronic you can not fix it ,it will tear
again,miralax will help with the hard stool, take as much to achieve stool
being completely soft.colace is fine also they are not habit forming and i take
this Regine after surgery.life to short get it done and start enjoying it.

good luck

thanks in advance I know that you will give me your 2 cents...are you a 100% recovered?

What's fissureomentry? is this similar to fissurectomy/advancement flap procedure? Is this procedure as painful as hemorrhoidectomy? I am at the stage where I feel that I am 95% healed in the morning until I had a BM; following that are bleeding, pain/spasm kicked in for 4/5 hr, then I am fine physically. I can even go out and play full-court basketball games with the guys!

The dr. scoped me and he said I had a fissure/an unhealed surgery cut gotten reopened. He said if the diltiazem doesn't work he will do an anal advancement flap. Should I request to have him cut an incision into my LIS to prevent future fissures? I am really afraid of becoming incontinent if he cut my sphinctor muscle group incorrectly!

Since the hemorrhoidectomy I have 3 tag/roids re-grew and double its orginal size, and one of these roids/tags located outside of the fissure area, 5 o'clock....fissure at 6 o'clock, 1/2 inch inside from the mouth.

Should I have another hemorrhoidectomy along w/ the fissureomentry? i can live w/ those roids/tags as long as the fissures is sealed up and the bleeding stops.

[lodgen]

tmnn123

i have to watch my diet and if i get a hard stool or constipated i will
pay for it. sorry for the misprint i had a bad day its a fissurectomy. my surgery was three hemmroids removed ,fissure and sphincter reconstruction
with flap.i had no choice my rectum was so tight i could no have a bm.if
you have a board certified colon rectal surgeon the decision is his not yours
he will know the best treatment, was able to do a lot to but reinjuring
your rectum after every bm is hard to recover from and it keeps tear and
scarring.took diltizam for three months worked good but never heal my
fissure ,if it chronic it will not heal.lis will cut till the base of the sphincter
and a good surgeon will no go futher,and the chances of incontinent is
no issues ,it rarely happen only in very bad injuries to the syfincter.you rectal
pressure tone is too high once its cut it will drop and you fissure will heal
and the spasm will stop instantly,it happened to me and it will to you.i have
have no pain from this now .you might need both asked your dr and he will
decide.hemmrid surgery should be done only in extreme cases i suffer threw
it and do not wish it on anybody,it takes a long time to heal from,i keep telling
people on this board to fine the best colon rectal dr to do this there is no room for error ,if he cuts it off right and sutures it well you should have no
problems their after its heal.i would fix the fissure and not worry to much
about the hemroids or tags,just keep having soft freeflowing bm ,go on miralax
if you need to ,its not habit forming,i use it and it works.

[tmnn123]

Lodgen -You're right.

I've just met one of the colo-rectal surgeons this morning and he said I need LIS, fissurectomy, to fix my problem. He also said I have anal tenosis...what are the medical procedure to fix anal stenosis?