First, some background. I have been suffering from AFs for more than 13 years. I am not a doctor or a medical professional, and I am not writing this post to convince anyone of anything, but just to provide some information that might be useful to others in a similar situation – just as I found information from many others very helpful as I was going through this. For additional background, and those not familiar with SAD – standardized anal dilatation, I suggest reading at least the beginning of this thread by wecc first: http://anal-fissure.org/my-standardized-anal-dilatation-this-morning-t4104.html. I use the terms dilation and dilatation interchangeably – I think the doctors use ‘dilatation’ vs. ‘dilation’.
I first got AFs when I had my wisdom teeth out and was given some very constipating medicine for the pain. Since then, I have done a LOT of research (and probably forgotten at least half of it) – I have tried nitroglycerin, lubricants, some self-dilation etc. and I had grown disillusioned with the ‘professionals’ early on because it seemed I knew more than some of them did – I had to push one of them (showing studies etc.) to give me the Nitro, and that was after I convinced him to check for AFs! None of the alternatives worked for me. I have been able to manage the pain with magnesium supplements (after trying a lot of alternatives like stool softeners, mineral oil etc.) – I would say even get it to ‘heal’ where there was no blood or pain, but over time I began to think I should look at something else as I didn’t think it was fixing the root of the problem and I would have constant flare-ups where pain levels would skyrocket to a 8 or 9 out of 10, and then take a week or more to get under control with increased magnesium. I mean really, forget waterboarding – if you *really* want to torture someone, give them an AF! :)
Over the years this condition has really impacted my life and I finally decided that instead of maintaining the course and worrying about the “what if something went wrong scenarios” to think about “really getting my life back” and doing either the LIS or SAD. After reading posts on this forum, and others, decided that dilation was what I wanted to do as it had the least risk of complications, even if I was giving up a slightly greater chance of a complete cure with LIS.
I live in California, and tried to find a CRS who would do the procedure, but when I called their offices, they didn’t want to answer any questions other than book me in for an appointment with the CRS. And when they did answer, they didn’t understand what procedures the CRS did - and when they did manage to get an answer from the CRS they were told that dilation was archaic, dated, and/or not the gold-standard like LIS is.
From my research I knew about the CRS in NY that did the SAD procedure and had learned some of this from Dr. Sohn (from my research, I knew about Dr. Sohn who had been re-visiting the use of SAD in NY, but I had not given up trying to ‘self-heal’ or ‘self-manage’ by the time he retired – see: http://www.thedoctorschannel.com/view/a ... -fissure-3). I setup an Internet chat session with the CRS in NY and after speaking with him, I thought he knew what he was talking about. He did not push SAD at all – just stated the facts and that included his feeling that cure rates might actually be a few percentage points lower than LIS, but that since the risk of complications are vastly reduced, SAD is the only procedure he does now. To confirm I had an AF, I saw a CRS in California who confirmed the issue, suggested either Botox or LIS as the gold standard – when I asked about dilation she said something about it being an outdated procedure that just tears the muscle fibers. But then when I asked her about her patients who had complications from LIS, she said it would take several weeks to recover, and that she had some patients who had complications, including at least one who was very sick to begin with and became incontinent (developed an infection) – don’t get me wrong…I think she was a good CRS and had good reviews…had done more LIS procedures than most and probably very good at it, but she still didn’t know anything about SAD.
So I made travel plans to NY with my wife (she has been AMAZING in supporting me through all this, and I needed her to check me out and drive after the procedure – at least we made a mini-vacation out of it and saw a bit of NY :)) and arranged to see the CRS in the morning for a consultation, and then have the procedure in the afternoon. In the morning, the CRS confirmed I had the fissure, and we proceeded as planned. He said that he would do the standardized dilatation, and also do a fissurectomy – which does not really cut away the fissure or scar tissue etc., but mostly just cleans things up around the wound such as skin tags etc. and that helps it heal.
The worst part about the procedure (and the part that hurt the most) so far was probably doing all the enemas. I had to do two before the morning consultation visit, and one when I got to the hospital. At the hospital, there were the routine checks, questions, paperwork etc, and I was given an IV drip. I was told that I would be given local anesthetic, but would be sedated. So after all of this, I was taken to the OR room, asked to lie face down on the OR table in a “superman” position. Next thing I know, I was waking up in the recovery room – felt pretty good actually, and did not have any major discomfort through all of this. After some more checks, a light snack, and instructions, I was discharged from the hospital. Total time at the hospital was around 4 hrs – with 30-40 mins being the actual procedure, and the rest being prep, recovery time etc. I was given some medication (Ketorolac) to keep any inflammation in check, and asked to drink plenty of water, take stool softeners etc., and also given a sitz bath device – basically a shallow bucket that you fill with hot/cold water and sit in.
Well, since we were in NY, we decided to check out the town and ate a lobster dinner at a nice restaurant – yes, I was walking around town the same evening after I had the SAD in the afternoon! I had some “packing” taped up down there after the procedure which made walking a little strange (a bit like wearing a diaper I suppose :)). I was pretty comfortable for the most part – just felt a little numb down there, and the only surprise was really that I couldn’t control passing gas while I walked – it just came out really easily. I had to catch my flight back to California the next morning, so the morning before the flight I took off the packing down there (there was some discharge etc.), cleaned up in the shower, and then put on a pair of depends I bought for the flight at the local drugstore (just in case) – turned out it was a good idea because there was some minor bleeding/discharge by the time I got home.
So I had the procedure on Monday afternoon, flew home on Tuesday morning, and had my first BM after the procedure on Wednesday morning. By Tuesday morning, I had no issues with controlling the passing of gas, and by Tuesday evening, there was no more bleeding or discharge. I was a bit worried about this first BM on Wednesday (after eating some good food in NY :)), but it was only mildly uncomfortable – I had soft stools since I was taking fiber and magnesium – actually there was almost no pain and really no comparison to what I had gone through previously with AFs! After the BM it felt a little sore down there, but still nothing in comparison to the pain of AFs! I had a hot sitz bath in the tub for about 10-15 mins after the BM. Even though the pain is much reduced, it really helps to take time off as all of this can take lots of time – you don’t want to be rushed, push hard, be stressed etc. I had scheduled a week off from work, and am really glad I did.
On Thursday, I had the second BM. This time, I had a little more pain (like a 4 out of 10) – maybe it’s because I started reducing my magnesium intake….let me explain why. I think over the years I had ‘trained’ my muscles to work with the soft stools resulting from magnesium – I would be able to control the ‘size’ of the stool and the ‘way’ it passed through the canal to avoid pain and keep it manageable, but I don’t think this is how the muscles should ‘coordinate’ normally and naturally. So I’m trying to avoid that by keeping the stools a little bulkier (but still not too hard) to stretch out the muscles gently. I expect that will lead to some increased pain, and I’m trying to balance that so I don’t go too big/hard too fast. With the stool size today, I’m sure I would have been back at a 8+ level of pain before the procedure, so I’m still hopeful I’m on the right track. I had a sitz bath after the BM which really helped relax the muscles again. I’m still feeling soreness down there a few hours after though.
So that’s where I am today – not quite where I want to be yet, but very hopeful I am on the right track. I’ll make some more updates as I am able, but based on my experience so far it seems that SAD was well worth a try. My own opinion is that it should work for the majority of cases, is not very painful or uncomfortable, and can help avoid complications associated with LIS. For me personally, I wish I had done it years earlier. The main downside for me was the expense as I had to travel to NY with my wife, stay at a hotel, and there are insurance costs if you are out of network etc. On the bright side, at least I was able to make a mini-vacation out of it :)
Hope that helps, and just in case you see this posted somewhere else – it’s because I want others who may not visit here to know about this too.
I know the pain many of you must be going through, and how much it weighs on your mind and impacts your life, so I really hope this post helps at least a few. Here’s wishing you all the best on your road to recovery!
Pdox.