Anal Fissure Support Forum

[SSK]

Yep, yep. I argued with almost everyone who told me that NYC has the most arrogant doctors ever and it was time for me get out of this maddening place for a fresher perspective. I told them there's no way such a small problem can't be treated in the "world's best city". Turns out I was wrong and I only realized this after I saw how things work at other places.
Anyhow, it is good that you trust one doctor at least. In case you decide to treat yourself locally, then you have feingold as an option.

[asdf123456]

Sorry for the rant. MN is not really a possibility for me, but I'll look to see if they have some sort of affiliation around NY. Frankly, I've been to about 5 different CRS doctors now, and in my opinion, pubmed and google has got them all beat. I'm going to give this a few more weeks, then go forward with MY diagnosis- mucosal stricture, inadequate mucosal bridges left from my hemmie surgeon to allow for healing, and a very mild muscular spasm. So a posterior house flap, as OMB is getting soon, 100 units of botox, (why not go for 5 rounds?), and possibly, an additional flap anteriorly if there is still any evidence of a wound there. If that fails, I got one more LIS in me for the F**k of it, and then I'll officially give up and become a monk or something.

[asdf123456]

Maybe I'll just drive to MN. I have nothing to do after all... no job HAHA. I have a REALLY nice car that I NEVER would've bought if I'd have guessed that I'd get anal stenosis and lose my job, but what the hell? Maybe I'll use it. It'd be a nice trip. I'll look into it. Even if they can't treat me, maybe they can at least give me some fresh perspectives, as you say.

[SSK]

Rant away! No worries.
Whatever path you do decide to go down, I hope it's the right one for you.

[asdf123456]

BTW, what tests did you have done there? Did you have an ultrasound and/or manometry? If so, were they horrifyingly uncomfortable and embarrassing?

[SSK]

I had already had a pelvic MRI here plus I had a very extensive exam under anesthesia by feingold. I had faxed all these reports to Mayo. When I got there, I was set up with a GI who had very extensive knowledge of rectal pains also. He did a brief painless office exam to assess if I am contracting my pelvic and abdominal muscles correctly. Turned out I wasn't. Basically he showed me a diagram of how a normal person's butt muscles should relax to make the correct angle to let the poop out. In my case, that angle is messed up leading to pain and having to go more than once to evacuate completely.
He suggested that I get an anal manometry to be 100% sure but that required am enema and I run miles away from anything that has to go inside my butt. I expressed my fears and didn't get the test. The doctor sounded very sure in his diagnosis anyway, so I was confident of his diagnosis. Aside from that I had 2 sessions with a psychologist which were very helpful too. The plan is to continue counseling and biofeedback.

[asdf123456]

Yea, I'm scared they will give me the manometry thing at some point. Sounds pretty embarrassing and painful...So do you have Levator Ani Syndrome? Or is it something different? And have you started the biofeedback yet? I forget where I read it, but I remember reading positive things about it and that it had helped the people who were writing about it. Do you know what it entails? Do they like hook up electrodes to your butt or something?

[SSK]

I have pelvic dyssynergia and tension myalgia. The doctor said that biofeedback is effective in 75% of the cases. But to be honest, I don't attach any real value to these numbers because I seem to be that weird case who falls outside of the favorable outcomes. I'm pretty scared that I will have to
Live with this condition forever.
I don't know a lot about biofeedback but yes you are right. They attach electrodes to see the signal from different muscles and then basically teach you to re train those defective muscles.
According to the doc, a large part of my pain is also psychological
Trauma from being in a hopeless condition for more than 2 years. That feeds into the pain which them feeds the tension and anxiety.

[asdf123456]

I see. Hopefully you can get some relief from the treatment. It's also encouraging that they really acknowledged how mentally traumatizing this whole ordeal must be for you. 2 years is a long time. And you are so young. Hopefully the counseling helps with relaxing those muscles. And, in my expert medical opinion, drugs are an option too. Doctors may fail, but pharma spends a massive amount of R&D money in developing all kinds of anti-depressive, anti-axiety, muscle relaxors etc. Might as well make use of all that effort, in my opinion. Some are habit forming, and some are not, so you have to be careful. Benzodiapines, while highly addictive, are anti-anxiety and mild muscle relaxers, so they might be useful in your case, at least short term. That's valium, xanax, klonapin, atavin, etc. Valium has been the only thing I think these doctors did that helped me at all in the last 2 years. I've also taken flexeril in the past for a fractured spine last year but I still have a bunch that I take sporadically when my back hurts. It's a skeletal muscle relaxer, so it might be very helpful for you too. It's not anti-anxiety, but purely a strong muscle relaxer, and very enjoyable at the least, so I'd give it a shot if your doctors say its OK. There are also anti-depressants that are SSRI, but I am skeptical about these because you can't take them as needed, you need a regiment for months. And they are a little newer than the other stuff, and they *may* cause constipation/blood thinning. That's reason enough for me to turn them down because that's a contraindication for someone with an open anal wound.

[Alyssa]

SSK,

Found a forum that might be also useful for you...

http://www.patientslikeme.com/condition ... yssynergia