3 months post-op and still in pain

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3 months post-op and still in pain

Postby tiredjay » 06 Aug 2013, 07:25

3 months ago I had a house advancement flap. Overall, I would consider the surgery to be a success. My bm's are generally painless with the exception of the incision sites on both sides of the opening. The spot where I had my fissure seems to be completely healed and there is no longer any stinging when going to the bathroom. My only concern is that I have had this constant burning pain in and around my anus on and off for the past couple of weeks. It's weird because I don't feel any pain when I first wake up but then it slowly increases over the next couple of hours. It doesn't get worse with bm's and my stools have been very soft since the surgery (I take a capful of Miralax). I'm not sure if this is still residual inflammation from my healing incision sites (like some sort of reaction since my incision is still healing--it's closed, but it is still painful to touch). Has anyone experienced this? Is this ever going to go away?
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Re: 3 months post-op and still in pain

Postby suzyljank » 06 Aug 2013, 10:47

Hi, tiredjay. I had bilateral sliding flap anoplasty (a double advancement flap) a little over 3 months ago. I'm healed too but the the side the fissure was on and the donor sites for the flaps especially where the stitches went into the butt remains tender at times. Over the weekend I had a little burning sensation too, that doesn't bother me much but it can make me feel like I have to urinate more often and I don't like that. My CRS told me that's all normal and part of the healing process. It can take about 2 years for the area to calm down. He gave me a water soluble ointment with lidocaine when I had my surgery so I just put a little around the area and it's helped. Don't give up your sitz baths either, even if you do only one a day. The acid from you bms can really irritate the new skin. I also dilate once a day to prevent the new skin and any scar tissue from shrinking and not being able to stretch. You have about 2 years to stretch the new skin and keep it pliable. After that you won't be able to stretch it much. Flap surgery is usually the last surgery you can have. Too many surgeries can cause lots of different problems. I'm constantly being careful with my butt but I'm back to my normal diet. I eat fiber at breakfast and make sure I drink more fluids but you don't need 8 glasses. My doctor told me to try to drink about 40 oz. a day. I don't use toilet paper, rubbing is not good right now, I just rinse off, and when I'm sitting and it's time to get up I don't slide my butt off the chair.
That pulls on the tender skin. I think in time things will settle down. I'm like you I'm just grateful for the surgery. Just hang in there and know someone else is going through the same things. Hope this helps. Suzy
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Re: 3 months post-op and still in pain

Postby suzyljank » 14 Aug 2013, 14:41

Hi tiredjay. I wanted to share what I learned today. I had a visit with the gynecologist this morning. I had my physical and she wanted to take a look at the advancement flaps. She told me that my CRS did a wonderful job and everything was healing nicely. I explained to her about the burning and how I my bladder sometimes feels like I need to urinate when I know I don't and she told me this. Because of the fissure and the stenosis my pelvic floor muscle ( which include the rectal muscles ) want to react like they did before. They're use to doing this. My pelvic floor muscles are reacting to any kind of pain. She said in time this should go away but she's going to be sending me for some physical therapy for pelvic floor so I can learn ways to relax those muscles myself. This is what is causing the burning sensation and sometimes some pain. I felt so much better when it was explained to me. My surgical site has healed and the daily dilation is helping keep the muscle flexible. She gave me a prescription for xanax too. If the burning lasts more then a few hours I'm to take one, this helps break the cycle of the pelvic floor contracting. Warm sits baths are supposed to help too. I'm sure this applies to men as well as women. She said this is not uncommon after rectal surgery and because the flap surgery is so invasive the surrounding muscles are reacting to the trauma. It is possible for there to still be swelling there too, it takes quite a while for things to calm down. Just having an explanation makes a difference. Hope you're doing better. Suzy
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Re: 3 months post-op and still in pain

Postby tiredjay » 14 Aug 2013, 21:18

Hi suzy,
Apologies for just replying; I was on vacation with my family and didn't have access to internet. As always, your posts are incredibly helpful and I sincerely appreciate your response(s). I figured that what you were describing is what is going on. I had done some research (which is definitely a double edged sword), and had pinned the burning down to the area reacting to trauma. It certainly comes in cycles, where the worst of it takes place when the burning sensation lasts for most of the day (currently it is only when I go to the bathroom and is ever so slight; definitely not like when I had my fissure). I considering going to my CRS for this but he really seems to think that it is pruitis ani even though I have cut out all of the foods that commonly cause it and have not reacted to the corticosteriods/suppositories he had prescribed. The burning sensation used to be paired with a feeling of tightness or bruising in the perineum (my fissure was posterior, so this feeling was definitely not related to the old fissure), which made me believe that the area was just reacting to the surgery/the 1.5 years of the fissure. Now hearing that your p.t. is sort of confirming this theory is more than comforting as I know that this is going to get better. On a positive note I am slowly improving as I no longer have that tightness feeling I had a month ago, and the pain on the actual incision site is slowly easing up.
I do want to say that I truly appreciate the time you take to write your posts, not only when responding to others but also in maintaining your own updates. Documenting your journey has certainly helped me and many others. While it is nice to know that we are going through this together, I hope that you heal quickly.
-tiredjay
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Re: 3 months post-op and still in pain

Postby suzyljank » 16 Aug 2013, 14:46

Thanks, not a lot of people have ever finished their posts on advancement flaps so I wrote down my experiences so it might help someone. It helps me too. Whenever I start to feel sorry for myself I can go back and read how bad I was and where I am today. I did get a few exercises to do for pelvic floor and they are really simple. I'm waiting to get in physical therapy. My insurance doesn't cover much but that's okay, if they can give me a few more exercises it would be nice. Most of the time I'm alright, it's just that sometimes I have a few days of that burning sensation, not as bad as before but it's there. I guess that's why my CRS said it would take about 2 years for things to fully settle down. Hope you're doing good, all the best Suzy.
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