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37, male, new to site

Postby draino » 16 Mar 2015, 23:02

I have been struggling with a fissure for nearly a year. In April 2014, I decided I wanted to lose weight and began exercising at a kickboxing gym. I also started myself on a high-protein diet. I started with the best intentions, but not knowing much about nutrition, I basically ate mostly meat and cheese. I also never drank more than 24-32 ounces of fluid in a day - EVER - even after I began working out. It didn't take long for me to become severely constipated and soon I developed an anal fissure.

I dealt with it on my own at first, but around June 2014, I finally went to a doctor. He started me on Miralax twice daily and a rectal suppository twice daily for about 2 weeks and then eventually Linzess daily. He also told me to eat more fiber and drink more water, though he never quantified it or even mentioned it again. At my breaking point, I was having 4-5 BMs a day, all of which were excruciating, and all of which would trigger hours of incessant, debilitating rectal spams of indescribable pain. In September 2014, after spending 18 out of 24 hours each day in agony for weeks, I absolutely lost it in front of everyone in my doctor’s office - nurses, doctors and patients alike. It was then that I was referred to a colon and rectal surgeon.

The surgeon stopped the Linzess (thank god), put me back on Miralax, told me to eat 25-30g of fiber daily and started me on Nifedipine in Petroleum Jelly applied twice daily to the anus. Two months of suffering later I returned to her with no improvement. I had a lateral internal sphincterotomy in early December. The first week after surgery was pure bliss. BMs hurt like hell but I had no spasms afterward and no blood in the stool, in the toilet or on the toilet seat for the first time in nearly 8 months.

The second week I had a setback, then another, then another, and within 6 weeks I was back to where I started before the surgery. The surgeon told me I would be the 6th person in her 20+ year career to need a second LIS performed. I wasn’t pleased but I was willing. Before I could do the surgery, I had to have anal manometry performed to see if I could tolerate a second surgery. The test took about 30 minutes and consisted of inserting a manometer into the rectum and inflating it while I tried to bear down, etc. The pain was horrific. The removal of the manometer is the most pain I have ever felt in my life.

After a month of hearing nothing, a medical assistant called and informed me that the results indicated I cannot tolerate a second surgery (i.e. I would not be able to control my bowels). She told me to schedule a colonoscopy, which I have coming up in late April. I have not heard from them again – no alternate treatment plan, no pain management advice, nothing.

I am once again at a breaking point, and I currently have no treatment plan. I do not know what direction to even start in. Should I go back to taking Miralax? A stool softener? Has anyone found anything that works for the pain? I tried Ibuprofen, Tylenol, and even Vicoden that was left over from my wisdom teeth being taken out - nothing stops the spasms or the endless pain they bring. Has anyone tried just not eating solid foods? I’m ready to never eat a bite of solid food again if that is possible without dying.

I’m looking for any advice anyone can offer on nutrition, water intake and pain management. Thanks for listening.
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Re: 37, male, new to site

Postby chachacha » 17 Mar 2015, 12:29

I'm so sorry to hear what you've been through, especially the fact that your CRS has left you "stranded".

I never got much relief from painkillers either (Tylenol 4's two at a time that are strong codeine narcotics), but they would sometimes bring it down to about a level seven and a half or eight, so don't know what to recommend on that front.

If the CRS put you on Miralax, maybe you can contact them to at least see if taking it would be okay, along with the same question with regard to a stool softener. I would hope that they could at least give you some guidance with that.

Can you see your family doctor again, and see what he/she suggests? I'm sure that they could at least help you with advice about pain management.

I didn't answer your question earlier, because I felt that others may have more experience, but since no-one has answered yet, I'd at least like to offer my sympathies.
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: 37, male, new to site

Postby msimon » 17 Mar 2015, 12:55

Hi Draino. I am so sorry to hear or the ordeal you have been through. I had an LIS done as well and also continue to have awful spasms. I had to have a second surgery 3 months post-LIS for a chronic infection that occurred in the LIS incision site. This made a very large open wound for me and I have been experiencing the worst pain and spasms of my life. They have lessened some as the wound closes but are still awful. You may be having spasms in muscles other than the sphincter as well as when in that much pain it sort of spreads. I wonder if a pelvic floor physiotherapist or pelvic pain specialist may be of help to you (seeing as your manometry does not indicate a hypertonic sphincter, I assume?)?

I wish I could tell you something that would help with those awful spasms. For me, a warm bath with epsom salts is the best option. The muscle-relaxing ointments help with time and when some healing has occurred you feel relief. The other thing to try would be botox. Have you discussed that with your Doctor? If they are concerned about incontinence it would at least only be temporary as it does wear off after a few months.

I, personally, take a lot of stool softening agents (miralax, magnesium and milk of magnesium) to keep my BM like toothpaste. Anything more dense than that is damaging to me. I plan to keep it this way as long as needed. Keep in mind you have to drink a lot of water to have them work. As for the pain, you could try an over the counter muscle relaxant, which would work on the non-internal sphincter muscles. Some people have had luck with valium for this as well. I found ibuprofen to be the best pain med post-surgery as it works on the inflammation, which can cause pain and spasm, but then really needs to be taken regularly to work that way (if you can tolerate it).

What is Linzess? I am not familiar with this.

It really sucks that your CRS sounds very dismissive and unhelpful. Would it be possible to see a different one? A second opinion might be in order. I hope you are feeling better.
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: 37, male, new to site

Postby draino » 17 Mar 2015, 16:03

Thank you for the replies and encouragement. I think I will contact my family doctor again and go from there. I never heard from my CRS after she recommended a second LIS surgery. A different doctor performed the manometry and it was her medical assistant that contacted me about the results 2-3 weeks later. All she said was "the numbers were not what we expected" and recommended a colonoscopy for further investigation as to why I'm not healing, etc.

Linzess is a (relatively new I think) prescription for chronic IBS and constipation that can be taken long term as opposed to Miralax. For the first few days it was a blessing because it kept my stool mostly liquid. Within a few weeks, however, it caused massive diarrhea 4-5 times daily and at times loss of bowel control. I believe my dosage was too high as I had multiple "accidents" at work and at home and dozens of close calls.

On the bright side, I survived another day. Thanks again everyone.
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Re: 37, male, new to site

Postby Fissurefrustration » 17 Mar 2015, 20:43

Hi there.

Welcome to the forum im so sorry to what your going through.

I'm a fellow male and this horrible condition affects both genders but predominantly females with childbirth etc. It's the most horrible debilitating thing ive ever been through and it's still not over - ive been suffering over a year and a half.

I completely sympathise sith you and how your doctors are ive had the same BS which basically means they don't know what to do! It's so horrible.

A few things that have helped me a bit.

Magnesium tablets - a miracle softener as they absorb water into your stool making them soft but formed.

Honey cream - a natural healer with no rash problems

Sudocrem - a great soother I found to help after s BM.

Most things I get a nasty rash with so I advise using any soap down there and try meditation. It's really helped me as I was getting so worked up.

You are amongst good friends here with a wonderful support network. I hope there is a path laid for you soon with a clear treatment plan

Suffering since June 2013 :(

Methods tried:
Sitz Baths
GTN cream - awful migraines!
Manuka Honey / Coconut oil / Aloe
Vitamin E suppositories
Tablets (Fiber, Cod liver oil with vit A+D, Multi vits)my + tag excision X 2
Dilatiazem - so far so good.
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Re: 37, male, new to site

Postby jlm1 » 18 Mar 2015, 08:47

Hi there,
Just wanted to offer my sympathies and support. What an ordeal you have been through! Yes, the pain is like no other and I have suffered greatly from spasms. My story is different, I had botox which healed the fissure. But I have had other complications.
I would definitely see another CRS. How dare he leave you like that with no other suggestions! Shame on him. Aside from what others have suggested I would try valium suppositories. Those have helped with spasms. And like others have said, hot baths, keep stools soft, hot water bottle, exercise to get blood flow to area. Also I would not stop eating solid foods.....I tried that and it didn't work for me.
Hang in there and keep us posted!!
fissure May 2014
nitro, diltiazem
botox July
fistula surgery, piece of skin tag removed Oct
fissure declared healed Dec
currently have burning/pain-told it is nerve pain
physical therapy, sitz baths, valium suppositories
hoping I am healing
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Re: 37, male, new to site

Postby SCS_Guy_48081 » 24 Apr 2015, 16:34

I am a 48 year old male. I had bloody stools and what my Dr. said were hemorrhoids. He suggested that I have hemorrhoid banding done. The first one was a piece of cake! The last two were very painful and actually left me many times in tears, begging for the hospital.. It was the worse pain imaginable. I dealt with the pain, just wanting to get the banding over with and get this done. After telling the doctor about the unbelievable pain, he gave me an exam and said after the hemorrhoids were taken care of, he could see a fissure. I can not believe the amount of pain these things cause! I'm just like c'mon already! He wanted to schedule surgery on the spot.. He explained that most fissures do not heal on their own. I asked to try other methods first of course, so he prescribed me Anusol and gave me Ultram (which didn't even begin to touch the pain) and told me to take metamucil fiber powder or tablets, dulcolax stool softeners, and sitz baths throughout the day.. I had to go with my norco for the pain relief..at least it took the edge off a little bit. I wasn't sleeping for days on end.. I couldn't sit,stand,walk.. and BM's.. Well forget it!

Reading through site after site, I noticed a pattern where coconut oil was giving people relief! I had hope again! I went and purchased some at the local store.. I also bought a portable sitz bath that sits on the toilet.. ($14.00) and it made it much easier than taking so many baths and waiting on the tub to fill up! I put a tablespoon of the oil in my sitz bath and within a half an hour my pain was tolerable maybe like a 3 where on a scale of 1-10 before, it was definitely an 11+ ..non stop! I have been doing this for 2 days now.. I dont know if its helping with the healing, but i do know that it is helping with my pain and making my BM's easier to handle. My pain is like a dull pain and not even constant at this point. I only take ibuprofen for pain now. :)

So here is my routine

In the morning:
I take a metamucil fiber tablet
I take a dulcolax stool softener
I have my usual BM
I take a sitz bath with a tablespoon of coconut oil
I clean up with a wet wipe and dry
I use my Anusol
I put a little coconut oil on the area.
(During the day I also use a heating pad for a bit to sit on)
I take one other sitz bath again with a tbsp. of coconut oil after dinner
Before Bed:
I take a fiber tablet
I take a dulcolax stool softener
I use my Anusol
I put a little coconut oil on the area.

I hope this helps .. I know the pain is something horrible.
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