6 months...what to do??

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6 months...what to do??

Postby Canadabum » 14 Apr 2015, 17:05

First of all -- thank you to all the posters who post and the wonderful people who share their experience and knowledge. I have benefitted from reading so many posts over the past 6 months....thank you thank you.

This is a bit of a long post....so thank you sincerely in advance for reading it.

I am a 43 year old male and developed a fissure 6 months ago. Like all of you it is a very long story and I will share the most important parts with you in hopes of getting some advice.

It all started the way it starts for many...intense burning pain and a few weeks of bowel movements that felt like i was passing glass shards. I visited my GP who told me it was hemmorrhoids and prescribed Anusol with Cortisone. After a month of treatment i was no better and was sent for a Flexible Sigmoidoscopy. As you can probably guess, the flex sig was a horrible experience. Lets just say I hit the ceiling when the technician did the digital exam and then inserted the sigmoidiscope. I can only imagine what the patients in the waiting room were thinking while they were hearing my profanity laced screams...anyways, at the end of the exam the technician told me he saw nothing and that i likely had an "atypical fissure" I was prescribed Nitro Ointment and sent on my merry way.

I used the Nitro for about 2 months -- it helped reduce my pain but did not really solve my issues.

By this point my symptoms included -- pain during bowel movement, pain that usually lasted most of the day after bowel movement that was characterized by intense burning, weird feelings in anus/rectum area (like movement), muscle spasm feelings and other fun stuff (not!). I went back to my GP and was then prescribed diltiazem.

I have been on Diltiazem for about 10/11 weeks now. I am much better but not fully healed. I can have decent days where i have minimal pain during bowel movement and little to no pain during the day (only some discomfort and awareness that something is down there) and then for no reason it seems i can have a couple bad days in a row where i have increased pain that is always onset after the bowel movement. The pain -- I think -- is muscular related in that I believe my sphincter is either in spasm or has tightened...not sure.

The other stuff I have been doing to help myself (that I have found helpful...and trust me, I have tried A LOT of the stuff people have posted):

1. I have cut down on volume of food i eat so that i only have to go to the loo once a day
2. Increase fibre -- but not too much (I found that bulking up with metamucil was terrible for me)
3. Drinking a ton
4. Applying coconut oil before bm
5. Sitting on heating pad at work/car...anywhere i can
6. Magnesium Citrate -- I take 450mg/day....this has been incredible for me in terms of softening the movement
7. Probiotics -- cant say enough good stuff about these helpful bacteria...i drink kombucha, eat miso soup, tempeh, kefir etc etc...huge help

My question is this.....I have been on Diltiazem for almost 3 months with some success, I have drastically altered my eating habits for the past 6 months with some success...but I still feel discomfort for parts of the day, still get some sharp jabbing pains to remind me that I am not 100%, I still get days where all i want to do is crawl in to a hole and wake up better, and yes, like you i am still brought to tears on some days by this predicament. What I am having a hard time with is making the judgement call to (a) continue on my regimen (b) see if nifedipine is better for me than dilitiazem (though given the feedback from some CRS that also did a digital i was told that if i don't heal in 8 weeks from the diltiazem i will not heal) or (c) should i seriously consider surgery.

If I continue with the cream -- my last surgeon consult told me to "put gobs and gobs" of the cream as far up my rectum as possible...so i get my diltiazem in tube form and have an applicator that i use (same as you would get on a tube on anusol that you buy at the pharmacy)....does anyone else do this. I don't find it easy sticking it up there multiple times a day...

One last thing -- the two surgeons who examined me after the sigmoidoscopy both told me i had a typical posterior fissure...it is high enough up there that i cant see it and i dont really have much of a sentinel pile.

Lastly -- Thank you for reading this. It is somewhat cathartic to be able to write about this to others who are going through or who have healed...I am looking forward to any feedback (scientist...if you are out there...I would love to hear from you...I read all your posts and find your wisdom/insight very helpful).

The very very last thing....the other thing i have started to do which has also helped me...is that I am now talking to people in general about my issue. I kept it hidden for many months which caused me a lot of added stress and distress. Now when people ask me how i am i tell them (if appropriate) that I am dealing with an anal fissure....first couple times i had a hard time saying it...but it is getting easier....and to my enormous surprise, a couple people I told responded by telling me that they either went through it themselves or are currently dealing with it.

Again Thank you all!!!

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Re: 6 months...what to do??

Postby jlm1 » 14 Apr 2015, 20:01

I don't have much advice or suggestions really. It seems as though you are doing everything you can. Hot baths helped me a lot.
I just want to say that I relate and am sorry you are suffering. I agree that it is good to share this, when appropriate, with others. There is really no shame and many others are dealing with this too!
I had botox and it healed my fissure. I had other complications but am much better now.
Hang in there and let us know what you decide!
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: 6 months...what to do??

Postby Scientist2516 » 14 Apr 2015, 23:17

Hi Canadabum - I'm honoured you think I can help - I will if I can.
I'm so glad you can talk about your fissure to people. That's got to be a great help mentally, because I found the loneliness of NOT feeling comfortable talking about it quite depressing (until I found one person to talk to about it). So good for you for having the guts to be open about it.

Hmmm, sounds as if you are making some progress, but not very fast. Your initial experience sounds quite similar to mine, but by 6 months I was having mostly good days with some bad days now and again. I still think you could heal, but it might take a long time.
I think there's still a chance to heal even months later, because according to the CRS nurse, my fissure was still open more than a year after it was first diagnosed. And now I feel totally fine. I've even had some hard BMs, and some stress, and no pain at all. So I think it's possible.

If you notice over all improvement over weeks, then it's probably worth persevering with the dilt. If you are going along with good days and bad days, but the good days are not increasing, and the bad days stay really bad, maybe you should have LIS. Do you keep a journal? Try keeping a record of pain, and any possible triggers like the hardness of your stools, stress, heavy exercise etc. After a few weeks look back and see if there's a positive trend, or no healing trend. You can keep your journal on this forum and have people cheer you on or sympathise when things aren't so great. It's really nice, and a great help if you are feeling low.

There was quite a long period - about six months - when I had significant pain, but could bear it because it was so much better than the first 2-3 months. It was at a level I could live with. It sounds as if you are at that point now. So as I say, I think there's hope for you.

Also, I wonder about sticking the dilt up inside? Maybe with an applicator it's OK. I used my finger and eventually thought I was probably doing more harm than good, so just applied the nitro to the outside. But nitro is well absorbed and maybe dilt. is more effective when applied internally. I hope that applicator nozzle is very narrow and soft!

Well, that's all I can think of for now. Hopefully others will chime in with their experience. You may have seen that Butt Queen just checked in with her success story. It's always good to read about the successes!
Good luck Canada! Keep us informed about your progress!
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: 6 months...what to do??

Postby Canadabum » 15 Apr 2015, 15:44

Scientist: Thank you sincerely for the reply...I know that your reply to me is really helpful to myself but also so instructive to the many who wander through this site looking for guidance.

I spoke with my wife about my condition...I feel that on some level I have lost a bit of perspective as to where I am at. Part of the reason for that is that my "feelings" about where I am at are cumulative since day 1 of this fiasco. So my wife tells me that I have been having more good days than bad recently (past 2-3weeks) though I still do have what I call set back days. I am very interested in hearing about the general timeline of your recovery (and so happy for you by the way). You mentioned that you spent 2-3 months in a more acute pain phase, then 6 months of lessened pain but still pronounced...what happened then....how much time passed from the period where you started having more good than bad days to the point where you believed you were pretty much better? Perhaps this is already covered by yourself in a previous post that you could direct me to (perhaps you have written your AF journey somewhere...)

I am not averse to surgery in general but will do what I can to avoid it...I just dont know how long I should hold out for. I also wonder what signals you got other than no pain that told you that you were healing?

Is there anything that you still do to maintain your healed status...have you permanently changed your eating or something else?

As for sticking the dilt up with the applicator -- I have found that dilt also gives me a rash (i read about yours and was bracing myself for the same...did not happen) that is itchy and causes red marks etc if I simply apply with finger. By using the applicator I am able to ensure the dilt is high up there and does not make contact with my outside skin...so i avoid the rash -- that is the only reason i continue applying with the applicator....and yes, it is very narrow (same one you would get if you bought a tube of prep h or anusol at your local pharmacy). Here is a quick you tube video that illustrates what I do...some others may benefit from knowing about this

https://www.youtube.com/watch?v=qYa8tL-XAtQ

My one workaround and very helpful MacGyver addition to the applicator is to cover it in coconut oil before i insert to make it slide in easier.

IfI may -- one quick question....have you or anyone reading this ever experienced what i would call a scab like feeling. I sense something like a scab internally though think that would realistically be impossible....just wondering if that is a "normal" sensation that is common...or something special just for me :)

Thanks again for your response -- it is greatly appreciated...and by the way, today was a pretty good day!

All best,
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Re: 6 months...what to do??

Postby msimon » 15 Apr 2015, 20:21

Welcome fellow Canadian (to the site you never want to have to find)! Where are you located? I am in Alberta.

Sorry to hear of another victim of the dreaded fissure but glad you found this place. It has been my saving grace. The people on here are so wonderful.

I don't have a lot to add myself. I have had a long journey with this now and it promises to go on and on it seems. You can read mine here is you like:

my-fissure-journey-t9294.html

Sounds like you have really done your homework and are on the mend. I hope things continue to improve for you. I do want to mention that as for the gobs and gobs of ointment, there is no benefit to applying more than say a pea-size as you can only relax the internal sphincter to a certain degree with these medications, and more is not more. The research says they reduce resting tone by up to 30%. You may just increase side effects or tolerance by over applying. My Doctor's have also always told me to apply the creams/ointments externally and there is no added benefit (and potentially is damaging) to applying it internally. It sounds like it minimizes irritation for though so you have to go with what works best for you.
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: 6 months...what to do??

Postby Scientist2516 » 16 Apr 2015, 09:18

Hi Canada,
Here is my story.
a-one-person-experiment-on-af-drugs-t7231.html
If you read it, you'll see a pattern of me feeling really well and happy, and then having pain again. You'll get a better idea of the time-line than I can give you from memory because thankfully I've forgotten a lot of the bad bits!

So what you say about your perspective of healing, and the perspective your wife has, is very interesting. I think that shows the usefulness of a journal. Try to be objective about the amount of pain you have every day, and see if a pattern of healing emerges.

The only signs of healing I could go by were the decrease of pain. Sure I had some other sensations that told me things were not quite right - squirmy feelings, itch, prickles etc. But as you will see in my thread, it appears the fissure was opening and closing for several months, so I had long periods of no pain when I was not fully healed. I never had any blood. The reason I think I'm healed now is that I've had periods of stress and a few hard stools, and zero pain. I don't know about a scab. I think other people have felt hard places inside their anus, but I don't put a finger up there any more so I don't know. As for whether it's normal - after reading this forum for a while, you start to think there is no normal, or on the contrary, everything is normal!

I did change my drinking habits from very little water, only tea, coffee and the occasional alcohol drink, to cutting back the caffeine and drinking more water. I've always had a healthy diet, so that didn't change. I'm back to drinking large amounts of tea (I'm English!), but do make an effort to stay hydrated. The biggest change was to recognize stress and consciously relax and calm down.

I'm really glad today (yesterday?) was a very good day. Hooray! Keep posting! Keep up the good work of healing!
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: 6 months...what to do??

Postby Canadabum » 16 Apr 2015, 09:46

Thank you for the feedback.

Msimon -- i am in Ontario...a hop skip and a jump from you. I read your story and my heart goes out to you....you have been through a lot and are clearly a fighter. You will get through this and you will be ok. I was wondering if you had looked in to Miralax...a lot of people reference it on this site -- can we get that in Canada? What softener if any do you use.

I have come up with a bit of a mantra for myself that i like to repeat at my highs and lows...while i am swimming, walking, sitting on the heating pad etc etc..i found a tune to hum this to myself and will say it out loud when walking alone "I am healing, I am repairing, I am getting better, I am OK". You might want to try it out for a few days...I know it sounds a bit hokey...but it has been helpful to me. You may want to make up your own that speaks more directly to you.

Scientist -- your input is invaluable. I feel like my journey is pretty close to yours....i am in the getting better with set back experiences phase it seems...hoping I come out the other side like you have. The diary is a great idea...is there a special place on this forum for one or should I just use this thread? As for everything being "normal"...i get it. If it is happening to me it has likely happened to millions before me and will happen to millions after -- this condition is so mysterious to us that it seems that every little sensation must be unique, strange and weird...when it is most likely a common reaction to our predicament.

I am going to start keeping a real pain diary (1-10 with descriptions of sensation) and think that is an incredible suggestion -- this way i will gain better perspective on the trajectory of the experience.

Thank you all again for reading and sharing your thoughts.

I have a lot of compassion for all of us who are dealing with this...I just want to let you all know that in my early days (first 3-4 months or so) I was really feeling at the end of my ropes and my pain was quite horrible and very very depressing. I abandoned much of what i loved to do physically and could not eat what i wanted and was scared out of my mind that this was only going to get worse and worse and there would be no help...lets just say i think i probably cried myself to sleep more nights than not during that time....but over time and by trying many different techniques from eating more oil with every meal, eating probiotics, magnesium citrate, potty positioning, drinking more water and juices, using coconut oil before bm, taking natural anti-microbials (oregano oil) and natural anti-inflamatories (turmeric), talking about it, using a heating pad etc etc i have found that i am slowly but surely making strides....it is not noticeable from day to day, but week to week it is amazing to see...i never thought i would even get this far. So it is possible to feel better...just take it one day at a time and try your hardest to remember that eventually you will be able to deal with your situation a little bit better each day, each week, each month...

Best wishes to all.

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Re: 6 months...what to do??

Postby msimon » 16 Apr 2015, 11:27

Thanks Canadabum :)

I do use Miralax (here it is called Lax a Day or Restoralax - all the same ingredient-PEG3350). It works wonderfully, although I find if I use too much I get bad smelling gas :affraid: . So I balance it with magnesium supplements and a tiny bit of Metamucil.

Thanks for the encouraging words and advice you offer. It will no doubt be helpful to those that frequent this forum. I hope you keep mending and will be soon freed from this awful malady.
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: 6 months...what to do??

Postby Bailey » 16 Apr 2015, 23:32

Canada in the house! Jets fan here... Manitoba:).

I too am very sorry to hear that you are suffering with a fissure. We all know the ups and downs... It's mentally and emotionally exhausting. I have been suffering since October and I'm happy to say that I've had 6 good weeks of no pain (and a colonoscopy during which doctor could not see the fissure). Many things helped - change in diet, drinking more water, heating pad. But, things really changed when I switched from nifedipine to nitro. But more importantly, Restoralax has given me consistently soft BM's and that has been all the difference! I have also been walking everyday... I think exercise increases blood flow and promotes healing. I will say that I was at the point where I was thinking about surgery when things really started to improve. I would never have believed it, but it is possible to heal and I had almost lost all hope two months ago. My goal was just to have one good day after another... And before long, they started the grow and grow. I had the occasional bad day (or a few) but like Scientist said, they were less and less. But, the consistently soft BM's were key...

I wish you all the best!
Diagnosed anal fissure October 2014
Tried nifedipine - fissure seemed to be healing but reoccurred January 2015
Switched to Nitro and started Resoralax - Beginning of March 2015
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Re: 6 months...what to do??

Postby Canadabum » 17 Apr 2015, 10:48

Bailey good to hear that you are on the mend...and glad that at least one Canadian team seems to be doing ok :)

I started about the same time as you -- but was not really diagnosed until about end of November so I spent a bunch of time not addressing this properly.

Did you suffer from constipation before the onset? I ask because that was not really my issue -- I am wondering what restoralax would do for someone like me. How often do you use it and do you know if it is ok for long term use? Does long term use make one dependent on it? What is even considered long term?

I have magically had about 3/4 good days in a row -- not without some weird sensations and the like...but compared to what it has been like i will take it! I can also attest that it is all about that bathroom trip (and not all about that base) that sets the tone for the rest of the day for me...so keeping it soft is at the top of my priority list.

Really glad to hear about your journey...pleased for you and it gives me some hope for myself...i sort of feel like i am at the early stage of some sort of real recovery (though i am reluctant to say that in case i jinx myself)....i will let you know in a future post hopefully.

Thanks again for your feedback

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