Advice needed for my fissure regiment...

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Advice needed for my fissure regiment...

Postby fisslayer » 30 May 2015, 18:27

I'm new here, and I'm trying to avoid surgery. I would like to know how long does a fissure usually take to heal (as in the scab to safely fall off) after a bleeding tear? Days, months? I just read on here from others that some thought they were in the safe zone after a few weeks, but were wrong and tore their scab.

Also, this is my current anti-fissure regiment:
3 Citrucel (soluable fiber) pills a day (2 at night, 1 in day)
3 100 mg Colace (generic) stool softners per day (2 at night, 1 in day)
2 tablespoons of mineral oil taken orally before bed
1 Pearls probiotic to prevent gas/diarrhea/indigestion
olive oil with vaseline applied right before BM for lubrication
2% nitro bid mixed with 4 parts vaseline - applied after all BM, and at night
eat prunes as needed if I eat a high protein meal
drink 2+ liters of water a day

Any additional suggestions or changes?

Thanks.
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Re: Advice needed for my fissure regiment...

Postby frank » 01 Jun 2015, 11:49

How long have you had it? Deep? Causing any spasms?
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Re: Advice needed for my fissure regiment...

Postby msimon » 01 Jun 2015, 12:15

Your questions are so difficult to answer because everyone is so different. What works for one may not work for another and while some heal right away, others go on for months or years. There are so many factors. There is lots of great information on here. Have you been to a Doctor yet? You cold try a fissure ointment before surgery (nitroglycerine, nifedipine, or diltiazem). Do you do warm baths or apply a heating pad?
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: Advice needed for my fissure regiment...

Postby fisslayer » 01 Jun 2015, 17:43

What are spasms exactly? Is it the burning/stinging sensation during and after a BM? Or does it refer to the spinchter muscle tighting up on it's own during a BM? In either case, I have both of those conditions.

I am doing the nitroglycerin %0.4 right after a BM, and have been doing so for about 1 month. I've had the fissure for 2 months total now. I feel a couple scams right inside the upper edge, maybe a centimeter deep, and deeper inside maybe 2-3 CM deep, I think I have one more smaller scab.

My doctor was quick to suggest surgery couple weeks ago, which was 2 months into my fissure diagnosis. I got nervous about that and told him I want to hold off. But I sometimes have second thoughts because I love eating high protein diets with a lot of meat and whey powder, which cause hard stool. I'm thinking, should I just give up, let him cut that muscle, and go back to eating what I want?
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Re: Advice needed for my fissure regiment...

Postby frank » 01 Jun 2015, 22:08

I'm at about 3 months in. The first month and a half was brutal. Just had an appointment with my CRS the other day. Fissure is still there. She said next thing was to try Botox. I told her currently I'm experiencing no pain so I would like to hold off until it becomes painful again. She said no problem and even after 3 months it could easily heal on its own. She even told me if I never get pain from it from this point forward and never heals don't even worry about it. I couldn't be so lucky.

So yes, I like you am trying to avoid injections and surgery. In the end will I fold? If it goes back to the pain I felt in beginning stages I will have no choice. But right now I'm able to handle a bad few days here and there.

I seem to suspect it's possibly muscle related but she's not trying to hear that.
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Re: Advice needed for my fissure regiment...

Postby msimon » 02 Jun 2015, 16:46

Spasms can be all of the above. You are wise to hold off on surgery. It really should be a last resort and not until one has given the ointment a few months to work. Do you take a stool softener? I eat a fair amount of protein and as long as I take my softeners things usually stay rather loose.
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
msimon
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Re: Advice needed for my fissure regiment...

Postby fisslayer » 02 Jun 2015, 17:13

msimon is your fissure completely healed?
Yes, I am taking 3 colace stool softners a day, along with Citrucel soluble fiber pills to move things along. Having about 2-3 BM's per day. Will go a few days without bleeding or pain, and then bam, back to pissed off misery. My 2 jars of Whey and Casein protein are collecting dust, along with my 50+ protein bars...
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Re: Advice needed for my fissure regiment...

Postby msimon » 02 Jun 2015, 18:24

My fissure has been healed since 2-3 months after my LIS but I developed and abscess at the LIS incision site and had to have a second surgery and am still healing from that. That has been 4 months. I am a cautionary tale about getting surgery. Infections are rare but do happen and it's been absolute hell ever since. Incontinence is another risk factor of the surgery so it is very important to have a colorectal surgeon who has done many of these. I would be wary of one that wants to do surgery so early on because statistics say that most anal fissures heal on their own. The first line treatment should be ointment, not surgery. Is your Doctor a CRS (colorectal surgeon)? Where are you located? I am in Canada, and with our public health care system, elective surgeries are not taken lightly.
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
msimon
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Re: Advice needed for my fissure regiment...

Postby msimon » 03 Jun 2015, 10:53

Do you have access to Miralax? Many find this to be superior to Colace?
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
msimon
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Posts: 1343
Topics: 64
Joined: 08 Aug 2014, 19:38
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Re: Advice needed for my fissure regiment...

Postby fisslayer » 03 Jun 2015, 12:58

I will take note of the Miralax idea in case the colace does not work well. I am located in California and also am on cheap public health care. My doctor is a "rectal and colon surgeon". He saw me for 2-3 months, put me on nitroglycerin 0.4%, fiber pills, and glycerin suppositories. After those 3 months, he recommended surgery and I said no. I asked him questions, and he said he's done these surgeries very often for the last 10 years, and that he can't promise me I won't have incontinence, that about 10% of his patients end up with that condition.
fisslayer
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