AF not visible?

fissure, differential diagnoses

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AF not visible?

Postby chiaseed » 03 Nov 2016, 12:57

30-something woman here. Looking for some insight or help!

So, I was diagnosed with anal fissure five years ago after developing constipation due to an infection of my enteric (gut) nervous system. At the time, i had acute pain, bleeding, those terrible anal muscle spasms, and developed this skin tag, too. :/ Despite sitz baths and NG, it seems to have never healed fully - I haven't had muscle spasms since those first few months, but every few months the fissure will open again for a few days--acute stinging pain with a BM, stings if I put any soap or anything besides warm water on it, there is usually a little bit of blood. The CRS I saw at the time wasn't able to see the fissure with a regular exam, but told me that is not unusual.

I recently saw a CRS in my area (I've moved in the time between) who is supposed to be excellent, head of department at a prestigious place, etc. She didn't see the fissure either, so a few days ago I had an anoscopy. She wanted to confirm the diagnoses, and make sure there were no other issues since I have some other health stuff. I just talked with her and she told me that everything looked healthy and she didn't see a fissure, or the scar tissue you usually see around a fissure... Nothing. She suggested it might actually be muscle pain.

I am really confused. I have had enough ailments to know about a lot of different kinds of pain, unfortunately. This simply does not feel like muscle pain, but feels and acts like a cut/ fissure.

Has anyone else had this issue? Is your dr able to actually see your fissure? Does anyone else have something that seems like a fissure but without scar tissue (though I do have a skin tag)? I am really confused and unsure where to go from here, but god, I would love to poop without fear!

Thanks so much!
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Re: AF not visible?

Postby juzaaaa » 04 Nov 2016, 19:42

Yes it is possible that fissure exist even if doctor doesnt see it. it is also possible to have pain just because muscles are too tight. However goal is the same in both problems trying to make your spinchter more relaxed.
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Re: AF not visible?

Postby chiaseed » 17 Nov 2016, 16:35

Update in case anyone else is dealing with this and my experience/ info is helpful:

Saw a second doctor. Clearly I don't have a deep, classic fissure, but I am having some kind of recurring superficial fissure as my symptoms indicate. I don't think she saw anything, but it also isn't bothering me right now - it just reopens every few months and bothers me for a few days before healing (poorly).

We had a long talk about my bathroom habits, and also diet, and she took a look (gently) with a scope. Forgive me for TMI, but I want to share in case this helps someone else: I generally have very soft and somewhat frequent stools; food seems to move through my system pretty quickly. She also noted that my fecal matter "had a lot of different colors" - indicating that my food was not well-digested.

She said that if food moves too quickly through your system or isn't digested well due to a deficiency in digestive enzymes or some kind of food allergy, your intestine doesn't reabsorb the acid from your food, or your stomach acid/ bile very well. Acid passing through your anal canal and anal opening can be irritating, and if this happening chronically, it can make the area sensitive -- it can cause itching and make you much more likely to get repeated superficial fissures.

Her approach to treating has a few parts:
1) Low acid diet to reduce irritants/ acid you are adding to your system - no caffeine, citrus, tomatoes, soft drinks, decaf coffee only, no spicy food (sad!!!! love spice)
2) Use a nitoglycerin/ lidocaine/ hydrocortisone cream to help speed healing
3) Take digestive enzymes before every meal and see if this changes the frequency/ consistency of stool

If these don't work, the next step is to see if there are any food allergies that are causing the irritating digestive problem that leads to fissure.


---

I've been reading about this a bit today after the appointment, and I have symptoms of Bile Acid Malabsorption/ Diarrhea - in terms of frequency and consistency of stool; also that there is sometimes a green-ish hue, which, if not from a sudden intake of spinach etc, is from bile not being broken down/ reabsorbed properly. Years ago I was told I had IBS because they couldn't figure out my frequent and soft stools - I wonder if this was the issue all along.

Anyway, I am going to try this conservative approach above that she suggested, and see if that keeps things in line.
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