Hi folks, been missing for a few weeks, just been miserable and lonely and feeling sorry for myself generally !
I finally had my surgeon appointment today and i am rather dissapointed and frustrated. Firstly after tears and a painful examination he told me that the external muscle i control is in good or okay order but the internal one is not so strong :( possibly down to my traumatic labour and my daughters forcep delivery (2 years ago, he also said if i was to have more kids, which is what i want then it would be cessarian which is fine by me to be honest) and he wants to avoid surgery at all costs because its weak. So he is going to examine me again under general anasthetic, give me botox round two and also scrape the fissure of any scar tissure. He is not ruling out LIS but wants to try this first.
Any thoughts or advice would be great please.
Also forgot to say that i have had to come of the Gabapentin as it was giving me terrible tummy problems and i also devloped numb and painful hands at night but im not sure this was the cause as im still getting that but not as bad. The gabapentin was helping the pain though so its getting to the unbearable stage again. Again folks please let me know what you think of it all. xx

Gee so sorry to hear you have so much pain. Glad you got to see your surgeon. If his assessment is correct and your sphincter muscle is weak then I don't think LIS is the way to go because it only makes it weaker. Maybe a fissurectomy but I'm not doctor. Keeping bms soft and sitz baths help some. I sit on a heating pad or something warm when my butt hurts. I had LIS almost a year ago now and it helped heal the fissure but I still get some pain at times. It doesn't take much to irritate the area. I hope you find some relief soon. I think if I would have had a c section years ago I wouldn't have had the problems I do today. I'm a relatively small person and my baby weighed in at 9 lbs. 9 oz. and she was 21 1/2 inches long. Ouch. Suzy

Jackie, I'm probably going to sound like a drug pusher :) But maybe you can try Valium (generic name diazepam) instead of Gabapentin? Valium does nothing for the pain during a BM but I swear it has done wonders for my post-BM spasms. When my doc first prescribed it to me, I thought she was nuts as it's usually used for anxiety, but after a few weeks I'm a believer. The downside is that it can be habit forming with extended use (medical literature usually sets the threshold around 6 months) but that's dosage dependent and you need only a very small daily dose (at least in my case) to reduce the spasms. I take one a few minutes before a BM if I feel a rough BM coming on, or after a BM if it irritated the sphincter and made it spasm.
Gabapentin (known as Neurontin here in the States) is well known for causing peripheral neuropathy as a side effect (usually more pain or aching in the extremities as opposed to traditional neuropathy like tingling or prickly sensations though). I've had issues with neuropathy in the past (hence my screen name here) and would not be surprised in the least if your numb hand sensations were due to the Gabapentin. Actually I would be rather surprised if they were not. Once your nerves become inflamed, they can take some time to settle down (mine took a couple months), so if the weird feelings in your hands really were due to the Gabapentin, they may not subside even for a bit after discontinuation.
Also, I have taken opiate painkillers for my fissure pain before too. They did help, much more so than over the counter stuff like ibuprofen or Tylenol (paracetamol where you are). One of my docs gave me some Percocet (oxycodone) when I was in terrible pain and spasms and it completely eliminated the pain to where I didn't even know the fissure was there for half a day. The downside is that opiates cause constipation, but I didn't have too much of a problem with that as the Miralax was strong enough to overpower it. Actually I haven't seen Miralax lose a battle to much just yet :) I believe where you are certain opiates like codeine are available over the counter -- maybe you can try those for a short while until your next doctor's appointment? I know opiates in general are contraindicated for people with bowel problems, but personally, I got to a point where the pain was so bad I said F'it, the pain needs to be killed now, consequences down the line be damned!
I really do think the diazepam can help if the Gabapentin is giving you problems though. It has no GI side effects for me, doesn't constipate, works quickly, and makes me feel noticeably more relaxed as well. It's no magic bullet but could be an useful short term path in my opinion.

Thanks NG , I am already on an opiate based painkiller Tramadol (not sure what you guys call it) and that is meant to be addictive but i feel it is not working much anymore, i wil take your advice and take another trip to my GP to ask for Valium, i tend to get anxious alot as it is so it can only help, do you know of any side affects, esp tummy ones.
Funny thing too about your name, i didn't actually know what it meant till i read about the symtoms in my hands! lol and i agree with you about it being more pain and aching, i couldn't even pick my daughter up in the morning, than pins and needles, it was excrucuating the first few nights but its bearable now, a student doc diagnosed Carpel Tunnel Syndrome till i went back to another doc who thought it was the Gabapentin
So bring on the valium and 'll keep you posted xxxxx
I'll phone my GP first thing so should have it by lunch time ( can you see them being reluctant to give me it? just wondered as its not been suggested before although if im lucky and get an app with the good doc i see then i cant see it being a problem)

Hi Peachy! I have to respect his professional judgment, I think. If your internal sphincter is weak, he is being prudent in not rushing to LIS. Maybe the second round of botox will give you more relief and time for the sphincter to get stronger. Did he say it might get stronger over time? NG seems to know his stuff about the Gabapentin!
Wonderful pic of you and your daughter, BTW!!

Hey Jackie,
Haha yeah my screen handle probably seems weird to folks who aren't familiar with neurological issues :) My GI system is pretty sensitive and I don't tolerate most drugs well (opiates give me a tummy ache and so do most painkillers, antibiotics REALLY mess me up) but I do fine with Valium. I felt maybe a light stomach cramp with the very first pill but not much after that. I worried a lot about whether it would constipate me and it never did.
Carpel tunnel syndrome and peripheral neuropathy can be very similar, both involve nerve inflammation, it's the extent and scope that differentiates the two symptomatically. In most cases, if the weird sensations are in one hand (I think the docs call them paresthesias), it's likely carpel tunnel, if it's more systemic (as in affects both sides of the body or the arms plus the feet) then it's probably something else...
As for whether the docs would be reluctant to prescribe Valium, that part I'm not sure about. Some might be. Here, I've seen several CRS for my fissure, and only one had Valium as part of her treatment plan. The others said they don't use it for fissures. I was very skeptical and now really feel it works though. The problem I can see is that some docs may see it only as an anti-anxiety drug and not consider it for spasm of involuntary muscles. But you can see here that at least some places have suggested it be used for anal sphincter spasms (search for "valium" about halfway down):
http://emedicine.medscape.com/article/776150-treatment
Valium usually isn't a primary drug of abuse, meaning people don't normally abuse it and get addicted to it the way they do to cocaine or heroin. It's usually secondary -- since it's a sedative, people who use cocaine or heroin or methamphetamines use it to "come down", so they can go to sleep, for example. So I think that's what most docs will watch out for... If they suspect some history of stimulant abuse, they might be reluctant, otherwise I can't see any big concerns (personal opinion only of course). Right now I take 5 mg a day on good, easy days, and up to 30 mg a day on bad ones, which is pretty low as far as Valium goes.
BTW I have had an anxiety disorder since my teenage years (used to be severe but only mild-moderate now) and the Valium does make me feel more relaxed, which is a nice side effect. It is not intended for long term use, so I can't use it for treating my anxiety disorder, but as far as drug side effects go, I can't say this one is too bad.
Good luck!

I think so too Kim...
That sounds all very well and good Peachy !
A fissurectomy which will encourage better healing that and botox, i do hope it helps !
When can they take you in ??
That is a gorjuss photo of you and your daughter ! :D

Hey Jackie, so it should be early evening where you are now -- any progress or news from your doc today? Hope you got some kind of forward progress!

Hey everyone,
Kim just wanted to say the surgeon didnt say it would get stronger or not, never thought to ask, i really should write a list before i go of questions! x
Tabby the surgeon says im now on a waiting list but should be within a couple of weeks, roll on! I have to go to another hospital in another town as thats where he is based but i dont mind (im from there originally and my mum still lived there) God i would travel to Australia if they would help me!
NG Hows you ? I went to the GP this morning, couldnt get the doc i like but thts the NHS for you. He wouldnt give me Valium!! not happy as i really got my hopes up, he says its very addictive so didnt want me on it, instead i got Pregabalin, seems that it is similar to gabapentin so duh! why give me that, i have take it today feel weird, still in pain and my tummy has started playing up again so i wont be carrying on i think, i wish he had just listened to me and tried me on valium, any thoughts on the Pregabalin?
xxxxxxxxxxxxxx
Oops forgot to thank you all for the pic compliments

Sorry to hear that Jackie :( The doc's concerns aren't completely unfounded, as Valium is indeed habit forming. My doc knew this as well but we decided that given the agony I was in, the benefits outweighed the risks. I'll tell you what, with the way my BMs were a few weeks ago, I'd gladly trade an addiction for being fissure free. I've kicked cigarettes before and I can kick another addiction if it develops. But anyway, that's neither here nor there, I suppose. Don't get too distressed over it, I got great results from Valium but that's not necessarily true for everyone. It may well be that it would have done nothing for you since you already tried Gabapentin anyhow...
I'm okay today, had a few more BMs this morning than I'm used to so now I've got some minor stinging down there, but other than that no big deal. Hope you have a good evening and feel better, hopefully the Pregabalin (we know it as Lyrica here in the States) will help some!