Anal fissure and possible fistula

Trying to determine my best option

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Anal fissure and possible fistula

Postby woeisme » 08 May 2019, 03:05

Hello fellow AF friends!

I have been lurking on this board since February. I developed a my second anal fissure in January (my first was back in 2011). I thought I had internal hemorrhoids and went to a GI doc that specializes in a minimally invasive banding technique. As he was doing his exam he found the fissure and prescribed nitro. I thought I would heal fine on the nitro as it was the same prescription I used for my first fissure. However, about 5 weeks in I developed an infection (although I was unaware it was an infection). I thought I was having an allergic reaction. I was supposed to see the GI doc for a follow up after 6 weeks of nitro use but I called and explained how I my rectum was super swollen and I didn't think I could endure a physical exam. I asked if he could prescribe diltiazem instead but he just gave me another script for nitro.

All throughout March I was having crazy symptoms. Constantly in sitz baths, using a heating pad/cold pack, constant throbbing of the region. Finally at the end of March I scheduled an appointment with a colorectal surgeon. One (gentle and only external) look and he thought I had a possible infected fissure. He put me on antibiotics (amoxclav mix) and prescribed diltiazem. Within 24 hours I immediately felt better. I took 20 days of the prescription and honestly felt great! I was sure I was healing. Just had my follow up with the doc 2 weeks ago and said there was a lot of drainage from my AF still :cry: and recommended a fistulotomy. I was crushed! Openly started weeping in his office. Couldn't even ask any follow up questions as I couldn't stop crying.

Once I got home and had a chance to process the news I called his office back to ask whether he was going to do any imaging studies, if there was any other options available besides a fistulotomy, if another round of antibiotics might work to heal the abscess behind the fissure, etc. He told me he wasn't going to do any imaging because his course of action was the same regardless of what he found. if it was only an abscess behind the fissure he would make a small incision under the fissure horizontally and drain the abscess. If there was a fistula tract behind the abscess he would de roof it and lay it open to drain. He didn't think another round of antibiotics would work. I have another follow up with the CRS at the end of May to assess the fissure, see if there is still drainage, and go from there.

I am SUPER hesitant to have the surgery. Ever since I have been on the antibiotics my fissure pain is non existent. I still have traces of blood when I wipe and can still see the fissure (what had been a high internal fissure, as it healed, became an external fissure on a skin tag), but it rarely gives me any pain. The swelling I had in my rectum is also greatly diminished/gone and am not having any draining from my fissure that I am aware of. Many people with fistulas talk about how they can feel the tract internally-I cannot. I find no presence of a tract. I am also super hesitant to have a surgeon cut under my fissure and cause more injury to the area just to find no fistula. I scheduled an appt. with a different CRS for a second opinion. I really think some sort of imaging study needs to be done so they know ahead of time what is going on and don't cut into my sphincter muscle blindly.

Sorry for the novel-just wanted to say hi and tell my story. It has provided me great comfort in the past 3 months to read the stories and helpful suggestions contained in this forum. If anyone has experienced anything like this, please reach out and let me know your story!
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Re: Anal fissure and possible fistula

Postby Pzgre » 08 May 2019, 17:26

Its a good thing you are getting a second opinion. Since your are experiencing no discomfort, i too would be hesitant to get surgery. Hope you get an answer and all is well
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