Botox and Haemorrhoid banding

My experience with treatment

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Botox and Haemorrhoid banding

Postby Water Bear » 12 Feb 2017, 23:37

Hi everyone, firstly let me say that this forum is a great resource for sufferers of AF!

I should start by saying I'm in Australia, where we have a great health system, and I'm also covered by private insurance so I have not really had to wait very long for treatment.

I developed a fissure shortly after emergency gynaecological surgery around 18 months ago that seemed to have caused some issues with my pelvic floor. The fissure came on slowly, starting with just the slightest tingling after a BM, but after a few months of failing to heal it became deeper and more painful. It was initially misdiagnosed as an external haemorrhoid, so by the time I got the right treatment it had become chronic and started to develop a sentinel tag.

I was referred to a wonderful colorectal surgeon in the middle of last year. She told me to get some GTN ointment from the chemist, which helped my fissure to heal quite quickly and relieved the pain straight away. Unfortunately, my fissure would afterwards recur from time to time for no real reason. I consistently felt the bottom was too tight, even though I have a very high fibre diet and no problems with constipation.

Three days ago I underwent Botox and had small Grade 2 internal haemorrhoids ligated. This was done under general anaesthetic at the same time as a colonoscopy. The worst part was the prep for the colonoscopy, but the doctor wanted to categorically rule out Crohn's disease and ulcerative colitis.

Immediately after my procedure, I had mild urinary retention that was relieved by putting a hot pack against my pelvic floor. I understand this can happen with haemorrhoid banding. I can feel where the needle went in for the Botox, once on each side, but it is not really painful.

The first time I went to the bathroom after the procedure, I very quickly had a lot of pain and a big spasm across my pelvic floor. I nearly fainted from it!

Since then things have become considerably better, perhaps because I have taken paracetamol with codeine each morning a good twenty minutes before going. So far, so good.

It has taken three days for the Botox to relax the sphincter. I feel generally 'looser' down there and it is *so* much easier to have a BM.

Pros and cons? Botox was expensive, at $500 (Australian). It is also not permanent, but I'm hoping it'll buy me some time and maybe help the sphincter 'remember' how to relax. I also think it was important to have the little haemorrhoid treated - it doesn't feel like there's a pillow in the doorway any more! At day three, I'm really quite comfortable except for a little bit of pain with a BM. It's difficult to say whether this is from the Botox or the banding. I'm ready to go back to work.

I realise that I am likely to need the lateral internal sphincterotomy at some stage, but I wanted to try all conservative options before undertaking the surgery. This is mainly because I'm yet to have any babies, and giving birth can cause trauma to all the structures of the pelvic floor, including the anal sphincter - in deciding whether or not to undergo surgery I wanted to consider my lifetime risk of incontinence, not just the risk at this point in my life. If I were to have a baby and the birth caused damage to an already compromised sphincter, I might kick myself...

I hope anyone considering Botox can get something out of my post. All best wishes to you for a speedy recovery from this awful problem!
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Re: Botox and Haemorrhoid banding

Postby Mypoorbutt » 13 Feb 2017, 07:32

Hi WB,
Great to hear your story, sorry to hear you have been suffering though. I too had Botox and it gave me a great deal of relief for about 3 months....I actually felt I could live a normal life again.
Botox can heal fissures my CRS said if they are caught early enough then it heals about 92%. You may be one of the lucky ones especially since it seems to have worked so well s quickly....some people can take 2-6 weeks for the Botox to kick in.
I know that one of our members mama fizz her fissure healed completely from Botox although she still has some tightness.
I wouldn't resign yourself to LIS just yet as lots of people heal very well without it, listen to your doctor and your own body, but also don't put too much emphasis on the risk of incontinence as its really very rare and my CRS says the worst he has seen in over 25 years has been slight marking of underwear.
Good luck and fingers crossed for a smooth recovery
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Re: Botox and Haemorrhoid banding

Postby mamafizz » 14 Feb 2017, 23:41

MPB, Hope your feeling a bit better now..? also it is about 8 weeks after Botox and one month fissure healed. So thanhkful for that. Still having the tightness, and that constant pushing feeling from surrounding muscles, Seems that is a pretty universal symptom, (post any procedure, hem surgery LIS even just with swollen Internal Hems It seems)? I have read many posts that seem to reflect this sensation, once this goes, I should be Good as new.. Can't wait to post symptom free!! I am hopeful this should all start to dwindle away little by little. Most of the posts of the people who had this same symptom seem to have moved on. (if you recall any posts let me know!!) Onward and upward...")
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Re: Botox and Haemorrhoid banding

Postby Water Bear » 17 Feb 2017, 00:23

Thank you for the warm welcome!!

One week in and the Botox is *really* taking effect - when I've gotta go, I've gotta go...

After about four days from my procedures, I started to get a lot of swelling and hard-to-reduce prolapse from the banded haemorrhoid. My surgeon said this is actually not a bad thing - it means the banding is working. It is unpleasant though, so I'm spending a lot of time lying face-down with my bum in the air! This seems to reduce the swelling. And it gives my partner a good laugh!

Mamafizz - congratulations on your healing! That is really great. I've also had your symptom of a 'pushing feeling'. I guess all the muscles in the pelvic floor react when something is happening in the bottom. I have started seeing a pelvic floor physiotherapist as my surgeon said they are worthwhile especially for women.
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Re: Botox and Haemorrhoid banding

Postby mamafizz » 17 Feb 2017, 17:40

WB, Glad you are doing so well so far... I have an appt next week with Physio, she is a pelvic floor specialist, But I heard the sessions are painful, and not sure I should disrupt things anyfurther, my levators and attached muscles are surely in high tension mode still...kind of like a knot feeling, &dull ache higher up and sore, not sure what will take this away, I suppose time. My fissure was healed a month ago and that pain thank God is better, now just need to work on the residual muscle pain. We're getting there:)
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Re: Botox and Haemorrhoid banding

Postby mamafizz » 17 Feb 2017, 17:42

PS The Surgeon did say I had two internal hems close to the tailbone so that could also be aggravating things.. ? Not sure even after 6 children I don't remember having any issues like that before.?
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Re: Botox and Haemorrhoid banding

Postby Water Bear » 20 Feb 2017, 01:12

Mamafizz, I completely understand your hesitation around disturbing the area. I know in my own experience the bottom takes a long time to settle down after something has made it angry! I'd suggest searching on the web for some videos of how pelvic floor physios do their examinations and treatment - it can be a bit confronting! I'm not sure I'm brave enough for the exam yet, my first session was information only.... It is so good to hear your fissure healed, I sincerely hope it never comes back on you!
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Re: Botox and Haemorrhoid banding

Postby mamafizz » 20 Feb 2017, 12:12

Yes, WB I know I am going to go in two weeks, to give it alittle more time to relax. Just feel like I was kicked in the tailbone now... sheesh, Were your hems inside or ext? Wondering if this is what is attributing to my remaining issues. Just wondering what your hem symptoms were and how long did you have them before having banding?
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Re: Botox and Haemorrhoid banding

Postby Water Bear » 22 Feb 2017, 00:58

I developed a troublesome internal haemorrhoid a few months after the fissure became really symptomatic. Apparently the muscle spasm caused by the fissure can increase the pressure in the veins in the bottom and turn them into problematic haemorrhoids.

Mine actually wasn't all that bad, but it would prolapse occasionally. It was never painful, and it never bled. It was just the prolapsing that would freak me out! I had it for less than a year.

I wanted to have it banded because I know a few people who were too embarrassed to get their hems seen to when they just started out, and now they have huge, painful, bleeding, permanently prolapsed ones that can't be treated except with major and very painful surgery. I'm all for getting things treated early!

At the moment, I'm still suffering from major swelling on the side where the banding was done. It's not really painful, but feels like I have a golf ball stuck up my bum, and I'm getting tired of having to reduce the prolapse every time it swells up. I can't really do much walking around without the swelling starting up again. This Friday will be two weeks since the procedure, so I'm hoping things will improve once the banded tissue sloughs off. At the moment, though, I'm trying *really* hard not to regret having the banding done!
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Re: Botox and Haemorrhoid banding

Postby mamafizz » 22 Feb 2017, 11:24

Hello Water Bear. Got it.. The surgeon who did my Botox said i had 2 and one it seemed prolapsed. But I started taking Diosimin and it seems to be shrinking now after 3 weeks. Seems as though that golf ball thing is the universal symptom for butt issues.. lol I cannot wait for that to go away. Right now that is probably the main thing I am dealing with which I suspect is a muscular thing and it is in full swing protection mode Feels like I was kicked in the tailbone so sore, but the Doctor also said the internal hems swell from the fissure like you said and it pulls on the muscles around the tailbone, It can take a while he said. So trying to be patient. .

Now if I could just convince my a** is has nothing else to worry about it will relax and go back to normal.. Prayers for us all... (I hope my internal hems get the message and they can stop swelling now..) I too cant do much.. Usually I am on the go this has totally put the breaks on.. Sheesh..
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