Chronic Anal Fissure

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Chronic Anal Fissure

Postby Sowilo » 09 Mar 2017, 23:28

Hello,

I have been reading posts on this forum and found them to be really helpful. I thought it was about time I said hi. To be honest, I am really feeling at a loss, and I am hoping to find information and support here. It is difficult for family/friends/boyfriend to understand what I am going through. I suppose that's often the case unless you have been through the same situation.

I will try to summarize my fissure history. I believe that I have had smaller acute fissures for years. They would bleed a bit and heal in a couple of days. I noticed a swollen bump just outside my anus a few years ago. When I asked doctors about it, not one person mentioned fissure or sentinel pile.

I have struggled with a hypertonic pelvic floor (predominantly obturator internus muscle spasms) for a few years. This problem developed after three abdominal surgeries between 2012-2014. Also, I have Irritable Bowel Syndrome, constipation dominant, (IBS-C). I believe these conditions have contributed to my current fissure predicament.

In Sept 2016 I developed a fissure that became quite debilitating. Despite trying Nitroglycerine, Diltiazem (calcium channel blockers), sitz baths, modified diet, increased water...the fissure has not healed. I had very painful sphincter spasms to the point where I could not handle an exam without general anesthetic. Some days, I couldn't even walk.

I got 1st botox under general anesthetic last week. 2nd injection is scheduled two weeks from now without g.e. which is terrifying me. Post botox #1, my muscle spasms seem much better; however, surprisingly, the fissure feels much worse!?! I am feeling deep throbbing pain, sharp needle-like sensations when I move my body.

I'm worried that this will never heal. I have not been able to work at all since January. Sickness Employment Insurance runs out in a couple of months. I'm really overwhelmed. I fear a future of pain and poverty.

To make matters worse, I do not feel supported by the general surgeon who performed the exam and did botox. He is a terrible communicator and I do not believe he is taking me seriously. I'm looking into switching to another specialist. (He said, flat out, he will not do Lateral Internal Sphincterotomy. After, I pushed to find out why, he confessed that he has not performed this surgery since graduating only 7 months ago!) This means a really long wait ahead until I can see someone else. It is so hard to see an end to this nightmare.

Thanks for listening. I need to run. Will post more later and will limely have more specific questions. By the way, I would love to find out if anybody on here is from Victoria/Vancouver, Canada.

All the best. :D
Sowilo
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Re: Chronic Anal Fissure

Postby Mypoorbutt » 10 Mar 2017, 03:44

Hi sorry to hear your suffering
I have IBS D and that is what caused my fissure so I guess we are polar opposites with the same resulting problem.
Please don't give up you will get better. Firstly try and get a good CRS I had to change docs 3 times before I found one who was understanding....also Botox can take up to 2/5 weeks to kick in, it stopped my debilitating spasms straight away but I was still getting the burning and throbbing for at least 2/4 weeks, after that I was only in pain for about 20 mins after a BM. So it's still early days in your Botox. I know a few members have healed from the Botox so you may not even need LIS. If you do then a CRS will be more than happy to do a LIS for you and 98% of people heal from that so please don't worry that you are destined for a life of pain because your not it really does get better
Good luck
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Re: Chronic Anal Fissure

Postby chachacha » 10 Mar 2017, 11:08

I trust that you're closer to Victoria but would travel to Vancouver if necessary? I'm in Ontario, but if you scroll down on this website, you will see that there seems to only be one registered CRS in Victoria (Dr. William John Orrom), and a few in the Vancouver area (when you scroll down, there are about 10 surgeons in random order, and then they start with Quebec and are in provincial order further below). I'm in Toronto, but hopefully some other forum members are in your area and can give you some firsthand experience with those listed on this website.

http://cscrs.ca/colon-and-rectal-surgeons-directory/

In any case though, I hope that you can find success soon.
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: Chronic Anal Fissure

Postby Sowilo » 14 Mar 2017, 19:12

Hello Mypoorbutt and chachacha,
I am really grateful for your responses. I did read your replies soon after you posted and thought about what you said. Your words of encouragement have given me some hope. Mypoorbutt it helps to know there is someone else on here with IBS, even if we are on opposite ends of the ibs experience (D versus C). As I was just diagnosed in September with IBS, I am still trying to figure out how to deal with it. It seems that some things which help non-IBS folks with constipation (e.g. increase fiber) can really backfire and cause intestinal spasms with me.
I couldn’t type a response until now though as my head space has been really negative. Feeling frustrated, tired, confused, scared, and overwhelmed. I have been wondering about a lot of things lately. Too many things actually. I might break these thoughts into more than one post because I tend to ramble on – especially with my scattered 'pain brain'.
I’m not sure about this Botox thing yet…The surgeon injected one side of my internal sphincter first (under general anesthetic) to reduce incontinent issues. I am scheduled to have the second injection (without g.a. in a couple of weeks). The first couple of days after my first botox injection, I noticed that the left side was more lax and I was not experiencing the spasms as intently. I was temporarily hopeful. However, a few days after my first botox injection on the left side, the sphincter muscle seems to be tightening again, and the right side feels tighter than usual.
My bowel movements have changed since my first Botox injection. Pre-Botox I would typically have two bm a day. The first bm would be explosive, re-ripping the fissure. The stool would be fairly well-formed and loose consistency. I would experience spasms that lasted most of the day. In the evening, I would need to go to the bathroom again, BMs would be more difficult to pass due to spasms. However, the consistency was similar to the morning bm, loose and well-formed. Once I got through the evening bm experience, I would go to bed, and do it all over again the next day./Post-botox, I am only having one BM in the morning. The stool consistency is really dry and hard, seems to cause abrasions on the way out. In the evening, I feel like I need to have a bm. When I put a finger inside to check, the stool is sitting only about a cm inside. However, the sensation of passing bm does not occur and I am not able to (gently) push the stool out. So, I try to ignore the uncomfortable sensation in my butt and fall asleep. I wonder if the stool sitting in the anal canal overnight is causing it to dry out. I am eating the same things at the same times of day as I did before the botox injection.
My Botox experience so far leaves me wondering about life after a Lateral Internal Sphincterotomy. (LIS). I may need to get this procedure done if Botox does not resolve this nightmare. For those members who have had LIS, do you find that stool becomes lodged in your anal canal between your internal and external anal sphincter muscle? Glad I have place to ask such questions lol
Chachacha thank you for suggesting Dr. Orrom. I am already familiar with him as my current surgeon works out of Dr. Orrom’s office. Apparently, Dr. O is retiring within the year. I was told for a person with a fissure, I could expect to wait about a year to see him. I think that’s why they have hired some new, young surgeons at the office (one of whom is mine). Since my surgeon only graduated 7 months ago, and has not performed LIS outside of school (I certainly do not want to be his first patient/he is resistant to even discuss LIS with me), I want a new surgeon with more experience! It seems that besides Dr. Orrom, there is only one other Colorectal Surgeon on Vancouver Island. He is in Nanaimo and I have been told it will take about a year to see him too. I think my only option is to find someone in Vancouver. Although, I will probably have to wait a year. I will be considering this option after my next Botox injection. This is crazy. It seems that there are way more CRS in the United States and that most Canadian CRS are huddled in Ontario! Why aren't there way more CRS specialists in every city across the country? It also seems that CRS in the US are much quicker to recommend LIS and can perform it immediately. What do members on this forum think about this? I suppose that is due to the privatization of their healthcare system?
Thank you for taking the time to read this. Sorry my posts are so long. I keep all of this stuff in my head all day and night. Beware! I will post again soon with more questions!

Warm Regards
Sowilo
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