Could it be an anal fissure? Please offer your opinion

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Could it be an anal fissure? Please offer your opinion

Postby adfbwubfffef » 20 Apr 2018, 10:17

Hi all,

So I definitely have an external hemorrhoid/skin tag. It seems to be a blend of the two because it sticks out a fair bit (it gets squished by my butt cheeks). I've had it for a while (3 months) and was given a hydrocortisone cream about a month and a half ago which was supposed to help it go away. At the time, I wasn't in much pain at all. I used preparation H and the hydrocortisone cream whenever I felt pain and after every bowel movement, and I was fine.

About 3 weeks later from when I started using the hydrocortisone cream (which is 3 weeks ago from today), the pain started to increase by quite a lot. Now I don't remember at the time, but now I'm sure that the pain seems to only happen AFTER I pass a stool. Passing the stool doesn't hurt at all. I'm on a vegan diet and eat high fiber foods along with a psyllium supplement (recently added). However around 1 hour after I pass the stool, I have this intense pain that lasts for around 4 hours. So one week after this pain started, I went back to the doctor and was prescribed 0.3% nifedipine 1.0% lidocaine ointment. I've been using this for the past 2 weeks however it doesn't seem to help the pain whatsoever. I use it in the morning, after passing my stool, and at night before I sleep. I'm still in pain 1-5 hours after passing my stool. I can barely walk straight, it feels like I have a stick up my ass. I have to lay down or lean to one side to try to get some type of comfort.

Now about a week ago I started thinking hmm, maybe I have an anal fissure? But the thing is there's no blood, and I don't feel pain as I'm passing the stool, only starting 1 hour later. I've seen a bit of bright red blood maybe 7 times total in the past few months, but not recently at all. Would this rule out the possibility of a fissure? Could an external hemorrhoid really cause this much pain? I also don't see why the lidocaine ointment isn't stopping the pain. I went back to the walk-in doctor yesterday and he examined me and couldn't see any fissure, and he also stuck his finger up there (very roughly might I add so he stopped abruptly as I said OUCH) but couldn't detect anything. I'd like to see a colorectal expert but it would take months to get an appointment under my free health care (currently waiting). I'm considering getting the external hemorrhoid removed by a general surgeon and seeing how that goes.

Sorry for this wall of text, I hope someone has had the time to read it. This issue has truly taken over my life for the past month. Luckily I'm not currently working. However I am going on a trip to Europe during the entire month of May and I'm praying that the pain is reduced by then. I'm also going to be starting a full-time job in mid to late June. This sucks.

Also as for sitz baths, I've looked online at some studies and there doesn't seem to be much evidence supporting them. I've tried taking a warm sitz bath after passing a stool but that didn't help whatsoever. What kind of sitz bath has worked for you? Anything else I could try?

Thanks for any input you have to offer.
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Re: Could it be an anal fissure? Please offer your opinion

Postby adfbwubfffef » 20 Apr 2018, 17:51

Something I want to add: I notice that when I have discomfort, my left butt cheek (about an inch or two from the anus) is very swollen. The right one is pretty much fine. What could this be? I'll try to see the doctor again on Monday.
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Re: Could it be an anal fissure? Please offer your opinion

Postby adfbwubfffef » 23 Apr 2018, 00:59

FYI, it is the beginning of an anal abscess. Went to the ER because I couldn't handle it anymore. Hoping the antibiotics work.
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Re: Could it be an anal fissure? Please offer your opinion

Postby clarissairene » 25 Apr 2018, 14:51

I’m so glad you were persistent and went to ER!!!!! How are you feeling now? And how did they diagnose ? Could they see the abscess? My pain is so bad I swear there’s an abcess by my CRS says nope it’s just a fissure even after examining me. I wonder if it’s something up in where he can’t see.
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Re: Could it be an anal fissure? Please offer your opinion

Postby adfbwubfffef » 25 Apr 2018, 16:27

Thanks for the reply.
How am I feeling?
Well I defecated 4 hours ago and have been sitting down for the past 4 hours without any of the usual throbbing pain, so it seems like an improvement starting today but I can't be sure. They said if the antibiotics work, I should notice a reduction in pain after 5-6 days. Today I'm on day 3. Fingers crossed.

How did they diagnose? Could they see the abscess? Funny story actually...
After waiting at the ER for 14 hours on Saturday, getting my butt checked by 5 different people and getting a CT scan, the senior residents concluded that they couldn't detect any abscess, and discharged me with constipation pills (I ended up defecating when I got home and the following morning, I was just stressed at the time and couldn't go at the hospital). For some reason, they couldn't feel the swelling that I have been clearly able to feel (at this point, it runs all along the crack of my left butt cheek and there is a bigger lump closer to the top of my crack). They apparently didn't see anything in the CT scan either.
At the end of the night, I hadn't had anything to eat or drink for about 30 hours so I was pretty fatigued. It seemed like they didn't believe what I was saying and just wanted to get rid of me at that point, since they never offered an explanation for the symptoms I was feeling. I was actually considering the thought that I could have imagined all the pain I've been having.
The next morning I realized that I never got a clear explanation but I was too out of it the previous night to ask them the important questions - I felt deceived. Defecated around 11am, and of course the pain started again. Phew, I wasn't crazy. A few hours later I decided I had to go back and get some answers, because I couldn't just keep living like this even if it wasn't an abscess.
I finally got to see the physician, and he was able to feel something. I was so relieved that someone believed me. He got the one of the resident to take another look at me. They didn't seem to feel an abscess, but they did feel something. They went to review the CT scan, and when they came back, I was told that the next radiologist (who reviews the CT scan to double check) DID see something that the 1st radiologist missed. I couldn't believe it and I was so glad that I went back to the ER. They said there isn't any big enough collection of pus yet so it can't be drained, but there definitely is something there (probably the beginning of an abscess) and they prescribed me Amoxicillin/Clavulanic Acid 875mg/125mg twice a day for 10 days, and referred me to one of their colorectal surgeon specialists for a consultation next Tuesday. Apparently my case is a bit weird, because by now (after a few weeks of pain) an abscess should have already formed). I'm praying that the antibiotics can get rid of it once and for all and that nothing else is wrong with me..
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