Failed fissurectomy

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Failed fissurectomy

Postby Rose » 20 May 2015, 13:18

Hello,
This is my first post but I have read almost all topics. Thank you all for keeping this forum going, it's was one of the things which kept me going during recent hard time..... :thankyou:
I have a chronic fissure. Don't remember exactly when it's started but a long time ago so I have been through usual tearing/healing cycles a lot but every time it was getting worse. Last April I had a Botox injection and it worked so the next 6 months were the best for several years! But in October i had another flare up and that time it wouldn't healed whatever I tried! :cry: My CRS suggested fissurectomy which he peformed at the end of January this year (+Botox again). He estimated that I need 5 days to get back to normal - I wish i knew how wrong he was. I took a month of sick leave as I couldn't functioning properly. The first two month it was a hell. It's still really bad even now, 4 month after the op. I visited him several times and he can see that the fissure is healed BUT!!!! I am in severe pain :cry: !!!!! Every time after BM I experience several pain for several hours, not a sharp pain but more intense burning pain! I can't do anything during that time. It's difficult for me to stand up or walk after BM, it intensifies the pain! ALso, sometimes I can't differentiate between gas and stool, I feel that it's stool every time, can't feel that it's actually a fart. My sphincter is so tight that it difficult to pass gas. Every visit my CRS suggested to wait and try different things like GTN, etc but it didn't work. Last time he offered an advanced flap surgery. I asked about LIS and he said that although LIS is not recommended for women here in the UK, it might be an option for me (although he still would recommend a flap). I need to decide in the next week or so... But I honestly can't understand how a flap can help in my situation (no blood, so a healed fissure but severe pain). I would prefer LIS but the fact that I can't sometimes differentiate between gas and stool means that I have sort of mild incontinence so LIS can make it worse probably.
Any advice from you guys?
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Re: Failed fissurectomy

Postby Savaici » 22 May 2015, 12:55

Rose, you might like to look at posts from one of our Moderators, Suzyljank. She had a lot of pain before her decision to have flap surgery, but she eventually healed. Hope the link might help you: search.php?keywords=&terms=all&author=Suzyljank+&sc=1&sf=firstpost&sr=posts&sk=t&sd=d&st=0&ch=300&t=0&submit=Search
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Re: Failed fissurectomy

Postby Slightlyimperfect » 31 May 2015, 13:13

Hi rose,

Sorry your going through such a bad time, I also has a fissurectomy and botox just before christmas and still not right and 100% worse than it was before, I seem to get to 3-4 weeks have a bit of blood then the healing starts again its really annoying, I hope you get everything Sorted I am also a bit in limbo wondering what my next move is going to be :sadd: we will get there huh :constipated:
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Re: Failed fissurectomy

Postby owmybum » 03 Jun 2015, 03:02

It may be painful scar tissue. This can take a long time to resolve.
I am currently waiting for treatment for nerve damage after my advancement flap. It sounds alot like my symptoms. Maybe get a second opinion??

Read my diary if it helps,... Over on the diaries section xx
OMB.
fissure after hem banding and tag removal feb 11
Pelvic floor therapy
Diltiazem
Botox June 13
Nitro
Internal flap July 14
EUA and polyps removed Nov 14
Diagnosed with neuropathy Jan 15
Diagnosed with HS EDS type 3 (causes poor wound healing )
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Re: Failed fissurectomy

Postby Rose » 03 Jun 2015, 16:32

Thank you all for your replies! :thankyou:

Savaici - thank you, have read all Suzyljank's posts, very inspiring!
Slightlyimperfect and owmybum -thank you! I hope you both will be better soon. I have read all your threads owmybum!

Visited my CRS last Friday. He looked and confirmed what I already suspected - the fissure is still there (although not as bad as before, he said). Last time he said it healed.... Oh, well :cry: ! All this post-surgery recovery suffering for nothing. But at least now I understand where the pain comes from. we had a long discussion and he insisted on a flap although by the end of our conversation he almost changed his mind to LIS. We agreed to try a advanced flap first, so I am scheduled for the end of June. Not sure this is a right decision though - my fissurectomy recovery was so painful so i think a flap might be even more painful !. The pain is still there. I think I had enough. I am so upset. I booked an appointment with my GP on Monday to ask for stronger painkillers. It wasn't my intention but I broke in tears right in his office and felt so guilty afterwards. He was really nice though and listened to me very sympathetically. He prescribed a strong painkiller (fentanyl as a patch not to upset stomach) and antidepressants (citalopram) + something to enhance painkillers (very low dose of amitriptyline). I decided to start in stages to look for any side effects, especially constipation. I now think that maybe it's too much of drugs for me. I always thought that I am a strong person but here i am taking tones of drugs just to be a bit more normal again.

One day I think: ok, let's try this flap thing but another day I think that LIS would be a better option. Still don't know and not sure if I can change my right before the surgery, probably not

all the best :smilyhug:
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Re: Failed fissurectomy

Postby msimon » 03 Jun 2015, 19:52

Rose, I am so sorry to hear of your continued suffering. Have you had children or plan to have children? I ask because this factors in to the LIS incontinence risk. Have you ever had incontinence to stool? Here in North American (Canada at least), advancement flaps are the last resort when a fissure fails to heal after LIS. It is known to be very painful and the success rate is not very high (50-60% comes to mind). If you and your Doctor are concerned about LIS he could do a pressure assessment on you first to determine if your internal sphincter is tight. If it is, then LIS would be the thing to do, I would think. It seems to me if botox helped but not long term then you would be a good candidate for an experienced surgeon to do a conservative LIS (to the top of the fissure only). This is just my 2 cents anyway. I have yet to heal from my surgery 7 months ago but cannot deny how successful this surgery is for most.
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: Failed fissurectomy

Postby Rose » 04 Jun 2015, 14:46

Thank you msimon!
I am really sorry that you are still not completely healed after 7 months. Do you know why it takes longer for you to heal from LIS?

Incontinence as a possible side effect was the main reason why my CRS didn't want to perform LIS. Here in UK they don't normally offer LIS to women although I think i am too old to have more children. I actually asked him about a pressure test but his reply was that it's painful and I don't need one as clinically I have a tight sphincter anyway as he could see. Even passing gas is difficult for me. I have an opposite "incontinence": even if it's gas only i still feel the pressure and it feels like stool. He told me that this strange feeling is sort of incontinence so he is even more concern to perform LIS. But I agree with you, it looks like it would be a good option. I am wondering if I can come at the surgery day and ask him to perform LIS instead of flap just before the op? He actually said that for him LIS is much much easier to perform so he might not mind.....
I asked him about a recovery time after flap. Last time for fissurectomy he said a week and it took me 4 months. Now he actually said 3-4 weeks so I am scared..... Told my boss today that i will be off sick for a while but without any details, I am embarrassed to speak about my condition with my colleagues. I even don't discuss with my friends, only with my family.
All the best,
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Re: Failed fissurectomy

Postby Roidsfizzman » 04 Jun 2015, 18:17

Hi Rose,

I had LIS over a year ago and I would consider myself healed after dealing with a fissure for 3 years. I had issues with the feeling of gas or real soft stool before LIS, and sometimes I would push thinking it was gas and I would get a surprise with a soft stool. After LIS the feeling down there is the same If I have real soft stools, I can not tell the difference between gas or stool. I had the problem before LIS and I have he problem after LIS. If my stools are firm #4 or #5, I have no issues.

I would only do flap as a last resort if my LIS does failed, then, I would have to do flap as I could not do another LIS or I would not be unable to control my stools. I do have less control of soft stools after LIS and I do need to get to a restroom as I can not hold a soft stool a long time. I am a male 64 years of age.

You can read about the flap surgeries on the site.

I wish the best for you on whatever procedure you do.
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Re: Failed fissurectomy

Postby Rose » 27 Aug 2017, 17:14

Hi all,

It has been a while since I wrote last time and I thought that I need to write down the whole story in case if it will help some people! I think I owe much to this forum and all the nice people here who supported me through my darkest time!!!!! It will be a long story so I might write in in several goes!
You can see the beginning of my story above. I never took all the medicine my GP prescribed me in June 2015. I was scared of starting in case if I will become drug dependent. In fact now I realize that by that time I was so mentally and physically exhausted from constant pain that I didn't react adequately to any more or less difficult situation, I couldn't make right decision, I couldn't work effectively, etc. Anyway, I was crying from pain but too scared to start all these drugs. I always took it with me in my bag as a bit of assurance that if pain will become unbearable I will use a patch and start with antidepressants. In fact, the pain was unbearable, but it just shows in what sort of mental state I was. So I came to the operation and said that i don't want a flap and asked for LIS. He sort of immediately agreed which surprised me but we went with the LIS option. The operation went OK and I was home the same day. Next day when I went to toilet I actually had a pain free stool... Pain free after years of suffering! I was really happy but at the same time couldn't believe.... And I was right! Because next day the pain came back... And back again! And it was even worse this time. I went to see my consultant almost immediately and, as usual, he suggested it's too early to see, so suggested to wait! And I waited but the pain didn't go away... In fact it was becoming worse almost every day. I went back to my work but I wasn't functioning properly despite me trying really hard. For me to travel to the office by public transport I need to walk for 10 minutes to get a bus. I remember that the pain was so severe that I couldn't walk it in one go even slowly. In the middle of my work I needed to stand and sort of bend over for a while for pain to ease. Can imagine what people thought :cry: . Also, i couldn't sleep because of the pain. Previously it was severe pain after I had a poo easing off towards the end of the day but by that time the pain became unpredictable. And it started to be dependent of my body position. I found out that I could sleep only in one position without pain.
After several visits to my consultant he admitted that he doesn't know what to do with me :sadd: It was a shock for me! :sadd: that he openly admitted this. He wrote back to my GP and suggested to refer me to a different consultant for the second opinion (he suggested a name).
Then it was waiting and suffering time for me. We didn't go for any holidays for two years and I really wanted. SO we booked tickets and accommodation in Spain for the 5th September 2015. I though that a good holiday and sea swimming might help me and definitely will not make things worse. So I was planning to recover from after poo pain during the second half of the day and go to the beach and swim afternoon. I was actually looking forward to this but at the end of August after a couple for especially painful days I was looking at my bump in the mirror and noticed (really sorry for being graphical) that it's sort of changing. Before it was one colour but I could clearly see some dark spots around my anus, a bit like small bruises. and it was progressing! so in a couple of hours them became quite prominent and.... it burst!!!! so I could clearly see pus coming out of there!!!! So as a result of all these mis-treatments I had developed anal abscess :sadd: :~!@: . It was another blow! The only good thing was that the pain eased a bit when it burst. I phoned NHS line (it was Sunday - typical!) explaining the symptoms and they referred me to out-of-hours GP immediately who scheduled an operation next day. As if like I didn't have enough of them already!. This time anesthesia didn't work really well, I woke up in pain (again!) and felling seek. As a result of developing abscess and this operation we cancelled our Spain holiday (obviously lost money as you can't return low coster flights :cry: . And it was just another thing - I was so much looking forward to it). Still not sure if that operation was necessary. The only thing they did was flushed fluid through the abscess which didn't help as pus was still coming out of there. In fact, in a couple of days another abscess burst near the first one but this time GP didn't refer me to an operation. So i was recovering again, taking time off work. And the recovery process was even more painful (if it's at all possible), as each day a district nurse came to my house to see the wand and put some tampons inside it (ouch!). Pain, pain , and more pain!!!
Meanwhile I was waiting for a letter from NHS with the second consultant details and a visit time. Finally it came and I visited him. He referred me to MRT scan to look for a fistula. Surprisingly I got a quick appointment. Surprisingly, it never showed a fistula which was wrong as the fistula had developed!!!! :x
So he said that I need a more serious ops for him to fix everything: de-roof my fistula and clean up my abscess, and see what else needed to be done. By that time I already had 4 (!) operations so was very skeptical about everything and lost any hope.
Last edited by Rose on 27 Aug 2017, 18:06, edited 1 time in total.
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Re: Failed fissurectomy

Postby Rose » 27 Aug 2017, 17:46

So I waited for the fifth operation and finally it was scheduled to January 2016. Anesthesia was much better this time and i really grateful to a doctor who administrated it to me. So the operation went ok (you never know in advance, do you?) and I was back home again, taking time form work (again) to recover. Another series of a district nurse visit, and painful wound care. So the recovery was VERY slow, the wounds were very deep so they healed slowly. But in March 2016 it was the first time I had a first glimpse of hope for the first time in years!!!! I wasn't pain free yet of course but I could feel that it slowly getting better! My bump was/is completely deformed by 5 operations but on the grand scale of not having pain it didn't matter that much for me as long as it functioned properly :D
So 2016 was a recovery year for me. Very slowly but steady. Things are not 100% perfect (I got occasional reminders of my condition) but in comparison with a constant pain period I feel like i had my life back! I worship my second consultant every day - I am so grateful that he final was able to help me!!!!

So i want to summaries some positives and negatives of my story.
Negatives. I think i was completely mis-treated by my first consultant. Somehow, as a result of his operations, or infected fissure, the abscess developed and he didn't noticed. He continued to treat me from fissure but the situation was more complicated by that time. He was good in getting appointment whenever I needed though .... I went through hell! and as a result I got very bad appraisals at the end of the year at my work :cry: but I knew I wasn;t functioning properly. I regret not telling my boss and colleagues about my condition and especially about how severaly I was affected!
Another negative is that i am still on Laxido. i need my stool to be soft over wise I feel my bum immediately. And there are so many scars down there that it's not as elastic anymore.
Positives. There are some good colorectal surgeons out there :D !!!!! Please believe in your self and that one day you will heal!!! ANd just wanted tom add that one thing that helped me to live through pain all that time was taking hot sitz baths.
I am more than happy to answer any questions to help people.

all the best for all sufferers!!!!
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