General advice needed after many years of problems

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General advice needed after many years of problems

Postby ashcharls » 11 Jun 2023, 05:53

Hey so I'll try and keep this long story brief and get right into it! I'm a 38 year old man. I have always had very delicate skin on around the anus. When I was younger (ie last 15+ years) I remember sometimes I would bleed a little from excessive wiping (this is without an actual fissure so no pain actually pooing just from wiping afterwards).

I started getting a chronic fissure in 2018. It was very mild but kept recurring. I tried everything. Diet. psyllium husk. Increased exercise, increased water. Squatting, sitz baths, I completely stopped wiping in favour of washing the area with water instead. I use the nitroglycerin cream, and nifidepine. Thrush cream. Coconut oil, anusol suppositories, botox etc etc. The only thing that seams to makes things easier was using osmolax which I still take every day and this is now the pain thing I rely on.

After a year a saw a colorectal surgeon who did a colonoscopy and found some internal haemorrhoids which he removed. I'm not sure they were related to my issues. The recovery from this was honestly one of the worst times of my life. I would be on the bring of passing out / vomiting when doing a poo the pain was so bad, and the recovery took months.

After around a year of the same thing, I got a second opinion from another colorectal surgeon who said I had a hypertrophied anal papillae and a slight polyp inside the anus, around 1-2cm in. There was also some scarring from the remove of the haemorrhoids. She gave me some corticosteroid suppositories which didn't do anything.

Continuing my extremely strict regime I am able to keep a proper bleeding fissure at bay, but it's sort of like a losing battle. If I do the slightest thing wrong (forgot to take osmolax, or don't drink enough water, or accidentally eat something that doesn't create the right type of poo) the next day I have a painful bowel movement. In addition to that, I am pretty much unable to use a public bathroom as any wiping with tissue paper which cause the skin to become very irritated. I try and carry wet wipes around with me, but even wiping with those tends to cause the same problem.

I think my problem is two-fold. I am obviously prone to fissures and the anal papillae don't help, but it also feels like there is some kind of dermatological issue going with the skin in that area being very prone to tearing. I have considered LIS but if the issue is dermatological then I'm not sure how much relied that's going to bring...

I'd really appreciate it if anyone had any thoughts or suggestions that I haven't tried.

Thank you!
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Re: General advice needed after many years of problems

Postby Hazey123 » 12 Jun 2023, 13:21

Hey Ashcharls
I can relate totally I’m in kind of in the same situation. Held hostage to my latest BM!! It’s so frustrating and the worst part is the fear of the public bathroom. I can only wash after a BM and can’t deal with wipes even. So it’s very limiting especially when you throw in a few stool softeners/laxatives to keep things soft. I think we all feel like our skin is extra sensitive and prone to tearing because it seems that it is, until fully fully healed. I am 16 months into this hell following surgery. For a while I thought I was just taking ages to heal so I never treated my fissure properly as I never realised I had one. Things like psyllium husk made it much worse. So now I’m just doing nitro cream Movicol and dilation and breathing exercises to relax the pelvic area. The big part here that we don’t realise is the anal spasms that develop with all the pain. This can really delay healing. Have a look at yourfriendlyproctologist on YouTube he explains this very well. Im treating my spasms with dilation. Not much fun but it’s helping a bit altho I still have good days and bad days pain wise. My CRS says the fissure is healing altho often it doesn't feel like it! I’m sorry I’m not full of positive tips as really I’m a bit stuck too in this pain cycle. It’s no fun but you are not alone. We will get better we have to!
AF following skin tag surgery Feb 2022
GTN ointment
sigmoidoscopy & EUA Sept 2022 no fissure found
2nd opinion Jan 2023 fissure diagnosed, diltiazem - allergic
recommended Botox Fissurectomy
3rd opinion - dilation 2x per day plus GTN ….
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Re: General advice needed after many years of problems

Postby ruchgupt » 12 Jun 2023, 18:50

One tip for the wiping - I got a little squeeze bottle with a nozzle and have taken that with me wherever I go - and right before I duck into a stall, I fill it up. It’s helped as I too am sensitive to wiping. The other thing is getting used to not wiping (even w wet wipes) and just dabbing firmly.
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Re: General advice needed after many years of problems

Postby Hazey123 » 13 Jun 2023, 05:50

Oh and thank you ruchgupt for this tip I just ordered a squeezy ear cleaner (I saw this elsewhere on the forum) on Amazon. You reminded me that this could reduce my going out stress…. I get so worried about using other loos! Thank you
AF following skin tag surgery Feb 2022
GTN ointment
sigmoidoscopy & EUA Sept 2022 no fissure found
2nd opinion Jan 2023 fissure diagnosed, diltiazem - allergic
recommended Botox Fissurectomy
3rd opinion - dilation 2x per day plus GTN ….
Hazey123
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Re: General advice needed after many years of problems

Postby Rich44 » 21 Jun 2023, 15:07

Ashcharls - It IS like fighting a losing battle isn't it? You can have 3-5 days of good BM and less pain and then WHAM! You are right back to where you started.

Hazey123 - The main problem I feel based on my personal experience with AF is stress induced tension of the sphincter. When you have stress, you have tension, when you have tension the blood flood to heal the fissure is restricted and you can't heal. Every single BM brings stress and more tension. Then you put more niphedipine on it or Rectiv/nitro or who knows what you take orally. It's a cycle of endless stress and tension.

It could be possible that the primary stress prolonging this for many of you may be from an OUTSIDE source (it was for me for many years). Bad job, bad relationship, financial hardship, anxiety about life, etc. The BM stress is merely adding to the outside stress. I dealt with severe spasms every time I had a BM that went away when I quit my job. It was the job that was causing the spasm. Unfortunately that wasn't enough to to heal the fissure but it did eliminate one major concern. I am also pro-LIS surgery as it worked wonders for me and gave me my life back.
Fissure June 2014 - Oct 2020
Botox, skin tag removed - Feb 2015
Levator Ani Sep 2014 - Feb 2016 (left job, cured!)
LIS, skin tags removed - Oct 2020
Fissure 100% healed - Nov 2020
Still healed as of June 2024
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Re: General advice needed after many years of problems

Postby Hazey123 » 21 Jun 2023, 16:14

Rich44 I’m sure you are right! It’s not easy to control this stress. The AF causes SO much anxiety all on its own. However I can’t have LIS as no surgeon will carry it out on me due to possible incontinence in later life. Seems to be worse for women… not sure why!
AF following skin tag surgery Feb 2022
GTN ointment
sigmoidoscopy & EUA Sept 2022 no fissure found
2nd opinion Jan 2023 fissure diagnosed, diltiazem - allergic
recommended Botox Fissurectomy
3rd opinion - dilation 2x per day plus GTN ….
Hazey123
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Re: General advice needed after many years of problems

Postby Rich44 » 21 Jun 2023, 16:25

Hazey123 wrote:Rich44 I’m sure you are right! It’s not easy to control this stress. The AF causes SO much anxiety all on its own. However I can’t have LIS as no surgeon will carry it out on me due to possible incontinence in later life. Seems to be worse for women… not sure why!
Have they tried to give you an anal manometry test to see if your sphincter was strong enough? I did one of those tests.
Fissure June 2014 - Oct 2020
Botox, skin tag removed - Feb 2015
Levator Ani Sep 2014 - Feb 2016 (left job, cured!)
LIS, skin tags removed - Oct 2020
Fissure 100% healed - Nov 2020
Still healed as of June 2024
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Re: General advice needed after many years of problems

Postby Hazey123 » 22 Jun 2023, 01:36

I had a whole bunch of tests I think I had a pressure test done. My CRS says I have a super strong internal muscle and that’s why I’m dilating to try and relax the area. He still won’t consider LIS for me which I’m partly relieved about altho I know it’s helped a lot of people too so I’m partly disappointed that if this continues forever there’s no ultimate solution. All three CRS I have seen said no to LIS. I am improving a little bit but still on the rollercoaster that I don’t like being on!
AF following skin tag surgery Feb 2022
GTN ointment
sigmoidoscopy & EUA Sept 2022 no fissure found
2nd opinion Jan 2023 fissure diagnosed, diltiazem - allergic
recommended Botox Fissurectomy
3rd opinion - dilation 2x per day plus GTN ….
Hazey123
Proctosphincteranalogist
 
Posts: 101
Topics: 1
Joined: 16 Mar 2023, 17:40
Location: UK
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