Hello All,

I find this forum very beneficial and want to pay it forward by document my experience in hope that it will help someone with this debilitating condition.

I'm in my 30s and consider myself active and live a healthy lifestyle. It all started in Sept 2015 when I was taking antibiotics and it caused my stool to be hard and as a result you guessed it...AF. I've tried all of the conservative methods to heal:

1) Cream (both diltiazem and nitroglycerin)
2) Change diet (lots of fruits and veggies and eliminated alcohol and caffeine)
3) Manuka honey. This provided relief from the AF but it would re-tear
4) Fasted for 10 days without food (only water) hoping that if I don't have a BM for 10 days, my body would be well rested to heal the AF.
5) Manual dilation. I bought the dilation kit and very slowly tried to dilate my anus
6) Tried a series of enema (sea salt, coffee)

I went through all of these in a span of 20 months, but my AF didn't heal. I would be fine for a few weeks, but if my stool was any bigger than my thumb then my AF would re-tear. The longest I've gone without a re-tear was two months, this was from trying the manual dilation. Before that, the longest was 2-3 weeks. The problem was the hole was too small so anytime it had to stretch, the AF would re-tear. I told myself that if the manual dilation didn't work then I would get the surgery.

I had Fissuretomy and LIS yesterday (5/30/17) performed by an experienced CRS. Checked in was at 1pm and had all of my vitals measured. For anesthesia, since the procedures would only take about 10 mins, I was told that local anesthesia would be fine. However, the needles for the local anesthesia would hurt alot so to make me more comfortable, they sedated and put me to sleep before applying the local anesthesia. The anesthesiologist told me that this is not technically general anesthesia and will be better for my recovery time and he was right. I was wheeled in to the OR at 2:30pm and the next thing I knew, I was in the recovery room. CRS told me that it only took him 9 mins to do both Fissurectomy and LIS. He said that he usually performs both for someone that has AF as long as I have to give the best chance to heal.

My recovery time was very quick, I went home at 3:45pm. When I got home, I drank alot of water and ate some congee and soup for dinner. I was surprised to even have an appetite, no nausea feeling at all. I think that's because of the recovery from the sedation instead of the general anesthesia. Around 7pm, my anesthesia started to wore off and the pain started. I could feel the swelling from my anus. I was prescribed oxycodone but i refused to take it fearing constipation. I rather deal with the short term pain rather than the pain from constipation and hard stool. I took ibuprofen and aleve instead. They seemed to help a little but was stilll in a lot of pain. I also took 2 fiber supplement pills (metamucil the pill form) which is very little because the serving size calls for 6 pills. Not knowing how my body would react to the fiber pills, I wanted to keep it small and test it out first.

I kept the dressing on my butt and went to bed at 10pm. I woke up at 2am from the pain and had to take off the dressing to go do a sitz bath. I felt better after the sitz bath and went back to bed and woke up at 8am. Still in pain, but seems to be less than last night. After waking up, I drank water and ate some oatmeal and strawberries for breakfast and had my first BM. I took 2 aleve before the BM and I was expecting the worst bc of the pain, but surprisingly it wasn't that bad. I didn't feel the pain from the fissure as the stool was coming out (they were decent size). The pain seems to be coming from the swelling or the incision site. Took another sitz bath after BM and it helped with the pain. The pain is still there, but I would say it was a little less than yesterday. I hope to improve everyday and heal soon. I will update again tomorrow for day 2 post op :) If I can help answer any questions, please let me know.

Post Op Day 2

Had a good sleep last night, the pain/soreness seem to be lessening each day. I'm able to move around the house a little easier today. In terms of pain meds, I've taken only 2 220mg aleve every 12 hours. Also, still taken 2 fiber supplement pills a day. So far I've been able to not have to take stool softener. Had another BM this morning with little pain with the exception of the soreness. Still seeing blood on tissue paper from incision site which is expected. In terms of diet, I'm eating oatmeal for breakfast, fruits (apples, mangoes, tangerines), salads, congee, and chicken noodle soups. Also, had some stir fry veggies with chicken meatballs and pulled pork.

For those that are curious about how much my surgery cost, below is the breakdown. These are fees in Portland, OR, but should give you a decent ballpark. There are three fees: Facility, Surgeon and Anesthesiologist. These are in network fees that have been negotiated with my insurance company.

Facility: $1,900. I had my surgery at a surgery center where they specialize in outpatient surgery and not at a hospital. If I had it at a hospital, the costs would have been 4x ~$7,500.
Surgeon: $1000
Anesthesiologist: $600
Total: $3,500

I have decent insurance so I will pay ~$1,200 out of pocket.

Hey kevinpdx,
I'm most likely undergoing the same procedure soon and have tried many of the same things you have. I'm following your diary so thank you so much for the updates.
Best wishes for a speedy recovery! Please continue logging!

Day 3:

I noticed a stinging sharp pain similar to AF pain but without the spasm through out the night last night. The aching pain has subsided somewhat, but the stinging pain seems to be taken over. I'm still not taking any oxycodone that was prescribed, only aleve for now. Aleve does seem to help with the aching, but not the stinging so i'm going to switch over to ibuprofen today to see if that will help with the stinging. I've trained my body over the years to have a BM every morning upon waking up and drinking a glass of water and I'm surprised that my BM has been so regular even after surgery. My BM decent today, I can tell that my sphincter is opening up bigger than before to accommodate the larger stool which is a good sign. There was some pain and stinging, but not too bad. I did sitz bath right after and that helped. My diet has been pretty consistent, lots of veggies and fruits and chicken noodle soup. I might try to eat a slice of pizza tonight to see how my body will respond. Going to lay on the couch and watch alot of Netflix today to relax.

Sgsh24, have you schedule your surgery yet? I was pretty scared that's why it took me almost two years to tried everything I could before deciding on surgery. At the end of the day you have to ask yourself, can I live with this for the rest of my life? If the answer is no and you have tried all of the conservative measures then it's time to get the surgery. What pushed me to get the surgery too is I didn't want to keep continue doing what I was doing and risk injuring it further and making it worst and at that point surgery might even be too late. Hope you get well soon!

Had mine about 10 days before yours:

Lessons:
Eat fruit every meal. Eat lots of veggies and salads. Eliminate all breads and cereals they add bulk.
Eat ground flax seed a couple times per day. 1tbsp at a time. I miss it with dried fruit or fresh fruit and warm milk.
Cherries are fantastic for keeping your poop moving - eating them all day is helping me tons Thank god they are in season.
Avoid preserved meats. For me fish and chicken have been best. Tuna fish with Mango or other fruit is really good to get protein without constipation.
In terms of alcohol - i have found that wine seems to help heal hemmoroids.
Caffeine - I have found Cocacola is the best fastest pain killer for rear end pain from fissures and hemmoroids. It has helped after surgety. Coke was better than any pain killer i have taken whether it was over the counter or prescription. Combined with tylenol it is best combo for pain.

Ibuprofen after pooping is a must - up to 800mg if you need it
Ice - is a lifesafer. Get one of those ice tubes from your doctor and place the tube of ice right on your anus. A frozen water bottle might work too.
Don't wipe your butt with toilet paper- it makes the pain way worse and scrapes against the sore areas. Instead get in the shower right away and wash the poop off with water. after the shower sit in a bath til the pain is manageable.

Pain killers didn't work for me and made me super emotional. Motrin has been the best thing to reduce swelling along with ice.

A few other tips-- take a baby wipe or gauze pad or even tissue paper fold it into about a 2-3 inch square soak it with Witchhazel and put it right up next to your anus. Use plenty of witchhazel is key. Do this for the first week or so after surgery or as needed til bleeding stops. It really helps reduce swelling and pain, plus it keeps it clean up there.

Take extra vitamin C and maybe E to help give your body tools to heal.

Also after 12 days I am off all pain meds and no motrin either. I am still taking ginger capsules every morining though. Ginger helps reduce inflammation and pain some too.

Hope this all helps someone else endure their recovery. The whole fissure and surgery experience has been excruciating!!! Good luck and god bless anyone suffering from this!

Kevinpdx I haven't scheduled yet, I get a 2nd opinion on Monday 6/5/17 And will decide then but after reading many posts and not getting any better, I think I need the surgery. You're right, I can NOT live like this any longer. For me the itching is what is unbearable, it wakes me up at night and bothers me during the day, at work and when I'm around ppl and it's all I can think about. I'm gonna also very scared of the surgery, but your story is helping me so thank you!

In the meantime try to reduce the throughput on your body. Soups are great for making you feel full with less bulk. The flax seed can help keep u regular, just don't overdo any fibers either. For me I found too much finer could make a fissure worse. Eliminate all bread and flour. For me bread and flour is the worst. Avoid eating too many nuts also. i found they tended to plug me up. Make sure you are gettin probiotics and enzymes to help your body fully process food better. A lot of the laxatives out there kill the good bacteria in your gut which contributes to hard poops.

One other thing to consider is stress. My AF started and occurred during a time of a lot of stressors in my life. If yyou can reduce stress in general it should help. Easier said than done I know, but perhaps realizing that stress can contribute might help you to deal with it better. Foods and things that lower stress might help. So matbe consider some relaxing teas like peppermint tea, etc. whatever helps you.

Coffee also was a big cause of problems for me. I was down to one cup a day or less before surgery. Now I have been able to. Increase it some after surgery sgain.

I found most hemmoroid medications made my fissure worse, once I started treating it like a wound to heal it, it started doing better. But, in the end it was food that unexpectedly made me constipated that would not allow it to heal. I travel a lot for work, and the result of eating out a lot causes problems because you have no idea exactly what is in your food that might be causing constipation.

Hope it helps

Thank you asspainsorebutt! Yes this does help. I've changed my diet to eliminate red meat, caffeine, alcohol, soda and fried foods. I'll continue with enzymes and veggies and add soup, great advice!

Day 5 & 6:

The swelling and pain has decreased by about 50%. I'm still only taking Advil and Aleve for now. I can walk a little better now, but at snail pace still. It was a nice day and I went for a walk today around the neighborhood, it was good to get fresh air and hear the birds chirping. I had 3 BM on Day 5 and 2 on Day 6, not sure what's going on, maybe my body is trying to reset? On Day 6, I started seeing blood streaks in my stool coming from the fissure. There was pain during the BM, but minimal pain afterwards. The pain is stinging sensation just like the fissure, I'm a little worried but will try to stay positive.