Hemorrhoidectomy 6 weeks ago & still in constant pain HELP!!

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Hemorrhoidectomy 6 weeks ago & still in constant pain HELP!!

Postby Badd825 » 18 Sep 2012, 16:16

I thought I had a fissure, my crs(the third I saw didn't see a fissure). He thought my pain was from internal and external hemorrhoids. He did an exam under anesthesia and confirmed his diagnosis and did hemorrhoidectomy. My pain has always been on the left. Everything the CRS did was on the right (go figure). The 1st CRS I saw also did not see a fissure but did Botox and recommended LIS if this didn't work. I'm so confused my current doctor did not think LIS was needed since he didn't see a fissure but the first guy was ready to do LIS even though he didn't see a fissure. I'm in constant pain. It is a burning stinging pain still on the left side. My CRS thinks its levator. I just don't know what to think. The post op recovery from hemorrhoidectomy was hell. I thought I would be fine at almost 7 weeks post op but here I am in the same pain I had before surgery. I like my current doctor but I wonder if one can have a fissure that can not be seen. Can it take me this long to recover from hemorrhoidectomy. Can this burning stinging pain be levator ani spasms? Please if you have any experience with all this let me know. I have been suffering over 9 months. My ordeal started with removal of clots from thrombosed hemorrhoids back in December. I'm on high fiber and water galore. Somehow I manage to have a difficult time with bowel movements every so often. My stools are initially hard than soft and smooth. I'm at my wits end. Any advice is appreciated. I hope a speedy healing for all
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Re: Hemorrhoidectomy 6 weeks ago & still in constant pain HELP!!

Postby Savaici » 19 Sep 2012, 19:40

So sorry that you are in so much pain, BADD82. 
Hemorrhoid surgery is awful, and I know just how awful as I had three and a thrombosed one. It took me a long time to get over it too. 
If you trust the second CRS, I would go with what he is suggesting. Sometimes LIS is performed during hemorrhoid surgery just to lower the resting pressure there, so he could be wanting to achieve this now. 'burning stinging pain' sounds like spasms, and I too have gone through all the worries about what it can be, from levitor ani to Pudendal neuralgia. Also the pain was in different places, first the right, then left, then just general. 
Have you considered getting another opinion? Awful thought probably. I have not had surgery, but have seen 5 different surgeons...The best for me was going to a teaching hospital. 
Hope that someone might come along with some other thoughts. Thinking of you. Image
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Re: Hemorrhoidectomy 6 weeks ago & still in constant pain HELP!!

Postby Badd825 » 20 Sep 2012, 16:10

savaici, you hit it on the head. I'm worried about pudendal neuralgia as well. I've had a lot of vaginal problems along with rectal problems. Cultures comeback positive so my gyn was fairly sure that it wasn't pudendal nerve involvement. After my post op yesterday it turns out my CRS saw a fissure which he thinks was a result of the surgery. I think it's been there all along and just wasn't diagnosed. This CRS was my third opinion. I saw the head of CRS at mt Sinai in NYC. He did the Botox back in April and told me LIS would be next. I didn't care for him at all. I went for a 2nd opinion and that doctor rushed me and gave me brochures on pelvic floor dysfunction and fiber. She told me come back in 3 months while I stood crying in her office. My current CRS is the 3rd doctor I saw. I really like him but I'm starting to wonder now that after all I went through and still may need another surgery. He didn't want to do LIS without evidence of a fissure but now he sees one and thinks I may need it anyway. Did I even need hemorrhoidectomy or has it been a thight sphincter that's been my problem all along. The first CRS was quick to do LIS without seeing a fissure and I ran for the hills but I wonder now if that was the right thing all along. This CRS had me under anesthesia and didn't think it was necessary. Why the discrepancy in their recommendations? I'm in pain and confused! I do appreciate your response and taking the time to answer me. It sounds like you've had a difficult journey. I hope you heal.
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Re: Hemorrhoidectomy 6 weeks ago & still in constant pain HELP!!

Postby Lauren12 » 21 Sep 2012, 15:55

Hi Badd
I needed a LIS, despite the fact that the chronic fissure I'd had had already healed spontaneously. After all the spasms from the fissure, my anus was tight and I was getting regular minor fissures when passing bowel movements. The surgeon I saw initially couldn't seem to see these minor fissures and kept telling me I had a perfectly normal anus - it was only when I changed surgeons that I learned this was happening (although I suspected it) - the last surgeon could detect the minor fissures. I also had a pain cycle going on, in that I'd been in pain so long from the major fissure that my sensitivity in that area had increased, so the kind of minor fissures that wouldn't trouble someone without my history, felt very painful to me. So I was still getting spasms, despite the major fissure having healed.
The first surgeon banded my piles, removed skin tags and injected botox in an attempt to treat the pain, but I was still in pain once I'd healed from all of this. Then she tried a second lot of botox, which likewise didn't help. The final surgeon knew exactly what was going on and gave me the LIS op, which cured it. It took some time after the op for the pain cycle between anus and brain to downgrade, so that the level of sensation in my anus became normal again, but I'm pain free now.
Post op, my anus apparently still has quite high muscle tone for someone who's had the operation. Each surgeon makes a judgment about how much to cut into the internal sphincter muscle. As a result, I still had a few spasms post op, and I've apparently got a reactive anus, in that even when it's examined it reacts. The final surgeon (I saw three in total) said that the anus is a delicate part of the anatomy and can take some time to settle down after something disrupts it. This is what I've found. He also said that post menopause, the muscle tone in the anus reduces in women and whilst this is a problem for some women, in my case that will be a good thing!
Apparently in the UK, if you don't have an unhealed fissure, you're not offered the LIS operation - although the surgeon who finally cured it said that some people need it, even if they have a healed fissure.
I imagine pain from any source (haemorrhoidectomy as well) would cause muscle spasms in the anus. It is confusing when specialists seem to offer conflicting advice - I've been there, and know how distressing it is to be crying in someone's office. I only know that the LIS brought things into balance for me, and my anus started behaving normally again. It did take quite a while to regain normality though. I saw posts from people saying they'd been pain free after the LIS operation in a matter of days or weeks, whereas it took me months. But a longer recovery doesn't mean it's not effective. If your current specialist is sympathetic and communicates well, why not discuss in depth the advantages of the LIS and ask why the advice has been so conflicting so far, leaving you confused.
On another matter, you say you had advice about fibre. As I'm sure you know, too much fibre can cause problems in the stool department. When I first got a fissure I upped my fibre intake, but my stools became so large and bulky, that I reduced it slightly to reduce the size and consistency of the stool. I've kept it at that slightly reduced level now I'm well. I also concentrate on soluble fibre rather than insoluble. When I was having pain, I was using stool softeners, but now I'm cured I don't use stool softeners any more, but keep regular, soft stools by eating lots of fruit and waterlogged vegetables with fish and chicken, plus probiotics, plus 200 ml of prune juice a day (and it matters which prune juice I've found). I used to suffer constipation before developing the fissure, which was no doubt part of the problem, but never do now.
I wish you all the best and hope a cure for you comes soon.
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Re: Hemorrhoidectomy 6 weeks ago & still in constant pain HELP!!

Postby Badd825 » 21 Sep 2012, 18:39

Lauren, I can't thank you enough for all your information. I believe I have an overly sensitive anus as a result of being in pain for 9 months. I'm actually over sensitive in every sense of the word as I cry at the drop of a hat these days! I think I may be eating too much fiber because my stool is very bulky. I feel like goldilocks trying to find the poop that is just right. I really like my current CRS. He was highly recommended and has a wonderful bedside manner. It still concerns me though he just detected this fissure almost 7 weeks post op. he thinks surgery caused it but my gut tells me it's been there all along and might have been made larger or aggravated by surgery. I'm so afraid of LIS because I wonder if I will ever heal from it. Why haven't I healed from all the stuff I've done already. I see you've been through a lot before you healed so it is possible, I've lost hope. I'm usually the eternal optimist but this has knocked me for a loop. Truthfully I've felt that I needed LIS all along but tried everything else from fear of incontinence and not recovering. When I consented to surgery during exam under anesthesia I really expected that when I woke up I was going to be informed that I had LIS. I was both relieved and disappointed since all along I have felt that a fissure was my problem. And my CRS says LIS won't help levator ani spasms. What if that's what I have. Man oh man this sucks!!! You've given me hope though because it sound like you went through an ordeal and are fine now. It may not be hopeless after all!
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Re: Hemorrhoidectomy 6 weeks ago & still in constant pain HELP!!

Postby Lauren12 » 21 Sep 2012, 22:01

Why not ask your current CRS why the fissure was not detectable before, if it was caused by the surgery. He may have a satisfactory explanation which will reassure you. When I had the LIS surgery, the surgeon told me when visiting me on the ward afterwards that two new fissures had been caused by the surgery, one at the front and one at the back, but that these would now heal because of having had the LIS.
I also recall that I re-fissured frequently in the recovery period because the tissue is puffy and swollen then, making the anus tighter. These were minor fissures, but to me they felt very painful. Of course, I panicked, thinking the operation hadn't worked, and wondering why everyone else I read about had recovered in a few days or weeks. I really wish I could remember everything I learnt at the time - how long it takes scar tissue to settle down for instance. I remember the surgeon said that now I'd had the LIS, I wouldn't get any more major fissures and eventually, I wouldn't get any more minor ones either and this has proved to be the case.
I know what you mean about trying to find the poop that's just right! I feel like a scientist that's trying to come up with the perfect formula. The surgeon said that for me, the aim was to produce narrower but softer stools. It can't always be controlled of course, no matter how rigidly you stick to a good diet. For example dehydration in hot weather can make stools dryer. Most of the time it's fine. On the few days I can't go, I use a glycerin suppository. I was worried about becoming dependent on suppositories, or not being able to go the next day, but the CRS said I wouldn't become dependent, and again was right. When I used a glycerine suppository when I was still recovering however (this was 8 months after the operation!) whatever substance it contains irritated my anus for 48 hours and made me feel very down. Now that my anus is less sensitive, it doesn't do this.
I can understand your concerns about LIS. I think we all have those concerns pre-op. In fact having the procedure assists healing where chronic fissures or recurring fissures are concerned. It also has a very high success rate - somewhere in the region of 95%, if I recall the reading of research I did on line. Of course, I was worried I'd be amongst the 5%, but I think where it doesn't work it may be the person needs to return to have more of the muscle cut into.
I fully understand becoming over sensitive and crying so easily, having always been an optimist before. I did too. That's how this kind of condition can affect you. The CRS I saw had had similar problems himself in the past and said no one who hasn't experienced this sort of pain can understand. I felt so relieved to be understood as I always felt written off by the previous surgeon, as though I was complaining too much about a minor condition.
On the question of healing, I asked the same kind of questions as you. In 1998 at the age of 44, I had a haemorrhoidectomy and recovered just fine and reasonably quickly. No muscle spasms, no fissures from surgery (that I was aware of), no recurring fissures in the recovery period (so far as I was aware) and back to normality quite quickly. But in 2009 when the major fissure first occurred at the age of 55, it took months to heal and even once healed, I had pain from muscle spasm, and regular recurring minor fissures from a tight anus - and a pain cycle developed. I also took months to get back to normal after the LIS op to fix the condition. Why the difference, I don't know. The conditions and circumstances were not exactly identical maybe. It wasn't that I didn't heal readily from the LIS op, I did, the surgeon checked. It was that my anus didn't resolve back to normal for quite a while afterwards and its tightness caused minor fissures and because of the pain cycle, and such muscle spasms as it was able to produce post op with the degree of muscle tone it had left, even minor fissures caused me to experience a lot of pain. Someone who hadn't had these sorts of troubles with their anus probably wouldn't be bothered by a minor fissure.
It might be however, that you'd recover just fine from the LIS procedure, especially since you've been suffering a shorter time. I'd been in pain for almost two years before I had the procedure, and had had haemorrhoids banded and skin tags removed by the previous surgeon during that period, which upgraded the pain cycle by causing more pain. In all of the accounts I've read from people who've had the LIS operation, the vast majority have become pain free earlier than I did, and you may well be amongst them just on the basis of chance alone!
As for worries of incontinence, I think with a good surgeon you won't get this. I don't know what the prevalence of it is across all research. I think it means gas incontinence anyway, rather than poop incontinence. Shortly after the operation, I did think I was going to pass wind, and it turned out to be the other thing, but apparently that's common in the immediate aftermath of the operation. It's never happened again and I have no trouble with bowel control, even with a full bowel where i have to wait to get to a lavatory.
I don't have any experience of levator ani spasms I'm afraid so can't offer anything there. This is where the expertise of the surgeon comes in for both diagnosis and treatment. From talking to the CRS who cured me, I get the impression the anus is a complex area and even though he explained very well, I can't possibly understand on his level of knowledge. I could only keep pressing questions until I got some kind of reassuring answers. I used to go in with a prepared list of questions, and somehow we got through them all!
I'm sorry to have written so much, and know how difficult it can be with anal pain to sit and type, so don't feel pressured to respond. I really wish for you to get a cure soon, and maybe this next thing will be what you need. If you yourself have felt this was fissure related from the beginning, you may be accurate. I felt that, but the hospital I was going to prior to seeing the surgeon who fixed it, could never see any of these minor fissures, and just kept telling me I had a normal anus. The consultant there even referred to "idiopathic pain", that is pain arising from an unknown cause, which made me very distressed. Yet when I saw the new surgeon he could detect the minor fissures, see the anus spasming (which they couldn't seem able to) and knew exactly what the cause was and how to fix it!
Hugs and good wishes for the future.
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Re: Hemorrhoidectomy 6 weeks ago & still in constant pain HELP!!

Postby Savaici » 22 Sep 2012, 11:22

Dear B825,
It is all so confusing, and believe me, know where you are at as am so often in a lot of pain myself. Sitting on a cushion today after a bad couple of days Image
I went through the PN worry (they can do all sorts of tests for that, which I have not had...), and investigated Levitor Ani Syndrome. So difficult to know. I have come to the conclusion (and who knows if it is right) that what I have has come from the fact of having an anal fissure, and scar tissue forming in an already tight anus after it healed. (was always told that my anus was tight when I went for my yearly pap smear...only now come to realise that that is not a good thing. I cannot have surgery, and do not wish to either Image so am going with the anal dilation route which have been at now for a couple of months.
I cannot say yet that I am healing - too scared of jinxing myself - and it is hard to do this. But, there is a slight improvement, and I can feel it. Very few days when there is blood; easier to have a bowel movement without intense pain; less spasms. But, as I said, it is hard to stick to a routine of doing something so foreign. But, am going to stick at it!! It is another way of doing LIS, except I am not cutting anything Image . Not for everyone I know.
Not every doctor knows the answer, for all their years of study. We do have to be the advocate for our own health, question question question. And I always get my medical records to see what they have done, for example.
Thinking of you. Great advice and info from Lauren12 too!
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Re: Hemorrhoidectomy 6 weeks ago & still in constant pain HE

Postby pinpin » 19 Nov 2013, 06:33

I am too at 9 months mark now. And suppose to get LIS done in December to relieve symptoms
07.02.2013 - got open hemorrhoidectomy, leaded to slow healing wound. Link to story
11.12.2013 - LIS surgery
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