Hemorrhoidectomy resulting in the fissure from hell

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Hemorrhoidectomy resulting in the fissure from hell

Postby BCR83 » 02 Dec 2015, 23:54

Not even sure where to start, I have been lurking on these boards for the last 6 months and thought I'd share my experiences with a Hemorrhoidectomy and fissure to help others make informed decisions...

First of all I was/am an extremely healthy, fit 31 yr old male. Training 7 days a week eating an athletes style diet.

I have a family history of hems and fissures although it skipped my parents (my grandparents had severe issues) and I have been the lucky receiver in my generation. Starting about 7 years ago carrying a couch up the stairs I developed a nasty thrombosed hem, it hung around for about 8 weeks and no matter what I did creams, diet, baths 5x times a day, aloe vera etc nothing worked. I saw a surgeon who suggested banding 3 hems at the usual locations with one of them potentially having to be cut out. He mentioned I may have needed 6 weeks off work so I chickened out.

Over the next 7 years I had a minimum of 1 hem occurrence per year lasting 4-8 weeks of inflamed hems, again I spared no expense each time and over the years spent $1000's importing creams, tablets, toilet stools, you name it I bought it. My house looks like a drug store however I came to work out that once those hems have dropped and they have swollen up, the gravity effect from standing, driving anything would delay the healing process. I resorted to lying down for a week pretty much praying they would shrink. Anything else in my experience was a waste of money, baths do provide relief and I came to find cold water swimming was the best for me although in winter that was impossible!

I never experienced bleeding, just itching swelling and pain. However most recently I had a bad flare up prior to an overseas snowboarding and hiking trip in New Zealand with my GF. so the week before I layer down almost motionless for 4 days in which the swelling subsided but as I got off the plane and was walking through the airport terminal i could feel the gravity pulling it down, basically ruined my holiday and I had enough of it

Upon returning I visited a local CRS who advised my current hem would have to be cut. I did not seek a second opinion or research new advancements (regretfully)

I had the surgery, surgeon mentioned there was too much trauma to band the other two hence I went through the surgery to cut one nasty hem.

And so it begins....

CRS advised I just needed a movicol after the surgery, well this biggest load of horse $hit and only now from reading the boards did I work out how much of mistake that was. Firstly, upon waking from anaesthesia I was given two sandwiches which formed a nice plug, compacted from anaesthetic and being told just to eat a "normal" diet and drink some water...

I basically exploded at my first, second and third bowel movements post op. I have never experienced pain like this before in my life, my parents live in a big house and after each BM had neighbours calling concerned as they heard screaming/yelling. They got used to it over the next 2 weeks.

There was the most severe contractions/spasms post BM that lasted 3-4 hours and even just when sitting down it was just immeasurable on a pain scale. So much searing and burning pain that I would almost jump from the toilet into the bath and just collapse.

Went back to CRS approx 2.5 weeks later (laying down in back seat of car as I could not sit) he spread my cheeks and nearly got a reflex kick in the face as he said it looks ok but we might do EUA to check if anything is going on, he warned it may cause more damage so I chickened out.

Over the next 9 weeks I suffered immensely, with every BM. My daily drugs were:

Targin (modified opiate to reduce opiate constipation) x2
Ibuprofren x6
Paracetemol x 4
Valium x 1

Movicol softener x3
metamucil x 3
Lactulose x 2
magnesium
multivitamins
3l water
arnica tablets (reduces swelling)
horse chestnut (vein strengthener)

I actually went back to work at week 6 and lost about 5 kgs - I could not sit properly in meetings and I travel 3.5 hours a day in heavy traffic so this was just a nightmare come to reality, BM pain was still 5-6/10 and I always without fail would get the most severe stinging burning pain after standing for more than 10 minutes. The only thing that relieves my burning pain when I was away from the bath was a heated wheat pack which I would sit on in my car and then drive 1.5 hours to my office. The heat pack stopped the burning spasms..... Sometimes I would just creep out at morning tea and sit in my car on the wheat pack so I could function....

In between all of this I went back to hospital on a morphine pump (week 3-4) to manage pain however as soon as I got home it was exactly the same.

Out of desperation I visited one of the worlds most qualified rectal surgeons - (Professor Michael Solomon) who went in with a scope and commented that I had one of the nastiest fissures he has seen in a long time, running from the outside the rectum all the way through (the hem wound split and joined to make this super fissure of sorts)

He commented it would not heal regardless of time, all the useless treatments I was administering he advised were useless and like trying to swim against a current, I needed either botox or LIS period. He also mentioned he has been in the game for 30 years and sternly advised me that my "cocktail of softeners" being used for 3-6 months is much more of his concern and warned that unless I want to be seeing him for the next ten years managing chronic constipation issues that I must correct the fissure and get off all the softeners & laxatives ( he was very vocal about this )

I was sceptical about another cut, so I visited another CRS for a second opinion. He examined me and referred to a place that can measure anal muscle tone and strength. Basically my sphincter was so tight and not from stensosis but from the body protecting itself from the fissure that the CRS said its like using an blocked icing nozzle to decorate a cake.... He commented that I can use as much softeners as I want, but my nozzle is closed/blocked and every time you have a BM you are ripping it open and theres nothing you can take to fix that. Your sphincter involuntarily contracts from the pain and you cannot loosen it unless you were to take 5 or more valiums which is bordering on dangerous (don't do that!)

He focuses on HAL-RAR surgery and believes in a less is more method for rectal issues... He suggested Botox for my fissure and has done more than 2500 botox shots, he commented that my tendency in the sphincter is to heavily contract with trauma thus doing LIS wont actually help in the short term, I will actually counter it with a contracted sphincter and may cause more damage or delayed healing, he said in my instance that the LIS is the last resort.

I took his advice and had the Botox, what he did was remove all the scar tissue that was developing as my passage was healing in a deformed state. He also injected steroids into the wound to minimise scar tissue build up.

So we are now about week 15 of this ordeal and I had my first pain free BM. I was expected and waiting post BM for the stinging burning etc... It never came. I have difficulty managing wind and my GF has been recipient of some of that unfortunately, also I was immediately able to cut back on all the garbage was taking. Day three, I was taking one metamucil and half a movicol and thats it. Still maintain my water and diet but cut all pain killers and drugs.

However two weeks later I have two nasty haemorrhoids (this situation feels like its never going to end) so I am back lying down icing and bathing.

CRS mentioned that with a loose/open sphincter the hems have a chance to free themselves plus I did go to the gym the 3rd day out of surgery (I felt fine) however I believe this aggravated the situation, CRS mentioned when they insert the tool that this causes a lot of bruising and swelling and may have provoked hems.

So I am praying (as is my family who are sick of hearing about this) the hems go away soon, however I would say for the immense pain and suffering I was experiencing to do your research, get second/third opinions and you can/should consider botox to relieve your issues.

You will hear more of the horror stories than the positive stories as thats the nature of forums, however I had a terrible hemoorhoidectomy experience ( which is I believe is partly due to my tight sphincter)

I did not select the previous to CRS to do the botox as they did not do it often enough, my CRS (DR Darren Gold) in Sydney has done so many of these and gave me a lot of confidence in why this was the more sensible step to take in the rectification process. I was under anaesthetic for 20 minutes and felt fine the next day with no pain in BM's.

Apologies for the long story, I just hope anyone going through what I went through can maybe see there are options and not to listen everyones negatives...The lesson I learnt was to pick your surgeon carefully - there are too many cowboys out there and I made the mistake of rushing the first op. If a surgeon specialises in particular procedure that may also be a better choice for that particular procedure you need.

Happy to answer any questions!
BCR83
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Re: Hemorrhoidectomy resulting in the fissure from hell

Postby msimon » 03 Dec 2015, 15:39

I'm so sorry to hear of your experience, but thank you for sharing. It is helpful for others to know they are not alone when this happens to them. I, myself, went through the dreaded hemorrhiodectomy surgery and completely agree with the level of agony you shared.

I am confused by your Doctor's approach though in avoiding the LIS. Can't say I've heard that before.

"he commented that my tendency in the sphincter is to heavily contract with trauma thus doing LIS wont actually help in the short term, I will actually counter it with a contracted sphincter and may cause more damage or delayed healing, he said in my instance that the LIS is the last resort."

This, however, is what happened to me. I think my CRS thought I was crazy. The injury of the LIS made my pelvic floor and sphincters go crazy. I did go on to eventually heal, which the botox did not do for me. I hope it works for you but am concerned about the long-term, which is why I went for the LIS.

I did want to mention that is seems rather common for botox to flare up hemmies. It has happened to me as well as others on here. Fortunately, it seems to be a temporary problem.

Keep us posted on how you are doing.
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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