Hi there, Hemorrhoid vs. Fissure

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Hi there, Hemorrhoid vs. Fissure

Postby as90 » 06 Sep 2017, 22:18

Hi everyone,

I'm new here and had to make an account to get some tips. I'm a longtime sufferer of IBS and was taking Amitiza 8mcg off and on. Since the 2nd week of July, I have been battling what I thought was a hemorrhoid. I wash my bottom after I have a bowel movement and I had accidently scratched some of the anal area. I did not notice any blood and everything was fine for the next couple of days. However, I was still having constipation and pain with defecation. My PCP just told me to do Preparation H and Hot sitz baths. I had been using the internal applicator without lubricating it when inserting prepration H into my anal canal. After another couple of weeks, the pain got worse and I saw a Gastroenterologist where I was working and he did a rectal exam as well as based on history, concluded I had an anal fissure. He prescribed Nitroglycerin and Lidocaine. The headaches with nitroglycerin were too severe so I was switched to Nifedipine/Lidocaine for my fissure. I really didn't notice much relief even after 2.5 weeks and still had bowel movements that were hard to pass. What really concerned me was that I would notice streaks of stool after I would wipe myself. This is not something I would experience before.

I also tried optimizing my diet, increased the Amitiza I was taking and started taking Colace as well. I don't care for metamucil so I take Fiber Gummies. I admit I live in Desert so my water intake is not always opitimal. However, I have tried to increase that as well. Last week, I saw another GI specialist back home who did an anoscopy and stated that I did not have fissures, but rather internal hermorrhoids. He did not recommend surgery but instead recommended Hydrocortisone suppositories 25 mg twice a day for two weeks.

I have been on it for 1 week now and I have noticed a little difference, though I still have streaks of bowel left after I poop. How long do you have to keep the suppitory in for the hydrocortisone to have its effect?

Thanks in advance and apologies for the long post as this has been an agonizing couple of months for me.
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Re: Hi there, Hemorrhoid vs. Fissure

Postby patience_and_healing » 08 Sep 2017, 13:23

It would be better to see a colon and rectal specialist. I found that my GI wasn't great at helping me treat my fissure (though better than primary care). I think you can just insert the suppository and as it melts it will have enough time to take effect. Also be sure that you're dealing with hemorrhoids not a fissure because the hydrocortisone thins the skin making it harder for a fissure to heal.
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Re: Hi there, Hemorrhoid vs. Fissure

Postby as90 » 08 Sep 2017, 17:44

Thanks I guess I'm just afraid of going to a surgeon as I don't want to have any surgery done. Im afraid the colorectal surgery would want to do surgery. Wouldn't an anoscopy show a fissure?
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Re: Hi there, Hemorrhoid vs. Fissure

Postby patience_and_healing » 11 Sep 2017, 21:36

An anoscopy would show a fissure but it would be very painful if done while conscious. A good surgeon will do their best to get you to avoid surgery. It really depends on the type of doctor. The first CRS I saw bluntly stated that she was not the type to push surgery, while the second one was indirectly hinting at surgery, and didn't even identify the correct fissure location! I've stuck with the first one for that reason.
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Re: Hi there, Hemorrhoid vs. Fissure

Postby as90 » 06 Oct 2017, 23:14

Thank you for the post. I saw the Proctocologist who said I don't have a fissure but rather 3-4 small internal hermorrhoids that have hypertrophied and he suggested conservative management. I was putting soap to clean the area for a good 1-2 months thinking I had an infected fissure, really, I was drying the area and causing irritation which was exacerbating the problem. The proctocologist recommended Bal-Neol.
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Re: Hi there, Hemorrhoid vs. Fissure

Postby patience_and_healing » 07 Oct 2017, 10:42

Omg, soap on the anus is a huge no-no. It's great that you have a clear diagnosis and you can be on the path to recovery now.
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Re: Hi there, Hemorrhoid vs. Fissure

Postby as90 » 07 Oct 2017, 13:06

It is, still very painful when having bowel movements and I am taking metamucil/miralax on a daily basis. It is not easy. I hope the redness/dryness in my anal canal resolves soon as it is very painful. I am using bal-neol as well.
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Re: Hi there, Hemorrhoid vs. Fissure

Postby patience_and_healing » 09 Oct 2017, 11:10

I think it would be helpful to avoid wiping with toilet paper as much as possible. Get yourself a travel bidet or attach one to the toilet tank line. You will cause less irritation when cleaning up after BMs. Also avoid too many products on the anus for now. Warm sitz baths might be soothing as well, just remember to dry off fully afterwards.
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Re: Hi there, Hemorrhoid vs. Fissure

Postby Dnank » 09 Oct 2017, 13:31

I've had both fissures and hemmorhoids ( internal and external), so I can speak to the differences as I experienced them. It started with a fissure which is 10 times worse than hemmorhoids. The big difference I see is the after-bm spasm pain. With a fissure, it's nearly unbearable and lasts longer. The during-bm pain is also more intense. The pain from hemorrhoids is less intense and dull, still bad but fissure pain is on another level.

It sounds like you need to soften your bm. I had great results with miralax. That and getting off norvasc saved my life.

My problems started 3 to 4 years ago and I've seen my primary doctor (useless), crs who diagnosed the fissure and a gi doc who has banded my internal hemorrhoids. After healing the fissures I have struggled with hemorrhoids. I had banding about a year ago and again a week ago. Banding recovery is brutal but it did help me greatly last year even though he didn't get them all. Hopefully this time around he did.

EDIT: Another thing I noticed with hemmorhoids is that I only see blood on the tp after wiping. With a fissure there was a stripe of blood down the bm. If you see that I think it's probably a fissure. I long ago stopped worryng about being too graphic so sorry if it's too much.
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Re: Hi there, Hemorrhoid vs. Fissure

Postby as90 » 09 Oct 2017, 17:04

Thanks for the tips. I ended up getting sclerotherapy done for the hemorrhoid, still in pain, but hopefully will help with discomfort.
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