Hi Everyone,
I am hoping for your advice and support as I am becoming increasingly hopeless and depressed by the day. I am a new Mom with a beautiful 4 month old at home. I have struggled with fissures since college…off and on for 10+ years. Had a really bad one about 5 years ago, the proctologist I saw at the time actually cauterized it in an attempt to help it heal (which I have since found is unheard of). It has continued to cause pain and issues since.
I became pregnant last year and feared what the pregnancy would do to my bowel routine and recurring fissure. Ironically, I have never been so regular and pain-free in all of my life. It was shocking. I have since heard that the increased blood flow to the area due to the pregnancy most likely had something to do with it.
I had a rough delivery with my daughter, pushed for 3 ½ hours until they realized she was facing the wrong way!! I ended up with an episiotomy, but ended up tearing beyond that anyways with a suction assistance. As far as I know, I believe it was just a 2nd degree tear and did not affect my sphincter muscles. With the pain meds, limited mobility, dehydration due to breast-feeding, and poor diet since new Moms eat whatever they can whenever they can in those first few weeks…I became constipated despite taking stool softeners three times a day. I had a horrible bowel movement in which I felt tearing.
I went to my OB/Gyn to make sure I didn’t harm the fragile area that was trying to heal or pop any stitches…which I did not. She said she didn’t see anything in my rectal area, but prescribed me with the standard hydrocortisone suppositories, muscle relaxers, and sitz bath. A month later, she referred me to a CRS.
I sadly enough was excited for my rectal exam so I could finally get some answers and relief. The woman was horrible! She did not listen to my history and kept cutting me off. She looked at the area and said, “there is a clear tear there” and told me to eat more fiber, drink more water, and to try some diltiazem/lidocaine topical. Spent less than five minutes with me and told me to come back in 3 months! I was in complete and utter shock. I cried with disappointment. The woman charged me $800 for the visit by the way.
After two weeks the pain became even worse and my husband had to start staying home to care for our daughter as I was bedbound lying on my side in the fetal position due to the pain. I went to another CRS the following week who was much more compassionate than the other (doesn’t take much). She said I had “at least 3 fissures” that she could see. She discussed the standard 3 options of conservative creams/meds/diet, botox, and LIS. She stated she has found botox to be only 50% successful and doesn’t even do it for that reason, but would refer me if I chose that route. She stated that I could continue on with the conservative route but with my history, she doubted it would heal, and if it did it would take a long time and ultimately open up again at some point (which has been my experience). She felt that LIS was probably the best option for me.
However, she then stated that most of the other CRSs she worked with would recommend it for me due to my age (32), traumatic birth, and plan to have more children in the future. She said all those things put me at risk for further trauma/weakening of the area with any subsequent deliveries, which would increase my risk for incontinence down the road. She felt it was a disservice to not recommend it to me but stated only I can weigh the risk vs. benefit as she cannot see into the future and predict how my future deliveries go. She stated she was very conservative in her technique as she would rather have to do the surgery twice than be too aggressive the first time around.
She was very informative and honest, but not as definitive as I would have liked obviously. It just made me so nervous that no one else would do it. I tentatively scheduled the surgery but started to have some relief so I canceled it. Now have had yet another setback and desperately just want to get this over with and have the surgery. I can’t live like this anymore. I am not enjoying life, nor am I able to care for my daughter in the way I had intended. I could use some advice. Has anyone out there been in this situation and gone on to have more children without issues? I know deep down that this will not resolve without intervention and this is the only option, but I just can’t seem to make the commitment to make the decision. Please please please help! Thank you so much for your time. This is such a terrible condition that I wouldn’t wish on my worst enemy. It is very easily worse than childbirth in my experience.

Hi There,
I also had a daughter 4 months ago and developed 2 fissures due to dejydration and stress. The pain is so much worse than childbirth and very depressing when it impacts your ability to enjoy your new baby. I also had an episiotomy which was a level 2 like yours. I don't have the fissude history you have though but I am close to your same age. I saw 2 CRS about my issue. One said similar things as your last CRS regarding the surgery being more risky for women who have had or will have babies. My other CRS who is said to be one of the best in my state did not even mention it. He took the time to meaure my sphincter tone which sounds like it correlates to risk.

There are stories out there of women who have had LIS after baby or before another and have been fine just as they are stores of those who have not. That is where you have to decide about risk. My fisdure is starting to heal with meds, but I've made the decision that if it comes back I will have the surgery rigt away as this is no life to live. My plan would be to have my CRS check my resting anal pressure to determine risk of incontenance and if my pressure were already low or normal I would not do it.

My plan if I do have surgery is to have elective c-sections with future pregnancies so as to avoid the risk of incontenance. In the end, the risk is there but I believe that a doctor can take some measures to check tone and pressure to help you make a more informed decision, and c section is always an option too. This is just my thought process and ultimately I think you will know when/if the benefits outweigh the risks.

Sorry you are going throgh this, but congratulations on yor daughter. One day I plan to tell mine that she ripped me a new a-hole as a gift when she entered this world ;)

P.S forgive all the typing errors, I still have not mastered typing on an iPhone while nursing

Hi,
I was wondering if you've decided on surgery or not. I have developed a new fissure and my others are not improving.

I went to my CRS today and he wants to do Botox before trying surgery because of my risk factors (same as yours) for complications from surgery. I am not too keen on Botox because it is so much less effective and I want my life back.

Anyway, I am getting a second opinion tomorrow, but wanted to see where your though process is since we are in a similar situation.

My doc did mention that an anal ultrasound could be done to determine if any damage has occurred to my sphincter muscle from childbirth. Having any damage would be a good reason not to have surgery. I thought I would mention it as it could be helpful in your decision making process

Hi Broncosgirl,
Sorry for the delay in response. Thank you so much for taking the time to reply. I am so sorry to hear of your setback. Hopefully, your visit today will help with your decision.

I have still yet to make mine. Although my doctor was really informative about options and her opinion, she did not discuss much with me about measuring my tone or determining extent of damage from my childbirth. I don't know if it was something she could not measure because of how much pain, muscle guarding, and inflammation was present. I assumed that measuring tone would be kind of skewed with a painful, flared up fissure. It seems like anyone's tone would be high with the constant guarding and spasming of an acute fissure. I remember reading that true resting muscle tone cannot be measured until you are under the affects of anesthesia as it removes those variables (muscle guarding) to truly see what is left. Again, my doctor did not mention objective measurements, she just kind of stated that my sphincter tone was tight seemingly based purely on my history. She said for whatever reason, I was "built that way" which is why this has been a consistent struggle for years and years.

To address your situation though, she did specifically say that if I had just walked in with my first experience with fissures post partum, she would stay on the conservative path for me and not recommend the surgery. It was because of my history alone that led to her recommendation. If this makes sense, my fissures were aggravated by multiple postpartum factors, not caused by them. It sounds like your experience may be the opposite. Did you develop the fissure actually during childbirth or was it a hard bowl movement later?? If you have not had fissures previously I would imagine that your true resting tone is probably closer to the normal, but obviously high right now due to constant pain and spasming. Not sure what meds you are on, but if you were having some success with anal muscle relaxants that could potentially be a good sign for botox.

Here is my understanding of botox. Yes botox is temporary and can be ineffective, however, it all depends on the resting tone. As stated above, if your tone is currently high due to the fissure, but typically within normal range fissure-free, you are an ideal candidate for botox. It will relax the muscle enough for a few months to allow the fissure to heal. With a healed fissure, you will stop spasming and your muscle tone will decrease hopefully to your normal pressure. For people like me, with constant fissures and assumingly high tone, it will help the muscle relax, but it is just a band-aid as my tone will ultimately return to being high as that is my "normal". Therefore, beneficial in the short-term but not the long...for me.

I am not sure if this made any sense. I am horrible at explaining things. If I had your history and was planning on having more children, I think I would go for the botox first, if that helps. For me, it just seems like an expensive Band-Aid but for you it might give you the time you need to heal on your own. Not sure what your insurance is like as I understand that can be a factor too. We have horrible insurance with an insanely high deductible. My two CRS consultations currently total $1000 out of pocket. The surgery will be too. Which is why I am here trying to get help with my decision without having to keep going back for further visits. When you are in this much pain, money shouldn't be an issue, but with a new baby at home and me out of work, sadly it is. I hope you are in a better boat than me.

Well I will stop my rambling now. Good luck today. I will be thinking of you and sending positive thoughts. Let me know how it goes. Again, so sorry about your setback. Just look at your little one when you are feeling low...that will at least always get a smile.

Hi there,

Just wanted to say I really relate to your story. Mine is a little different; I didn't get the fissure from childbirth although I do think my labor (and pushing even though it came to a section anyway in the end) contributed to my fissure. I too have had fissures in my early 20s (I'm 38 now) and all I really remember when seeing a doctor about it was to change my diet and increase fiber. At that time, I guess that was enough to heal. But I have had hemmorhoid/constipation problems my whole life from a young age. Anyway, I think I was ripe for a deep and significant fissure, which is exactly what happened to me in late May. It has been quite a roller coaster since then; I had to be put under for the CRS to even see the fissure. She offered LIS or botox. My family decided on botox. Botox simulates the LIS but is not permanent. It did heal the fissure but I unfortunately had other complications: got an abscess, then a fistula and had surgery for that. Evidently as my fissure was healing part of it healed from the outside in creating a fistula which had to be laid open. Now I am still in some pain but it is different. It is a burning pain and some pinching during a bm.
Anyway, I have a 2 year old and was trying for another baby when I got my fissure so I relate to what you are going through. And I am no spring chicken, LOL!! I really feel like the clock is ticking but I cannot think of getting pregnant until I have a few pain free months. Personally, I will have another c section; so WAY I will try to push anything. This experience has been far worse than labor and delivery and I had a hard time. If I were you, I might give botox a try. I also suggest doing physical therapy for pelvic floor. This has helped me a greta deal and many women suffer from this. Or if you don't want to try botox, do the LIS and just plan on having a section.
I am so sorry you are suffering. It seems so unfair and I know what you are going through. But you will heal and move on from this. Try to stay positive!! Vent here and hang in there :)

I hope you both heal soon. WL1014, have you decided what you will do yet?

I scheduled surgery for a week and a half from today. I am ready for this to be over and decided to go with the most effective route instead of the possibility of many more months with Botox and such and then still having a high risk of needing surgery or relapsing down the road. If I never think of my butt again it would be too soon. Best of luck to you and whatever you decide. I trust that this is will be a distant memory for us all at some point.

Congratulations Broncosgirl! That is so great that you have committed to a decision. I obviously know how hard that is. I still am battling with it myself. Luckily I have had some relief this week, which has giving me more breathing room to decide. I know it is only a matter of time before a setback but I will still enjoy this time while it lasts. Went out with my daughter to the store and for a nice long walk yesterday. It was so great to feel like a normal human being not bound to my sitz bath all day. Hopefully, you will be there soon too...for good! Out of curiosity, what was it that ultimately helped you decide...did you finally just hit that pain point where enough is enough or was it based on information you received at your second opinion visit? Either way, I am so happy for you and will pray for your speedy recovery. Please keep me updated how you are doing. I will probably not be far behind. My husband and I are starting to put some money aside to save in anticipation of the surgery in the near future.
Jlm1, your experience sounds awful!! I am so sorry! I can't even imagine having this issue with a child as mobile as a 2 year old. It's really hard for me and my daughter is only just about 5 months! So you never ended up needing the LIS, just the surgery to repair the fistula? Well, I hope you continue to heal. As for your comment about the fear of having another child...I can relate. As stated in my earlier post, I was so happy to be pregnant but was terrified of being pregnant as all I heard about was constipation and hemmorhoids. I knew it would not be ideal with my fissure history and I was so worried I would "unleash the sleeping giant"! I was completely shocked when my bowel movements became effortless and so regular. I can't say it was my diet, because I had my good healthy days and I had my hormonal bad binge days. But I did not have a single bout of constipation or fissure flare-up. I was later told that it was most likely due to the increased blood flow to the area, which I can only imagine helped to relax my sphincter tone a bit. Hopefully when you decide to try for your second, the same will apply to you and help you continue to heal and remain relaxed. Good luck to you!

Glad you are experiencing relief. I had botox in July, it healed the fissure but I got a fistula. Am healing. Good luck to you!

I am glad you are having better days. I hope that continues!

In had about 2 weeks of intolerable pain when the fissure began. It was so bad I felt like dying. After I began a diet change with more fiber and water the pain went from a 10 down to anywhere from a 1-5. It has varied between those pain levels for a month now. I will think I am healing and then bam, I feel it tear again.

I could live with the pain as it is forever if I had to. It hurts the worst for about 15 min and then is a dull ache for a few hours. The pain is not what made me opt for surgery but the desire to have my life no longer be consumed by thoughts of my butt. All I think about now is my fissure and live in fear of it getting to a level 10 again. I don't feel like this is any way to live and the constant anxiety is almost as bad as the worst pain I felt. So, my decision was to choose the option that had the highest rate of ending this now and forever. I know there is a risk with it, but I decided I would deal with that if it is an issues. The problem in front of me now is this fissure. Incontenance is just a possibility and one I will deal with if it comes to me, but in talking with my doctor who has never had that happen to a patient I just don't feel like I am going to be that person.

I hope that helps a bit. We have bad insurance too with a high deductible. We will be paying for it all out of pocket. It sounds like the surgery itself is only $360 adjusted but the General Anasthesia is what is expensive. My doc uses IV sedation though so I hope it costs less.

I had my surgery moved up to this Tuesday so I will let you know how it goes.