non healing wound or chronic fissure

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Re: non healing wound or chronic fissure

Postby jr2 » 12 Jun 2013, 12:31

igrik,
I'm so sorry you're having so much trouble and conflicting information with doctors. But yes, what you said at the end of your post is true. If you can get some pain relief from the fissure in any form, it will in turn help the spasms, and in turn help with the blood flow. Other things you can do to promote circulation of course are to alternate warm baths with short applications of cool compresses, and massaging the muscles all around the anal area. you don't have to even get near the actual anal opening. Just massage the muscles all around the outside, which will help promote circulation and also promote relaxation of spasms. 
Botox and nitro. help to ease spasms by working directly on the muscle itself. But yes, pain relief is also another way to ease spasms as well. Best possible scenario is to use a combined approach. Botox and/or nitro. plus a pain reliever.
I hope you are able to make some progress soon.
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Re: non healing wound or chronic fissure

Postby Ever the Optimist » 12 Jun 2013, 12:38

Igrik,
Sorry to read this but Congratulations on the birth of your son. That is truly wonderful news but sad that his birth has the shadow of your fissure hanging over this. Please try to enjoy him and the pleasure of having a newborn child as much as you can.....
Where are you from? It's hard to imagine that there are no remedies there to help you? Diltiazem is another suggestion you could make or Rectogesic (that is Nitro) but another name that might be familiar???
If it is possible for you to find another CRS? as that would be really helpful especially since your last caused you further damage?
Botox assists the healing as it is directly injected into the internal sphincter muscle, generally under general anaesthetic, which relaxes the muscle and the spasms accordingly & promotes blood flow to the area to help the fissure heal naturally. It lasts around 2-3 months which is felt to be sufficient time to allow the tear to heal.
LIS actually makes an incision/ cut into the internal sphincter muscle again to reduce the resting pressure of the muscle (reduce the spasms) and improve blood flow to promote faster healing. This is seen as the the most effective & successful procedure for treating chronic fissures but a CRS will suggest this, generally, as the final stage if all else fails. It is normally a very successful & simple procedure with possible side-effects of incontinence.
When the internal sphincter muscle is in a state of spasm or tightens, it pulls on the wound edges of the fissure, which causes all that horrible pain and if it is in severe spasm, causes pain that lasts for hours. Because of this and reduced blood flow to the area, it makes the wound healing slow & difficult. It's a very difficult cycle that often needs intervention in helping break it.
The above methods therefore, help relax the internal sphincter muscle (and spasms), promote blood flow to the area, helping the healing process although they do not heal the fissure directly.
Some really helpful tips you might want to try to help, are to pre-lube your anal opening prior to every BM with Vaseline to help coat & protect the fissure & ease elimination of stools. Never strain and never wipe hard with tissue - Dab with baby wipes or clean-up with a shower head.
"Sitz" baths or sitting in a hot bath are really beneficial in dealing with spasms because they help get the blood flow moving to the area.
Coconut Oil/ Manuka Honey, Zinc oxide/ A&D ointments have all been found to be really helpful by others in just providing relief.
Hopefully, like you say, because some of your fissures are acute, with soft stools and easy to pass BM's, they may well heal quickly, not having yet reached a "chronic" stage but PLEASE stop straining & pushing when you go!! This will only make things worse & create new issues. If you are having an issue passing stools, ensure you are eating lots of fresh fruit & veg, drinking lots of water and taking a stool softener - Olive Oil helps (orally) as does Magnesium supplements. This is essential!!
All the very best to you and let us know how you get on.....
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: non healing wound or chronic fissure

Postby pinpin » 12 Jun 2013, 14:00

Hello,
Thank you for the answers. I am from Latvia, small EU country.
Tomorrow, I will have appointment with my original surgeon and insist to get such ointment
Glyceryl Trinitrate 0.2% + Nifedipine 0.2% + Lidocaine 2%.
What do you think about such combo?
Also will discuss what can we do with spasm, probably I will try to get some diazepam. (known as Valium among you).
Also there is spasm related drug Mydocalm. Though it is not very efficient.
What else can I do? I see Botox is not really successful, but I will talk about Botox once again to him.
Today's BM was small, I was trying not to push and just suffering while it slowly was ripping by my wounds :).
After BM I am ok also. But in day when I have a lot of BM to pass out, I am more in spasm and pain usually...
I will keep you posted tomorrow, after my visit.
07.02.2013 - got open hemorrhoidectomy, leaded to slow healing wound. Link to story
11.12.2013 - LIS surgery
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Re: non healing wound or chronic fissure

Postby Just 'Pain' Tired » 12 Jun 2013, 22:17

I'm working on trying to heal a very nasty AF and it's not easy!!!!  I do believe that the warmth of a sitz bath and I also use a heating pad at night (or like today, spams during the day!) to get the muscle to relax and increase blood flow.  Ointments like nifedipine, ditilazem (?sp) and nitro increase blood flow.  Magnesium helps muscles relax and softens stools.  Keep it going, guy, and congrats on the new baby!  :)
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Re: non healing wound or chronic fissure

Postby pinpin » 13 Jun 2013, 05:09

Hello,
Just returned from visit to my doctor and also sorted out some papers for my wife and related maternity leave.
So I had serious talk to doctor, and he prescribed everything I asked.
1. Combo I mentioned in mail before (nitro+nifedipine+lidocain)
2. Diazepam, though I am not sure if I have to use it now. But I will try to check what it does with my spasms taking one pill tonight.
I have told him what are treatment strategies in EU and USA. And so they consists  from 3 parts, ointments, botox, LIS.
Also we agreed I will use this combo for some 4-5weeks, and if completely no improvements, then there is one surgeon doing botox injections in our city, and my doc told better to do injections with the one whom already did them. 
I also mentioned LIS, but he like declined this and told this is something not be done. I am not sure why, but seems nobody does these surgeries so often like in your countries. Probably there are less AF suffers here? Or they just somehow survive? Do not know.
Nobody here does LIS to get AF healed. Though, I didn't visit all CRS yet in my capital city.
There are few left, whom can be consulted with. But I am afraid visiting them, as they do finger exams..
Ehh, whom knew I will end up like this after one hemmie removal..
07.02.2013 - got open hemorrhoidectomy, leaded to slow healing wound. Link to story
11.12.2013 - LIS surgery
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Re: non healing wound or chronic fissure

Postby pinpin » 13 Jun 2013, 11:32

Hello,
Small update, just had a BM which was quite painful. No blood. 
Also pharmacy already prepared combo drug, I bought latex gloves and applied cream in anus.
Currently laying down and feel a bit dizzy. Does that mean it works, and I am getting some spasm relief?
Also I got Valium 30 tabs, not sure I should take this one also to attack spasms all around?
07.02.2013 - got open hemorrhoidectomy, leaded to slow healing wound. Link to story
11.12.2013 - LIS surgery
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Re: non healing wound or chronic fissure

Postby pinpin » 16 Jun 2013, 01:44

Day number 3 on nitro+nifedipine+lidocain combo.
Fissure is still acting up during and after BM.
Though, everything down there feels more relaxed these days. Probably effect took place and will allow everything to heal.
I will not track progress everyday, as think there will not be huge changes everyday. Most probably weeks should be taken as base.
So the plan is to use this stuff for 5-6 weeks. And if completely no improvements, then will check botox possibility.
07.02.2013 - got open hemorrhoidectomy, leaded to slow healing wound. Link to story
11.12.2013 - LIS surgery
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Re: non healing wound or chronic fissure

Postby pinpin » 17 Jun 2013, 00:02

Hello,
I need some advice, this morning I noticed blood inside canal during appliance of my combo. I have used it only for 4 days. Before I used nifedipine for already 8 weeks.
So second opintion doctor tore my fissure at 25.04.2013. I have this fissure already almost for 2 months, and it is not healed, acting up during BM. Sphincter is very very tight, my BMs are maxim 1.5-2cm in diameter.
I want to heal so much, I have option as Botox currently. Should I hurry up or not? My wife suggests to wait, all relatives also.
Though 2 months is quite a period, also I don't feel it is healing as I am tearing it every BM as canal is very narrow now. Also some blood were observed.
Botox should not harm, right, what are possible complications, despite temporary inconsistence?
I am really really not sure, if I got panic at the moment, or I really should insist on some real healing using proved methods?
Please assist me in decision!
07.02.2013 - got open hemorrhoidectomy, leaded to slow healing wound. Link to story
11.12.2013 - LIS surgery
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Re: non healing wound or chronic fissure

Postby pinpin » 17 Jun 2013, 04:02

Anyone? :(
07.02.2013 - got open hemorrhoidectomy, leaded to slow healing wound. Link to story
11.12.2013 - LIS surgery
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Re: non healing wound or chronic fissure

Postby Deleted User 2543 » 17 Jun 2013, 05:07

Hi igrik,
Congratulations on birth of your son Image. Some people get the headaches and dizziness from the cream and this is supposed to be a sign that it is working. I used to get the headaches but still got the terrible spasms so didn't work for me.
You really shouldn't let the surgeon do a rectal exam when you are that sore its inhuman refuse next time.
I gave the creams 3 mths to work with no joy so went onto botox id highly recommend it for you. The first time i had it done i had no side effects at all usual soreness for a wk or so but then no pain at all for 8 mths until i tore again probably my own fault. I had another round of botox in march this year but it failed so i'm just recovering from lis, fissurectomy and tag removal which really isn't that bad either. If you have the option to do it go for it, nobody should be in this type of pain day after day. 
I wish you the best in your decision and hope you get some relief soon.
Take care;)
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