Plant-Based with an AF

Recurrence and Fear of LIS

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Plant-Based with an AF

Postby ksaco18 » 11 May 2020, 16:24

Hi all,

I am a 27-year-old female that has had a chronic fissure for 4 months. One important thing to know about me is that I'm plant-based, so I have a very high-fiber diet.

I developed my first anal fissure in January of 2019 which last for 4 weeks and was healed using nitroglycerin ointment. Fast-forward a year later, and the same fissure reopened. I recently moved, so I found a CRS in my area to have the fissure checked. He prescribed me nifedipine which did nothing to alleviate the pain. After 6 weeks of no change, I went back to see the CRS and he wanted to schedule me for botox and LIS, which I declined because I've heard of the side effects of the procedure and wanted to do more research. I asked the doctor to prescribe me Rectiv for the time being and he did. This gave me more relief than the nifedipine but did not heal it completely.

I made an appointment to get a second opinion with a new CRS in the area at the beginning of April. What's crazy was at the time of the appointment, I had been a week pain-free but still wanted to be checked. The new CRS gently examined me and said the fissure seemed to be healing and to continue doing whatever I was doing to heal it. After the appointment, I had an additional week without pain, then after one stool with a hard tip, the fissure reopened. I entered back into the cycle of pain (but with very little blood) for another 3 weeks. Last week, I had no pain for about 6 days then reopened the fissure again last Friday. I have no idea how it opened considering the stool was as soft as can be (however it was not diarrhea).

In terms of what I've been doing at home, I've been taking sitz baths 2-4 times a day (I even purchased a sitz bath that has a hose to gently clean the area after a BM). I have also been using the Rectiv 2x a day, along with coconut oil, olive oil and aloe to attempt to soothe the area. I drink plenty of water as well. My fiance` is also an acupuncturist and had been treating me with acupuncture in the area as well. I've tried anal massages by putting on a finger condom, applying coconut oil to my pointer finger and gently massaging inside the anus. I bought a squatty potty for optimal BM positioning and even dowloaded a mindfulness meditation app to get my emotions and stress from this under control.

I take 2 colace a day, along with 1 magnesium citrate supplement and 17mg of miralax. Also, because I am vegan, I have a naturally high-fiber diet, as I consume plenty of veggies and legumes a day. I've wondered if maybe I'm consuming too much fiber and that's making my stools dense. I've played around with this for the past few weeks but have not seen a change (lowering my fiber intake, counting how many grams of fiber I eat a day, etc.).

I'm at the end of my rope here. The throbbing after BMs can be debilitating. I'm constantly in a state of depression and I feel horrible venting to my fiance` and mom who have been supportive, but also feel helpless. I'm terrified to get LIS, as I've heard horror stories about the side effects. I also plan on having children in the next few years. I'm also getting married in 5 months, and the thought of not being able to dance or stand for more than 10 minutes at my own wedding causes me severe stress and depression.

I'm so sorry for the novel, but any at-home remedies or advice is appreciated and welcomed. It's comforting to know there is a community of support here, and I look forward to talking with you all soon.
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Re: Plant-Based with an AF

Postby dmcff » 13 May 2020, 03:30

I'm sorry that you haven't received a response to your message yet. The forum has been rather quiet recently, don't know if that's connected with Covid_19 - maybe.

Sorry also to hear of your troubles with AF - it is a stubborn condition, and sometimes seems to resist almost every treatment and procedure. You mention acupuncture - where in the area have you been doing this, how close to the fissure? One thing that from time to time comes up n people's experience of AF is that it's often better to leave the area of the fissure alone - it can respond badly to interference with physical objects, including creams and ointments when they're still being used after a period of 6 weeks or so.

Stress and depression are also frequently reported by AF sufferers - in my own case, I ended up regularly seeing a psychotherapist, though this is a route that may not suit everyone. You are not alone, and I hope that other posters will come onto the forum and share their experiences with you. Good luck.

dmcff
2014 Anal fissure
2015 CAT scan, EUA and sigmoidoscopy, 2 MRI scans - 4 hospital stays - severe to low pain
2016 Anal fissure - pain severe then moderate to low
2017 Return of moderate pain
2018 Physiotherapy, pain management
2019-20 Just living with it
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Re: Plant-Based with an AF

Postby ksaco18 » 13 May 2020, 10:07

Hi dmcff,

Thank you for your response! I stopped doing the acupuncture about a month ago after my fissure reopened. After 10+ treatments, I wasn't sure if it was helping at all. However, when I was getting it done, I would get one needle in each elbow, 2 in my lower back, and one about an inch or two above my anus and would lay face-down for 30 minutes.

I haven't thought about stopping the ointments. I've been using Rectiv (nitrocglycerin ointment) 2x a day every day as recommended since it was prescribed to me in mid-March because I'm afraid that if I don't use it, my muscles will be too tight and will make this situation worse. I guess I could try it for a few days and see what happens? I think that my primary issue is muscle tightness and spasms since both CRS' I've seen said they can feel it when they do an exam on me.

Do you think light exercise might help? Since the quarantine (and because of my fissure), I've barely been exercising. Before my fissure opened in January, I was exercising 5-6 days a week and now I'm lucky if I can do yoga once or twice a week. The problem is that after a BM, my muscles are so tight and spastic, and the throbbing becomes unbearable. Sometimes I can barely stand for more than 5 minutes. Maybe if I at least go for a walk every day, that will help my blood flow to the area and will also soften up my stool. What are your thoughts?
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Re: Plant-Based with an AF

Postby dmcff » 13 May 2020, 10:42

Most of the ointments and creams aren't really effective after 8 weeks, and there's some evidence to suggest that when used longer than that they can actually make things worse. So it might do no harm to discontinue the Rectiv for a while, at least. The problem might be tight muscles, but those could in turn be caused by other issues. In my own case they were related to irrigation, and for a time I got some relief from using a rectal irrigation system called Qufora, which I think is only available here in the U.K. There is also the possibility of physical therapy, though you may already have covered this with the yoga exercises you mentioned. Maybe get another consultation/examination? I'm not a medical professional, and can offer only limited advice.

I think walking (like swimming) is an ideal form of light exercise for this condition, and if you could take a gentle walk each day that would definitely help.
2014 Anal fissure
2015 CAT scan, EUA and sigmoidoscopy, 2 MRI scans - 4 hospital stays - severe to low pain
2016 Anal fissure - pain severe then moderate to low
2017 Return of moderate pain
2018 Physiotherapy, pain management
2019-20 Just living with it
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Re: Plant-Based with an AF

Postby Coconutoil » 17 May 2020, 00:07

Hey just wanted to say I’m in the same boat as you. Your story sounds like mine! Is your fissure deeper in? I can’t imagine the finger massage because that’s where mine is located. I’ve been dealing with this since end of January. I finally got the nitroglycerin prescribed last week and was prescribed twice a day. I realized I only need it after my bm though and at night so sometimes I only use it once a day. I have the same tightness and pressure after bm, looking forward to that every morning is tough. I’m also plant based too and eat a lot of fiber. Hopefully we can keep up with each other to see how each other improve.
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Re: Plant-Based with an AF

Postby ksaco18 » 17 May 2020, 20:56

Hi Coconutoil,
So weird how we both got fissures considering we have healthy, high-fiber diets. Maybe we consume too much fiber and that irritated the area? Who knows.

I actually decided to go for the LIS surgery, which is happening tomorrow morning. It was such a hard decision to make and I'm extremely nervous about it but my CRS reassured me when I spoke to her over the phone on Thursday. I really didn't feel like she was trying to "sell me" on surgery so she could make extra money or something- she seemed concerned and said she thinks I'll be happy I decided to do it so I can get back to living a normal life.
The last time I saw her was the beginning of April and at that point, I'd been pain-free for about a week. Of course that ended a few days later and I've been in pain since then. I told her that I've had more bleeding recently and told her all of the things I've tried. She told me that I could try and live with the pain but that I was the perfect candidate for the LIS. I asked her about 500 questions because I've read a lot of the experiences of others on this website that have gotten the surgery. Here's what I learned:
My CRS does a partial, closed LIS by making a lateral incision on the right side of my sphincter muscles. I've read that if you get the surgery, closed is what you want. I have no idea why, but that's what I've heard. My CRS said she takes a very conservative approach and has been in practice since 1993. She said LIS is one of the most common procedures she does and said her success rate was around 95% . I told her that most CRS frown upon women that want to get LIS, especially if they want to have children soon and asked if she felt the same. She told me this wouldn't impact childbirth at all and that since I'm still young, I should have a good recovery.
Next, I asked her about side effects such as incontinence and leakage, since those seem to be the most common ones that people have mentioned on here. My CRS told me that less than 5% of the people she's done the procedure on have had that problem, and if they did, it's not crazy leakage or losing your bowels at any moment like you'd think. She said there might just be some brown on the toilet paper if you didn't have a BM. I also have a pretty big skin tag that sticks out of my anus. I always thought it was a hemorrhoid (and so did 2 other CRS), but my current doctor said it's a tag. She said she's going to examine it tomorrow once I'm under and see if it needs to be removed. She said she would only remove it if she felt it was blocking/hindering my fissure from healing. While the tag is ugly and in the way when I wipe, it doesn't hurt at all, so I'm hoping she doesn't have to remove that since that will be another open wound that will have to heal. She said she will use a dissolvable stitch and said I can expect some spotting and bleeding afterwards during a BM. I'm TERRIFIED for my first BM after surgery. The CRS said she could prescribe me 1-2 days worth of pain killers but they can cause constipation, so I'll see how I'm feeling afterwards. I'll just have to make sure if I use them, I eat enough fiber afterwards. She said most people heal in 1-6 weeks, but most of her patients have healed within a week.
I always think surgery should be a last resort and feel that people should always try conservative measures first. After 4 months of excruciating pain while trying medicinal ointments, oils, sitz baths, dietary changes and acupuncture, I've decided that this is the next step for me. I can't remember what it feels like to not have pain and it's definitely messed with my mental health. I used to exercise 5 days a week and have barely been able to do yoga 2x a week since January. That being said, I'm 27 and live a healthy lifestyle, so I'm hoping that I will be able to recover without any hiccups. Luckily I'm working from home due to COVID and will be able to rest and take sitz baths when needed, so that's a bonus.
I'll definitely keep you posted as soon as I can with how I'm progressing but in the meantime, I hope this was helpful and I hope your able to relax a bit!
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Re: Plant-Based with an AF

Postby Coconutoil » 18 May 2020, 01:30

Oh wow congrats on making that decision. I know how scared you must feel but also relieved that you can finally do this and heal. I started having pain Jan 27th, so I’m approaching 4 months also. I feel the same, I can’t remember what it would feel like to have no pain when it comes to going to the bathroom. But I know it will happen. I also worked out 4-6 days a week consistently and can’t imagine that was my life. Yoga put me in so much pain last week. YOGA! I thought I could at least stretch lol. I’m excited for you to feel better and let me know how the healing process goes. Thanks for all the information, you asked all the right questions. I have a skin tag too and that’s how I learned that I had a fissure. All new to me. Good luck tomorrow!!! You probably are already done by the time you read this. Yay!
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Re: Plant-Based with an AF

Postby ksaco18 » 18 May 2020, 08:39

My procedure is at 11:30am, so I'm trying to keep busy until then. I was abIe to get a few hours of sleep last night which is good.

It's crazy how similar our stories are! Have you had any periods of no pain, or have you been in pain every day for 4 months? Hopefully the nitroglycerin heals you up and you're good to go. Is this your first fissure?

The first time my fissure opened in January 2019, it healed because I used nitroglycerin. I also used lidocaine to numb the area which helped. My CRS also tried to band my "skin tag" twice since she thought it was a hemorrhoid which shrunk it, but did not get rid of it. I'm thinking that probably helped the fissure heal too since there wasn't a giant blob blocking the area. My current CRS where I live now never gave me numbing cream which probably would've relieved a lot of the pain (although it doesn't heal the fissure), but did not do anything about this skin tag in the past 4 months. I'm thinking she'll have to remove it today. Not thrilled about having another open wound but if it helps with healing, then I'm okay with it.

I also tried yoga a few times and felt pain just like you. I started going for walks every morning before a BM to get blood flowing to the area and to make sure my stool wasn't hard. Maybe you could try that too. I'll keep you posted on the procedure. Talk soon!
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Re: Plant-Based with an AF

Postby Coconutoil » 19 May 2020, 00:06

I responded a few hours ago but I don’t see that it posted. Darn. It’s 10pm over here, not sure if we’re in different time zones. So you’re probably home right now resting. Hope all went well. It’s only been less than a week since I’ve been using the nitroglycerin. With healing, it seems like everyday is different but yes, I’ve had consistent pain for 4 months! I’m looking forward to just one day of no pain. That’s why I’m looking forward to how your healing goes because it’s nice knowing that’s an option. I like that your doctor seemed concerned and wasn’t trying to sell you. I always think that in the back of my mind too. Anyways let me know how you’re feeling as soon as you can!
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Re: Plant-Based with an AF

Postby ksaco18 » 19 May 2020, 13:19

Hi Coconutoil,





Here’s an update on my procedure. I went to a nearby outpatient center for the surgery around 11:30am (I’m on the east coast of the U.S.) and had a great experience with the doctors and nurses there. I was sedated and did not see, hear or feel a thing during the procedure. The doctor said it only took 5 minutes! She ended up removing the skin tag which she said was blocking the fissure like we thought. She said all went smoothly and put a thin gauze dressing on the outside of my anus. She said I could remove the gauze whenever I wanted, but I didn’t want the blood to be too dry and therefore cause the gauze to stick to the area, so I decided to take it off right away. It ended up being partially in my anus and hurt a bit taking it out, but I’d definitely advice removing it before the numbing medication from the surgery wears off.





After the procedure, I felt this slightest bit of pain, but nothing crazy. By the time my mom and fiance came to pick me up, my pain was between a 3-4, and by the time I got home, I was at about a 7. When I say pain, I don’t mean fissure pain. I’ve barely felt any pain from my fissure so far and it’s been almost 24 hours. The pain I feel is from the incision site. I can kind of feel the dissolvable stitches plus some soreness from the incision. It’s kind of hard to describe but doesn’t feel as bad as the fissure pain.





I was prescribed Vicodin and got the script filled, but I don’t plan on using it. When I got home from the surgery yesterday, I took 2 tylenol and iced the area. That definitely took the edge off and brought me back down to a 3 on the pain scale within 30 minutes. The pain seemed to dissipate throughout the night, and I haven’t had any issues so far *knock on wood*.





My doctor told me to continue with a high fiber diet and to keep taking colace and miralax. She suggested milk of magnesia in case I became constipated, but I don’t think I’ll need it. I was also told to get Tuck’s wipes which have witch hazel and offer cooling relief after a BM. I’ve been taking 2 extra strength tylenol every 4 hours and as much as I hate taking meds, I’ll continue to do that for the next few days so that I’m always ahead of the pain. Also, I had some bleeding and clearish red discharge after the surgery, but that was to be expected.





As for today, I had my first BM which I was absolutely dreading but it ended up being so much better than I anticipated. My stool was soft and I didn’t feel any pain during the BM at all. I definitely had some minor discomfort after but nothing worse than the pain I had from my fissure. There was some blood when I wiped but again, that was expected. I did a sitz bath after and made sure to thoroughly clean the area afterwards. I currently feel a bit sore there but haven’t had any intense throbbing like I did after BMs before the LIS.





As of right now, I’m very happy with my decision to get the procedure done. I hope the area continues healing and that I start feeling better each day!





I meant to ask, do you use a squatty potty while you go to the bathroom? I found one on Amazon and it definitely helps with BMs. It puts you in the optimal sitting position for BMs so that you don’t have to strain. I’d definitely look into that. Also, I got a sitz bath on Amazon that has a little hose/pump in it. After a BM, you fill it with warm water and squeeze the pump which gently blows water into your anus (kind of like a bidet but low intensity). It’s enough to really clean out the area which is important. If you want, I can attach the links for you. I’ve found those to be helpful after BMs.





Talk soon!
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