Hi,

I've been looking around this forum for recent recommendations for CRS in London and I haven't found too many recent ones so I thought I would share my experiences. I developed an AF in Dec 2021 which became chronic and still struggling with it.

I first saw Mr. Buchanan recommended via my GP, who was initially patient and quite kind. I found his manner subsequently to be a bit brusque and after 3 months, I found him to be surprisingly rude, so went in search of another CRS.

My GP recommended Sara Mills who is in general much more personable but also in quite a rush. The impatience sometimes comes off her like a gentle steam :-)

She's easier to speak to but her appointments are only available one month or more in advance so if you have an urgent question or need to see her, it's not going to happen. I know, I tried. She's my primary CRS, who gave me Botox after a year of waiting for the fissure to heal. I like her approach as less is more with her and is not keen on surgery. She said that she hardly ever does LIS and particularly for women, as the risk of incontinence with age increases and it's not worth the risk. However my fissure keeps opening and re-opened post Botox and I also have two large and irritated skin tags, which she takes no notice of and says there's nothing to treat as removing them would also cause a further fissure.

I am still lookin for a good CRS for a 2nd opinion - my GP again recommended Dr. Chang who sees in Harley Street, but his diagnosis and suggested treatment pathway was entirely surgical and completely at odds with what my CRS has said. He said he would do a hemorrhoidectomy (I didn't know I had a hemorrhoid, Dr Mills says I don't have any) and then a fissurectomy and then anal flap surgery. A laundry list of surgical options so I'm not going back to him because it was so much at odds with what my CRS has been saying all along.

I have seen some other names suggested on this forum albeit quite some years ago now, like Robin Phillips and Mr. Windsor.

I would really like to know if anyone has had any experience with Ms. Mills/Buchanan/Phillips/Windsor or anyone else they could recommend. I really want to go for a 2nd opinion but was very discouraged by Dr. Chang and don't want to run through the roster of CRS's in London!

Wishing everyone well on their healing journey

Morning AF3!
So I’m based near London and my current CRS is Andrew Williams at London Bridge hospital. Basically I started with mr Scala at Guildford Nuffield who carried out my skin tag surgery which ultimately led to this dreadful situation I’m in now having had no previous butt issues other than a few haemorrhoids during 3 pregnancies which deflated but I think left skin tags that then swelled with a lot of road biking and indoor bike training. He was not sympathetic after my surgery and basically failed to diagnose my fissure. So I went to seek a second opinion with a CRS at London Bridge called Vivek Datta who was very nice immediately diagnosed a fissure and recommended cream failing that surgery (Botox plus Fissurectomy) this scared me the Fissurectomy part so I asked around and by chance met someone (head of GI at London Bridge) who said Andrew Williams was the best CRS in London and very empathetic and kind. He said if it was his family member Andrew W was the only one he’d send them to. So I thought if I need surgery I need the best person to do it so I don’t get a rerun of my disastrous skin tag removal. Andy Williams was very thorough and kind and much more holistic. Interestingly everything he says aligns with what your friendly proctologist says ie LIS would not work on me nor likely Botox as we need to cure the root cause ie the anal spasms first. He would never do LIS on me anyway as he says I’ll end up incontinent when I’m older. He doesn’t rule out Botox but says he would prefer the approach of dilation etc first to see if we can heal naturally. Ok not sure whether it will work!! I’m definitely improving but there is no miracle yet. Altho Today i had a painless BM which makes me want to tell everyone!!!! It is a step forward. I know better than to get excited as tomorrow is another day. But for now it’s improvement. Dilation is hideous I won’t lie. But I’ll do anything at this point. I highly recommend meeting Andy Williams as he’s head of the colorectal group at London Bridge and he’s a lovely empathetic man. Just my thoughts anyway if you haven’t found anyone else. I felt silly getting a third opinion but I’m glad I’m being given a chance to avoid surgery. We will see xx

Morning Hazy123!!!

Congratulations on your pain free BM!! As you’ve said (and many others here), it’s a process and everyday there’s a symptom free BM or some other positive, it’s a move in the right direction.

Thank you for the recommendation (Andy Williams). From what you say, he’s interested in exploring other options and not suggesting frightening surgeries, which (to me), is key as I’m not looking to have anything more done if I can manage it. My CRS says what he says about LIS and is strongly against it.

I am quite bewildered at the moment with these tags and that’s what I want a now 3rd opinion for. My CRS says they are not hemorrhoids and that they will settle (they are not, 4 months post Botox), the 2nd opinion CRS says they are hemorrhoids and will not go away without surgery. Since they are causing me so much more misery vs the fissure, I think I need a 3rd opinion with someone who will spend the time and explain and also let me ask questions. It’s also frustrating that I’m being told such contradictory things about these taggy hemorrhoids, since they are what’s destroying my life at the moment.

Glad to hear you are making progress with dilation. I’ve tackled spasms through meditation and trying really hard to relax (sounds counter-intuitive I know), belly breathe and generally lower my level of freak out.

I don’t think this applies to you, but my conclusion is that I am here because of a) poor bowel habits; b) increased anxiety due to various events over the last several years - I also have IBS and lactose sensitivity which always worsen when I’m stressed; c) letting my thoughts control my body in a negative way. The combo of these three have led to the chronic AF as opposed to an acute one,

Trying to heal the fissure has also led to a huge change in my thinking patterns and tackling the anxiety head-on. Not going to lie, that has been my biggest challenge to date but I’m convinced that stress and fear make the sphincter even tighter so I’m working on eliminating that!

Hope you have a brilliant day.

He might be worth a try for your tags - he is very anti surgery for these too I know. How confusing that one diagnosed tags and the other haemorrhoids?? They are such different things altho I thought my tags were haemorrhoids initially. However I’m not an expert. I know how horrible they are. I also have remaining smaller tags despite removal surgery, which sometimes swell horribly (eg with certain creams) or when my fissure is bad. They drive me crazy when swollen so I hear your frustration. However they have finally settled down. Sounds like you defo need a third opinion whether Andy Williams or someone else. He spent an hour with me on my first appt which was impressive given my previous ones gave me 15 mins. He did however insert cameras and all sorts so it wasn’t fun but he was extremely gentle with me and didn’t hurt me which was extraordinary.

That sounds very much like my tags or haemorrhoids … they don’t seem to settle consistently but are definitely a clear signal of how the fissure’s faring.

A one hour appointment is remarkable. I’ve only ever managed a somewhat rushed 15 minutes.

Hazy123 - have your tags settled down despite your fissure flare-ups? As in now, even if you have a relatively bad day fissure-wise, the tags don’t swell and drive you mad?

I would really love to stop obsessing about the tags + fissure and just be able to go back to obsessing about the fissure (which was right up until the day before Botox :-D ). Who knew that was a good place to be!!!

They have settled a lot now altho it’s taken ages. I hate them so much and when they swell I feel totally distraught. I prod them regularly in the hope they’ve gone down!! Even when my fissure hurts they seem to stay down now (fingers crossed) but a few months ago they got huge with diltiazem. I was so upset. But they settled after I stopped that. I have heard tho of others having Botox and then their internal haemorrhoids have popped out. Due to the muscle holding them in being relaxed I guess. So you need to know what these are for sure. Whether they are tags/haemorrhoids. Then you know how to treat them properly. I do think any form of surgery stirs everything up and the swelling takes ages to heal. So even your Botox may have done this and it’s not settled yet.

I think you are 100% correct. Your first two sentences are as if I wrote them!

I know you didn’t have Botox but how long did it take yours to be non-reactive to the fissure?

That’s very helpful to know that others have had hemorrhoids popping out after Botox. If my CRS had said anything about that, I might have re-considered or at least been prepared, instead of being couch-bound and distraught every other day for the past 3 months. Because of these swellings, I’m terrified of flights especially long haul, which is soul-crushing as my family are a 12 hr flight away and I have delayed and delayed visiting them this year because of these awful swellings.

I agree re surgery which is why I am I also looking into relaxation hypnotherapy - it worked beautifully for my IBS and my CRS was very supportive of it and told me about studies that IBS patients with hypnotherapy had better outcome versus medication groups.

If you have any interest in that, happy to give you the name of the person that I see for relaxation. I know it might not be everyone’s cup of tea but I will literally try anything that’s not surgical because that just doesn’t seem to be the right path for me.

I never thought the day would come when I was looking forward to new CRS appointments…!

Hi AF3 I think the swelling from my tag surgery took over a year to settle down altho this surgery was brutal. I had no clue what I had agreed to! I would think Botox would be less brutal. Altho my CRS said Botox involves having your sphincter fully stretched out and you can incur micro tears while this takes place - what an awful thought! But a micro tear heals ok and is worth it to heal a chronic tear. Sounds a bit crazy to me but I get the logic.
How sad you can’t fly to your family:(( but I know what you mean about flying. I was petrified going long haul over Easter with the dehydration and loo situation but actually it was fine. I ate dates and drank water all the way!! And I survived it.
I would love relaxation hypnotherapy details please! I’ll try anything like you that’s non surgical. I hope your tags behave for you tomorrow! Horrible things - you remind me why I had mine removed in the first place (a question I ask myself repeatedly during all this pain!)