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New to the world of pain

Postby bottomline » 20 Jul 2010, 15:51

So I am new to this ordeal and have been devastated by the seemingly little but life altering cut on the bottom.
Got my first one about 2 months ago. Before it started, I had a very stressful period of about 3 weeks with irregular and hard BMs, diarrhea on a couple of occasions. I also used to sit on the toilet for 30 mins. and just surf the web. I also had itching which i promptly did - a little inside the anus as well. At this point I had no idea what a fissure was.
So one day, I saw some very minor blotting on the TP for two days in a row and went to the GP. He said it looks like a minor fissure. He asked me to use hydrocortizone suppositories, add metamucil to my diet and sent me home. 4 days later I went to a CR who did anoscopy, did an HSV (herpes) culture (which came out negative), asked me to stop hydrocortizone and start using calmol 4 suppositories. He said it is a small fissure.
I was taking metamucil, increased my water intake a little. Did not make many changes to my diet which obviously was not great. None of these docs explained to me how serious can it be.
For the next 2.5 weeks, there was no blood, just mild discomfort. I also obsessively kept looking at it using a mirror and a lamp - every single day. I did not see anything more than a minor scratch. I did not know I was disturbing it.
It was feeling better but the area outside was red and itchy. So one day I could not resist and I itched it. Two days later there was significant bleeding on the TP and stinging pain. I made an appointment with the CR for a week later. The day I saw the CR, it seemed fine. So he said it is getting better and asked me to use synalar for the outside inflammation.
I did that - all well for a week with minor intermittent bleeding. I also started getting much better on my diet - oatmeal and a fruit for breakfast, salad for lunch, beans or steamed veggies for dinner. Little to no meats, taking a tbs of metamucil upto 3 times a day.
About 2 weeks later, again there was significant bleeding and stinging. called up my CR - he said stop using the synalar as it may have thinned the skin and go back to the calmol 4 again. So I did. I also added 4 tabs of colace everyday.
Another 2 weeks went by relatively ok. Then one day, I carried some heavy stuff from the grocery store, and ate fried bacon. 2 days later I had the bleeding from hell. Like I'd never seen before. So i called up the CR who said it is not an emergency so gave me a 3 week later appointment Disappointed, I made an appt with another CR.
I saw him last Thurs (7/15). He did sigmoidoscopy and confirmed that I have a fissure as well as some small internal hemorroids. He basically told me that I will have to get surgery for the fissure done. He said that I could try Nitro first but it is not a permanent solution.
So I have been using nitro for the last 5 days. No change in the first three days but today feels a little better. There has been blood and the cutting pain in every single BM though.
The size of my fissure is 1cm x 1mm x 1mm.
It is great to find this forum. Obviously all of us here know how much anger, grief and distress this could cause. Planning my whole life around a BM. Can't eat anything. This is no way to live. Absolutely not.
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Re: New to the world of pain

Postby bottomline » 20 Jul 2010, 15:54

Forgot to mention that I am a 30 yr old male.
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Re: New to the world of pain

Postby cherylk » 20 Jul 2010, 16:07

Bottom,
We're glad that you found our little group. Diltiazem helps many heal.
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Re: New to the world of pain

Postby bottomline » 20 Jul 2010, 16:25

Thanks Cheryl. I spoke to my CR an hour ago and he told me that it will take at least 2 weeks to notice an improvement. And he said even then bleeding may continue but the pain should recede.
I have been reading a lot of latest research in this area recently, particularly thinking that there is a chance that i will eventually have to go into surgery.
By the way has anyone seen this --
http://www.gcrsa.com/subcut-fissure.pdf
(This procedure seems promising -- no LIS required so no long-term side effects even though I am sure the recovery period and pain will be there)
This is the one that scared me --
http://www.ncbi.nlm.nih.gov/pubmed/15906136
Sorry i am rambling. But i do appreciate your reply.
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Re: New to the world of pain

Postby NeuropathicGuy » 21 Jul 2010, 01:11

Hey bottomline, in a bit of a hurry but just wanted to post what the typical treatments for a fissure look like. Usually first line treatment consists of one of these three ointments:
0.2% nitroglycerin
0.2% nifedipine
2% diltiazem
Combined with a high fiber diet and stool softener of your choice. Some popular examples include Miralax (polyethylene glycol 3350) and Colace (docusate sodium). My personal fav is Miralax but your mileage may vary.
Using an effective stool softener and topical ointment, most folks are able to at least greatly reduce the level of pain from the fissure.
If that doesn't heal the fissure, then a lot of people, myself included, try Botox injections, which usually provide at least temporary relief (and in some cases permanent relief). If that doesn't work, then surgery is usually considered.
Point is, you don't necessarily have to skip from steroids to nitroglycerin to surgery. There are different things you can try along the way.
I'll admit that I only had time to skim your first post, but just wanted to give you a brief summary of what you could look into before jumping right into surgery. Surgery is highly effective for most people but most folks definitely try conservative treatments first. BTW I also had nasty hemorrhoids before I got my fissure, and in the course of my diet changes and stool softener use, they went right away while I was fighting my fissure.
Anyhow hopefully this was of some help, sorry if I rambled on about anything redundant that you already knew about. I got my fissure when I was 30 as well and went from a McDonald's and beer guy to a veggie soup and water guy, so for what it's worth, there are definitely others in this rocky little boat of ours :)
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Re: New to the world of pain

Postby bottomline » 21 Jul 2010, 17:40

Neuropathic Guy
Thanks a lot for your response. Much appreciated.
I am doing oatmeal/beansoup/veggies/fruits/softbread for food.
And I am taking Colace and Milk of magnesia.
I am angry at my doctors because I did go to them pretty early on. I had what was nothing more than an abrasion (this is what my GP told me). But none of them made me realize how bad things could get so I did not realize the importance of diet/fibers/softeners and not disturbing the fissure.
There's not a single moment in the day when I don't think about this.
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