Hi, My name is Paul, 36 yr old – I ran across this site in December last year before my LIS. I found it to be a great resource so I thought I share my experience for others. I got my first fissure back in 2005 after a night of beer and pizza. Next mornings BM was not good. I went to the CRS after going to the general doc who identified the fissure at the 12 o’clock. I was prescribed the Nitro paste. This helped a little but caused my heart to race which was freaky. In 2006 they thought I may have an abscess since I had so much drainage and pain. I did an exam under anesthesia and they found nothing other than the fissure. I was given a prescription for oral Nefedipine. This helped immensely and healed the fissure partly – enough to make it bearable. I went years with bad and good days scared of surgery.
In Aug 2009 something bad happened. I think I got either an external hem or an abscess. I had a painful bump and one day it drained a lot of fluid. I went to the CRS and they thought it was external hem but also found a new fissure at 6 o’clock. Then I was in massive pain again. I would get muscle spasms that would make me hobble around. They tried the Nitro paste and Nefedipine again. This time I had really bad cardiac reaction to both. Heart would race like mad – terrible feeling. This is when I finally said enough is enough and scheduled surgery.
The surgery was done on Jan 8, 2010. He found a fistula also during the surgery. So in all I had an LIS, skin tag removed, two fissurotomy’s, and the fistula cut open along the track. To say the least I felt like that area had been butchered. The pain after surgery was intense. The pain meds made me vomit so I switched to Advil after a day. I also was given Flagyl and that was some nasty stuff. My digestive system revolted during taking it. Nothing like having diarrhea…. I had surgery on Friday and went back to work the next Tuesday. I am a fairly high energy person that has a hard time sitting still. Recovery has been slow going. The first three months were the worst.
After surgery he became concerned that I may have anal Crohn’s since things looked inflamed and had a fistula. He became less concerned after several check-ups. Fast forward to today. I still have pain and drainage. So some days are good (pain free) and some are bad. I think pain wise I am better than before the surgery. The Fistula area still doesn’t feel completely healed. He told me to come back in October if things haven’t healed completely.
So that is my story. I am still somewhat frustrated that after taking the “plunge” to have surgery that I am battling with this. The concern I have is that I really do have Crohn’s impacting that area. They did biopsies of the area during surgery and that came back normal. But I still wonder if I should get tested more….. I have never had a colonoscopy. If I would like to get test more should I go to a GI doc or back to the CRS? I am thinking the GI doc is probably the person to see. And like most I am always trying to figure out what to eat to make things happy. I sometimes think I have been going a little overboard with the fiber intake. I average 2-3 BM a day. I used to only go once a day before my fissure saga started and I started the whole fiber bit.
Well I thought I would share my experience. Overall I would still do the surgery.
-Paul

Awwwee Paul - that is just awful :( ! I am so sorry to hear that you are still struggling with butt pain :( !!!!
I can only tell you that you made a good decision with having a surgery since fistula was discovered and you would have needed that "cut" anyway *sigh - better sooner than later since that way infection is not spreading even further in the soft tissue .
Yes - I see how you think that you would need a colonoscopy and both CRS and GI can do equally good job regarding procedure itself. For a treatment , though, if Crohn's is discovered, you might want to go to GI , perhaps.
My colonoscopy was done by CRS and he did a superb job !!!!
Regarding too much fiber - I do not know what to say :roll: Do you get "extra" fiber by eating a lot of fruits and veggies or by taking Metamucil and such ???
Also - if cutting back in fiber would produce one but very big and hard-formed BM, than it is better to go 2 -3 times with medium soft ones :roll:
My natural rhythm is 2 -3 times LOL, so everybody is different. Unfortunately the only way you can see what works for you is by trail and error : (((, and errors can be EXTREMELY painful *sigh : (((
So, if this 2-3 times poop is not a problem for you but is nice and soft , I would stick with it
Wishing you the best of luck with it all

Hi Fissulyna, thanks for the feedback. :D I will just plan to go back to my CRS. I really like my CRS – listens and very caring with a lot of experience. These seem to be rare traits for most physicians now days.
The main issue I have been having is trying to get soft and formed BM’s. Mine seem to be on the loose side a lot. My pain is directly correlated to if my BM is to loose. I think the main issue is trying to get the area clean afterwards and the acidity. I eat a diet with a lot of whole grains, veggies, and some fruit. I avoid red meat. I have been taking one dose of fiber supplement at night before bed.
I have tried:
Metamucil – was bulking things up nicely for awhile now it seems to have lost its affect.
Citrucel – doesn’t bulk things up as much but works so-so.
Benefiber – My BM were way too soft and messy with this stuff – not good.
Any other suggestions for bulking stool while keeping it soft? It is such a fine line to balance. Too much bulk or to loose = pain. Frustrating.
Thanks.
-Paul

Hmmmm...it seems that your BMs are really too soft :roll: ! How about trying to exclude additional fiber supplements - maybe your diet is good enough to give you soft poop without Metamucil, Benefiber etc. ??? Try to lower the dose by half and than after couple of days see how it goes !
I use white rice to "stiffen" my poop when it is on the "mushy" side - maybe you can try a small portion with your veggies and see what happens .
Hope you will find a perfect balance soon : )))) !!!!
It is wonderful that you found great doctor - yes- they are worth their weight in gold and some more LOL !!!!

Well my saga continues. Since last Saturday I have had a dull pain in my buttock. When I touch the area I get a very sharp pain. I am thinking I might have an abscess that formed for some reason. I ran a slight fever(99-100) on Sunday. I was able to get into my CRS on Friday so it has been a hellish week for me - sitting at my desk on one cheek. :D Taking Advil to take the edge off the pain. Luckily I have been able to sleep.
I was wondering. Can you normally feel a lump with an abscess? Something doesn’t feel normal but I wouldn’t say I have a hard lump that I can feel. Well I guess I’ll find out on Friday. I just keep hoping at some point I can get some closure to all these butt issues. Been 5 years of torment and it just gets old.
-Paul

Paul,
Sorry to read about your problem. Has Crohn's been ruled out in your situation? I know that sometimes fistulas can occur with Crohn's. I forgot where in the Midwest you live if you stated it previously. I live in Illinois. I think you might be from Minnesota?

Hey Paul, sorry to hear about your troubles. When I developed an abscess after LIS, it presented as a bump that I could feel. The bump was firm but tender and looked pink. It would sometimes drain some nasty stuff. My bump was easy to feel because it was right around the anal opening, where the LIS incision was made. But depending on the location, it may also not be touchable as an actual lump. If you have sharp localized pain plus a fever, that does sound suspicious IMO and I think you're right to suspect an abscess. But to be honest, after what you've gone through, you probably know better than me, unfortunately.
Given what you've been through, I'd also be curious as to whether things like Crohn's or ulcerative colitis have been ruled out. Either a GI doc or a CRS can do a colonoscopy. I had mine done by a GI doc, although if I did it again, I'd probably go with a CRS next time around.

Hi Paul,
Its sad you are still suffering.Have you seen someone?If u have fever,u can have an infection or abscess.Do see a doctor soon.
Hope it gets better for you soon

Thanks for the comments.
Cheryl – Yep I am up in MN.
NP- Ya, it seems in my research that usually there is a bump, redness, swelling, etc. I don’t seem to have these. Just constant pain and then if I touch the area very sharp pain. But I suppose if it more deep tissue you may not observe the common symptoms.
Pinky- I am seeing my CRS tomorrow(Friday) afternoon. That is the problem when you find a good doctor – they are booked solid. He usually is booked months out so I was happy they worked me in. They offered me to see another doctor earlier but I would like to have some continuity in my care. Plus I trust my current CRS.
After I get my current issue resolved I am going to push to find out what is going on down there. I think my CRS does think I have Crohn’s impacting my anal area. He calls it “anal Crohn’s”. I think after my last surgery he thought things looked better as time went (2nd follow-up appt) on so I think we kind of agreed on a wait and see approach. He told me to come back in October if I didn’t fully heal. Clearly something isn’t right since I would think at some point things would heal after being treated - 8 months out. What is strange is I don’t have any of the other symptoms of Crohn’s. But it does sound like it can be isolated to only the anal area. I think my CRS said it is somewhat rare under 10% of the people with Crohn’s have it just isolated to the anal area.
Thanks. I am so glad I found this forum. It helped me finally decide to have surgery last Jan. It is nice to be able to have people that understand the torment these problems create in one’s life. My wife is very supportive and understanding but it still isn’t the same as talking with somebody that can relate. Plus I think she gets tired of me talking about my rear end. :D
Well back to work for me.

Paul,
All our spouses/SO's get tired of hearing about our butts!! Interestingly, I'm going to our Crohn's support group tonight!! We're going to discuss our first Take Steps Walk that raised over $20K this past June. Best wishes for a good outcome from your appointment.