I've been on this message board a lot the past 8 months and I wanted to share my Anal Fissure experience and how it treated it. I hope that those who read this will feel more informed and be less apprehensive about the various medical options so they can recover quickly from this incredibly painful condition. Anal Fissures are embarrassing, control your life, and can be totally debilitating. You feel like you can't talk about it with anyone, so please know that you aren't alone.
I'm a 28 year old male and began experiencing rectal pain in September 2010. I never had pain during bowel movements but I would experience incredibly painful spasms for about 5-8 hours after using the bathroom. I figured it was an anal fissure...I've had acute fissures in the past so I took stool softeners, drank lots of water, and kept a bland/high fiber diet. Nothing seemed to work and the pain got worse over the next few weeks.
I saw a Gastroenterologist in early November 2010. He didn't find an anal fissure so he scheduled a colonoscopy because my older & younger sisters both suffer from IBS (Ulcerative Colitis and Crohn's respectively). The colonoscopy found evidence of Crohn's so he started treating me for that. He prescribed Entocort, Pentasa, and Canasa for the Crohn's. Ultracet (Tramadol Acetaminophen) and Lidocaine cream were prescribed for the rectal pain.
In January 2011, the pain got so bad that that I scheduled an emergency doctor appointment. My regular Gastroenterologist wasn't in so I saw one of his colleagues. He immediately found an anal fissure in the 6 o'clock position. Naturally, I decided to switch to this doctor right away. He told me to take Sitz baths as needed for the pain (ah, he relief!) and Nifedpine 0.2% cream. I also took Metamucil 3 times a day and 3 Colace pills before bedtime. This made me feel a little better but the monster always poked his head out again after a few days. It got real bad after about 3 weeks, so I saw the doctor again. He did a sigmoidosopy and closely examined the fissure. He also took a biopsy to see if there was any correlation between the fissure and the Crohn's disease. Luckily, there wasn't. In fact, my Crohn's isn't active and never has been. Hopefully, it will stay that way.
The Gastroenterologist recommended a colorectal surgeon so I made an appointment for the following day. The surgeon was adamant that we try Botox injections because surgery could cause problems later on if my Crohn's disease ever became active (I liked him already)! The Botox provided huge relief because it paralyzed the internal sphincter muscle (I didn't know that we have two) and the internal spasms were my biggest problem. I was able to control the external Sphincter spasms with sitz baths and Lidocaine cream. From February to mid-March the pain was at a level 3-5 instead of a 10.
However, the Botox never fully healed the fissure. The surgeon said that Botox isn't as controlled as surgery. The Lateral Internal Sphincterotomy surgery (LIS) reduces the pressure in the exact area of the fissure. Botox achieves the same result but it isn't permanent and spreads out over a greater area.
I saw the surgeon a month later for my follow-up. He said that we explored all medical options and that the only way to fix this was with the LIS surgery. He opted not to do a fissurectomy, which he said just creates a bigger Fissure. We talked about the risks of incontinence and he assured me that he'd done the surgery at least 100 times a year (he's been practicing for over 20 years) and never had any instances of permanent incontinence. He said that the biggest thing to worry about was infection, which is normal with any surgery.
I had the LIS a week ago (Monday, 3/28/11) and I was incredibly nervous the week prior. I just buried myself in my work (when I was able to stay out of pain) so I wouldn't think about it. Luckily, I can work from home so my boss is allowing me to stay home for two weeks after the surgery. I only needed sick days for the first 3 days.
Sunday night, I stopped eating and drinking at 12 o'clock. I took a fleet enema, which isn't fun when you have an anal fissure. The next morning I took another enema and a sitz bath. They put me out for the surgery, so my mother drove me to and from the hospital. The anesthesiologist also gave me a "block" in my lower spine, which kept me numb for the next 12 hours.
The LIS was a breeze. I was in and out of the hospital in 5 hours. The doctor prescribed me Vicodin, which I only took for the first day as a precaution. I'm not even sure that I needed it.
The next day, I was sore but it wasn't too bad. I was able to walk and use the stairs. I had some trouble sitting but I was still able to do it for short periods. I was really nervous about the 1st bowel movement but it never came.
I finally had a bowel movement two days after the surgery. I was really nervous that it was going to hurt but it wasn't any worse than the pain before the surgery (the Botox still hadn't worn off). Actually, it was better than that and felt like a healthier pain (no spasms, just consistent soreness). I'm pretty sure that that this was from the surgery and not from the fissure.
I still have blood in my stool and on the toilet paper but I expected this after the surgery. The blood is decreasing everyday and it looks like it will stop in a few days.
I started to feel a lot better by the 4th day and I'm now on Day 6. I still take sitz baths after bowel movements but I no longer feel an urgency to do this immediately. I still am, however, because old habits die hard. Two to three hours after I move my bowels and take a sitz bath, I experience "pressure" in the fissure/surgery area. It's really just discomfort and I wouldn't call it pain. Another sitz bath takes care of the pressure and I'm fine for the rest of the day. The "pressure" lessons everyday.
I EXPERIENCED NO INCONTINENCE ISSUES AT ALL!
It's been a rough 8 months but I finally feel like I'm starting to have my life back. I'm beginning to feel like I can be active again and live days where I don't have to make plans around my bowel movements. If you have rectal pain, don't wait to get treatment. They're embarrassing but fissures are very common. I'm glad that I explored all medical options before having the LIS. If all else fails, please feel confident going for the LIS. It's really a walk in the park. The recovery isn't that bad and the incontinence risks are over-exaggerated.
Best of luck to everyone dealing with Anal Fissures! I'll send another update later this week. Feel free to ask me any questions.