Hello my name is Allen and I’m 26 year old female. I have been dealing with chronic anal fissures for 6 Ѕ years. It all started many moons ago with a stapled hemorrhoidectomy that went terribly wrong. My internal sphincter muscle started to spasm after the procedure and it was the beginning of an ongoing nightmare. I went under to have some of the staples surgically removed and then I was diagnosed with anal fissures and had a fissurectomy. The fissures didn’t seem to be healing properly and my surgeon quickly suggested a lateral internal sphincterotomy. I went to get a second opinion and was strongly advised not to go through with the surgery and looked into options for testing the sphincter tone.
I had an anorectal manometry and a pudendal nerve motor latency test. The tests showed that my internal sphincter muscle was spasming four times what is normal. The doctor that administered the test looked at my chart and asked that I come see him and that he would figure out a way to improve my quality of life. I tried biofeedback, used a T.E.N.S Unit, every type of rectal cream possible and then I found research online about botox injections. I suggested to try the botox procedure and my surgeon agreed so he ordered the machine, needles and everything necessary to make it happen. It seemed like a dream come true the first time I had a bowel movement without a spasm! I started to heal and about two months after the injections the muscle was back into its routine of spasming so we did another round of injections with Botox Type A. The second time around the botox no longer worked and we were puzzled and disappointed. I had blood work done to find out if I had developed antibodies against Botox Type A and a month later found out that I did. I was extremely lucky because Botox Type B just came on the market and we tried it out and had success again. From my understanding Type A and B are similar, Type B is just a slightly weaker form of Type A and the amount of units administered is adjusted to equal the strength as if I was being given Type A.
I had one year off from the pain and I completely healed and started to live a pain free life and out of nowhere I relapsed. The past year and a half I have gone under anesthesia for examination with botox injections every three months. I had fissures on the left and right side that were surgically removed by fissurectomy along with botox injections in April 2011. The recovery wasn’t easy but I finally had total relief in June and around the three month mark in July the fissures were back again. My surgeon was on the east coast and I had to wait for his return in September to have the next round of botox injections on 9/22/11. Since then I was hospitalized for pain management, examination under anesthesia and was monitored for the blood loss during bowel movements. My surgeon feared that something was terribly wrong but the fissures were just inflamed and I was sent home with pain medication and hydrocortisone acetate suppositories. The past few days have been manageable with slight burning during bowel movements.
I have been a compliant patient and have incorporated a high fiber diet, lots of water, colace stool softeners into my daily regiment. I feel like I’m running out of options so I’m hoping by posting on this discussion board I can gain some knowledge of alternative treatments. I appreciate any ideas in advance and I hope that my story will shed some light on testing available etc. I’m seeing my surgeon in the morning and I really hope there is some improvement with the fissures.
Sincerely,
Allen