New user, looking for some advice.

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New user, looking for some advice.

Postby dkr » 22 Dec 2011, 14:08

Hi, I'm new on here and have been suffering with an anal fissure for almost 6 months now. It came about during my giving birth to my baby girl, and I haven't been able to have a normal, comfortable BM since. I requested stool softeners while in the postpartum ward after giving birth via episiotomy and vacuum. They were not given to me nor was I given instruction to take sitz baths. I expressed my concern to my OB at my 6 week follow up appointment and described all of my symptoms (i.e. bright blood following BM, extreme pain during BM as well as for several hours post BM) he told me that this was all normal due to a hormonal change in my body from giving birth. With that i went to my family doctor, she did an exam which was excruciatingly painful and said there were no signs of hemmroids so it may be a fissure. She referred me to a gastrointestinologist. He examined me with a scope and diagnosed me into the anal fissure club. Now, what he prescribed to me has me baffled. Anurex, a small, plastic object that i am to store in my freezer and insert into my anus 3 times daily to help heal my fissure. Cryotherapy is the term for this type of therapy. Its a waste of time! it creates more pain and no relief. I was also prescribed a compound ointment of 2% xylocaine and .2% nifedipine. this seemed to help with the pain when applied prior to BM. For some reason it has stopped working.
This is very difficult to deal with when I have a 6month old baby to take care of, who now is sick. I have another appointment in the new year to follow up with my condition and i was told at my last appointment that if it seized to improve by the new year it'll be time to talk surgery. This is something I'd like to avoid at all costs.
Also, sitz baths have not helped me and my stool is not hard and is quite regular so i dont believe its my diet.
Any and all advice is greatly appreciated. I just want to spend all my time and energy with my baby and not having to worry about my bum.
dkr
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Re: New user, looking for some advice.

Postby JR » 22 Dec 2011, 15:37

Welcome to the forum dkr.
First off I know these stupid fissures can be a pain in the ass..LITERALLY. Now while im not a female, I have no idea how you could of explained all those symptoms and just brush it off as a hormonal issue....uhhh... sure. Im not really sure how those two ointments may work for you, but try asking for a referral to a CRS, asap. Not sure where you live but I surprisingly didn't even have a referral or even need one until after my surgery here in Florida.
Also since you said you been dealing with this for almost six months I doubt any cream will even help at all. It may take the pain away but actually healing the fissure is another story,( you want the pain to go away, but the source of the pain as well..ie fissure). You want to work at getting rid of the spasms that is what mostly keeps you in pain throughout the day. Sitz baths help TONSSSSSSSS. HOT WATER for twenty mins will do wonders for that area.
One last thing Id like to add. I know you arent going to be interested in this portion, but surgery may be the best option. Your fissure is chronic by this point, so surgery may be the best option, but dont fret its not even that big of a deal. Trust me I had it done two days ago and feel SO MUCH BETTER. If you need any help dont be afraid to ask.. everyone is nice here and so willing to help.
P.S. when the days get bad, look at the smile on your baby im sure that will liven up the mood.
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Re: New user, looking for some advice.

Postby Deleted User 579 » 22 Dec 2011, 15:57

Hi dkr! Welcome Image and congratulations on your new baby :D
I am sorry you have to be here, but you've certainly come to the right place. Everyone here definitely understands your pain and there's lots of great advice and support here.
If you don't mind me saying, I'm rather shocked and very disappointed with the poor quality of care you got after you gave birth. AFs are very common after childbirth and you definitely should have been given stool softeners and instructed about sitz baths.
I'm also kinda angry that you were given Anurex. Of all things! I've done A LOT of research and every credible source I read indicates that warm baths (including sitz baths) are best because they stimulate blood flow. This is very important because it is a lack of blood flow that causes a fissure to become chronic (i.e., lasting longer than 6 weeks). Usually the blood flow is inhibited once the sphincter muscle starts to spasm and tighten up, and that's why doctors who know what they are doing prescribe nitro, nifedipine or diltiazem - those ointments are vasodialators and so they stimilate blood flow in the butt. If the nifedipine has stopped working, maybe you can ask a doc about diltiazem or nitro.
I don't mean to sound pushy, but I'm wondering if you should dump that GI and find yourself a good Colorectal Surgeon (CRS). CRSs are the specialists most of us here deal with, since they are the experts on things like fissures.
I'm familiar with Anurex - it is heavily endorsed by a surgeon here in Canada named Dr. William Rudd who runs a clinic in and around Toronto. It was developed for hemorrhoids, but the folks at the Rudd Clinic prescribe it for just about everything. I had some pretty awful experiences at the Rudd clinic (as have a few other boardies from Toronto here), and my wonderful new surgeon doesn't seem to have much respect for them. I'm really amazed that you would be given cryotherapy for a fissure. Image
I hope you don't mind that I've voiced some strong opinions here. But I do hope that you can get a good doctor who can treat you properly. You really shouldn't have to suffer with this, and you definitely deserve to spend quality time with your little girl. :)
I really hope you find relief soon!
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Re: New user, looking for some advice.

Postby dwarfs8 » 26 Dec 2011, 03:47

yes, please find a CRS. All the rest of the doctors whichever they are called, esp. OB, are ignorant of how to heal fissures/hemms.
I feel sorry for u that a joy turned into a nightmare.. when i had my miscarriage/D&C, and then got myself into terrible constipation due to my confinement diet, i torn myself like there's no tmr in the toilet. I told the OB abt my constipation and all he could say was "it has nothing to do with the d&C"
So... anyway, if you like to get some ideas on how to heal this damn thing, u may like to see "my success story" thread. Do a search.
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Re: New user, looking for some advice.

Postby dkr » 27 Dec 2011, 12:37

Thanks for all of the support! It's really helpful knowing I'm not the only one going through this. I am going to get a referral to a CRS in the next week hopefully, just a little worried. my family doctor tends to refer me to incompetent doctors.
To Hopetoheal, I'm also from toronto so any suggestions on reputable CRS's would be really helpful.
dkr
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Re: New user, looking for some advice.

Postby Deleted User 579 » 27 Dec 2011, 16:36

Hi again dkr! I'm so glad you are getting a referral to a CRS! I'm not actually in Toronto - I live just outside the GTA, so, unfortunatley, I don't know of a good CRS in the city.
A few years ago I had some trouble with a referral from my GP, so I did my own research and found a wonderful gyno by going to the website for the Ontario College of Physicians and Surgeons: http://www.cpso.on.ca/
You can do a doctor search, check qualifications and records, etc. If you see a doc you like, then you can call her/his office and ask if they are taking new patients and how soon they can see you. Then you can look them up on ratemydoctor:
http://www.ratemds.com/doctors/ON - in case other patients left some good info. Of course, you can also look up the CRS your GP referred you to as well. :)
You are certainly not the only one going through this! Image I was really astonished to learn how common AFs actually are - and I was even more astonished to find out how little GPs know about them! Image I was so grateful to find this forum! I got lots of great advice and wonderful support. :D
Lots of folks here compose a list of questions to take with them to their docs appointment. I think a list is a great idea - a list helps you learn more about your condition, and, perhaps just as importantly, it helps you get a sense of what kind of doc you're dealing with. If you like, I can dig up my old list that I put together from posts on this forum.
Please keep us posted - I hope you get to see an excellent CRS the first time! Image
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Re: New user, looking for some advice.

Postby dkr » 28 Dec 2011, 11:59

Having an especially rough day. Woke with the lingering pain of yesterday mornings BM still aching away. Then i had the worst BM to date. I felt completely incapacitated, my legs were shaking so horribly from the pain it took forever to get into the shower.
After having an extremely demoralizing conversation with my brother about my fissure I thought, what else could pick me up out of this slump today. So here I am posting here. It really is such a great release being able to share with everyone on this site without being put down. The conversation I had with him basically was him telling me I clearly don't want to get better, and its my fault im in pain.
I chose to stop using the anurex because prior to its use i was unable to see the fissure, but now it goes from the inside to the outside and im able to locate it now. I really just want all of this behind me, if surgery is what i need i am open to it even though its not my first choice. Anything that can help this paralyzing pain.
Hope, yesterday i was reading through your posts about your fissure adventure and you really are just an amazing person. To go through what you went through (which was completely ridiculous) and to still be in such high spirits, and able to be so supportive towards everyone else here is just beyond words.
If anyone has any recommendations for a good stool softener, it would be greatly appreciated.
And also hope, if you could give me that list of questions you mentioned yesterday that would be amazing thanks!
dkr
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Re: New user, looking for some advice.

Postby Deleted User 579 » 28 Dec 2011, 13:58

Aw, drk – I’m so sorry you are having a rough day. Image It certainly doesn’t help when the people in your life don’t understand how painful and debilitating AFs are. There have been women here who went through the most difficult childbirths imaginable who claim they would go through a difficult delivery again rather than suffer with a fissure. And there was one guy here a while ago who suffered a gunshot wound who said the AF was worse. I believe him!
The pain truly is beyond description and nobody who hasn’t experienced it can possible understand. I’m sorry your brother wasn’t more sympathetic. I also had very shaky legs and struggled to take showers. Actually, the pain took so much out of me I could barely move at all some days - I was so weak and exhausted. People don’t really understand how exhausting pain can be too. I really know what you are describing! Image
To answer your question: Restoralax (Miralax/Movicol) is a favourite stool softener here. I swear by it. It can take a few days to start working, but it really helped me a lot. One thing I like about it is that it comes in powder form, so you can modify the dose to what works best for you. Also, it’s an osmotic laxative, not a stimulant laxative, so it’s very gentle.
I’m so glad you stopped using that vile anurex! I’m still angry that you were told to use it. Image I completely understand that surgery would not be your first choice. Ass surgery is the scariest thing I’ve ever had to face! Image But I was like you after a while – I was willing to consider all my options to get rid of the pain. I found my old list of questions – here’s some of what I asked when I first saw the CRS and expected to be given ointments first and surgery as a next option:
1. What are the (statistical) chances that my AF will heal with ointments?
2. What has your success rate been with this treatment?
3. How many LIS procedures have you done?
4. What is the (statistical) success rate of LIS?
5. What has your success rate with LIS been?
6. What is the complication rate of LIS?
- infection
- incontinence (to gas, liquid stool, solid stool)
- recurrence
7. How many complications have you had with LIS?
8. How would you manage/treat a complication?
9. What is a reasonable recovery time?
10. What will the procedure involve?
These questions are good to ask so that you have an idea what you are getting into, and also to ‘test’ your doc. As Dawn has said many times here, if your doc says they’ve had patients become incontinent, run! They should say that they have NEVER made a patient incontinent. Also, it’s important to note that there are different kinds of ‘incontinence’ – the common stats I’ve read for rates of post-LIS incontinences are 6% to gas, 8% to liquid stool, and 1% or less to solid stool. For gas incontinence, that usually means it’s a bit harder to control when you toot, but that often improves over time. With incontinence to liquid stool, that’s usually a slight bit of ‘leakage’, where people feel they haven’t quite wiped enough. There are some threads here that talk about this, because some boardies have had this happen; however, most of them still don’t regret getting the LIS, and they consider the leakage more of an inconvenience than anything else. Also, it tends to improve over time. I’m not sure what the infection rate is, but it has happened, of course (like to me!).
The most common stat I read for cure rates with LIS is 95%-98%. Also, docs usually significantly underestimate recovery time, so s/he might tell you that you will be back to normal life in two to three days. That's bunk - it's more like two weeks, but surgeons don't seem to know that. :roll: If your doc gives you answers that deviate significantly from these - and/or information you can find here - then I think that would be cause to take a careful look at the surgeon. Others might chime in though, with more information.
As you probably already know, I wasn’t able to ask my carefully designed questions, and I really should have run away as soon as I met my crazy, demonic doctor – but I was in so much pain and so desperate, I really didn’t feel like I had a choice. Thanks so much for your kind words. :D The folks on this forum helped me so much, I’m sure I wouldn’t have been able to recover as well as I did if it hadn’t been for the support of the folks here. Everyone here understands what you are going through, and we’d definitely never put you down! Image We will more likely give you a medal for bravery!
I hope your day is improving a bit. I really know how it feels to wake up in pain. Hang in there! You can beat this and it will not last forever. Image
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Re: New user, looking for some advice.

Postby dkr » 28 Dec 2011, 14:12

Thanks so much hope! Recovery time for me really isn't an inconvenience seeing as I'm still on maternity leave, and I know my spouse will take time off of work to help take care of our daughter when the time comes. I found a CRS that works out of Toronto East General that I'd like to go see. I'm going to ask my GP tomorrow for a referral to speed this along. He seems to be well acknowledged and has worked in the states as well. I will definitely be bringing along that list with me.
I know exactly what you mean about the pain being so extreme. When i was in labor with my daughter I was in labor for a total of 35 hours, i didn't receive the epidural until 28 hours in, and only after i began vomiting. I was pushing for 2.5 hours and she was stuck, so i had an episiotomy and they used a vacuum to suck her out. I was left with a second degree tear that was so painful Oxycontin didn't help. I'd easily do that again then continue to deal with this.
Also, I've noticed that I'm very inflamed back there, and I'm starting to worry about the possibility of infection. I get my spouse to take a look every so often but yesterday in the midst of all the inflammation there seemed to be a part that had a yellowish color to it. It wasn't liquid just part of my tissue. Not really sure what that was but it isn't there now.
I also notice a lot of people on this site talk about skin tags... what are they and how are they dealt with when having an LIS?
dkr
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Re: New user, looking for some advice.

Postby Deleted User 579 » 28 Dec 2011, 16:12

Wow! I really admire mothers so much! I can't imagine such an experience! Thirty-five hours?!?! Image You are truly one heckuva strong woman! Image
I'm so glad you found a good surgeon. I really hope he can see you asap. My butt was constantly swollen and bright red Image With the tightness and the spasms and the ointments, and so on, the tissues in the butt get a little angry and get very delicate. After I had my fissure for a while, other areas would tear a bit too. :roll: Of course, keep an eye on things - if the pain sensations change noticably, if the area gets hot, and if there is a strong odor and discharge, definitely go to a doc right away.
A skin tag often forms when the fissure becomes chronic. Sometimes it's called a 'sentinel pile' because it stands guard over the fissure - it can look like a pile (or hemmie), but it's really scar tissue that forms to protect the wound. They can get fairly large and painful. Lots of folks get theirs removed during the LIS - either by having it cut off or frozen/burned off. Many doctors believe that leaving the skin tag in place interferes with healing; but other docs prefer to leave it alone. There have been some mixed experiences with skin tags here. Some folks found that the skin tag removal made their LIS recovery a bit rougher and longer than it otherwise may have been. Others who left theirs alone found that their tags caused them pain even after their fissurse had healed. Others left their tags alone and developed loving relationships with them. :) Still others, such as me, had theirs removed and the skin tag removal caused no problems at all.
I hope some of this helps. And I hope you are having a nice evening with your spouse and your darling daughter. Do let us know how it goes with your GP tomorrow - I'll be wishing you lots of good luck! :D
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