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First Post, long time lurker

Postby arbguy » 20 Jul 2013, 17:02

Hi all,
I am a 29 year old male, otherwise in good health.
I have been dealing with a fissure for a about two and a half years now, it seems to have started with a bowel movement following a long bike ride in March 2011. It wasn't very painful and unfortunately, I didn't deal with it promptly and let it linger on. Also, the GPs treated me for hemorrhoids rather than a fissure. However, it was more of an occasional nuisance rather than a severe problem. Sometime in March 2012, I developed post-antibiotic IBS which aggravated the problem slightly. In about August 2012, I occasionally started having bowel movements where the first piece to come out would have a sharp leading edge, which would tear me up. My GI(who I was seeing for the IBS) put me on Miralax and citrucel and I seemed to have found a sweet spot at 1/2 a dose of miralax and three citrucel tablets a day. My IBS more or less resolved in September 2012 and since then I was doing pretty ok on the miralax and citrucel. My only complaints were mild bleeding (usually a reddish tinge on a toilet paper) about once or twice a month, mostly after a hard bowel movement, which in turn was usually a result of me slipping up on miralax/citrucel/water intake or occasionally after prolonged periods of sitting. In Dec 2012, my GI examined me with an anuscope and didn't find anything.
However, since mid April 2013, I seem to have taken a turn for a worse, out of nowhere I had some bleeding and I also slipped up on Miralax/Water intake which resulted in a few hard bowel movements. I started the usual tricks that I had learnt here, like applying vaseline before a bm, sitz baths after a bm etc. However, the problem persisted through May. I started to develop pressure like pain in my buttocks after periods of sitting and some external hemorrhoids, which would occasionally appear and disappear. In early June I saw my GI who found a fissure on a digital rectal exam and put me on Rectiv, I went for a followup in Early July when he examined me and said that the fissure was healing, though it wasn't completely healed yet. The two times he examined me, he didn't see any external hemorrhoids. He also told me that if I develop a fissure in future, I should consider surgery.
Also, starting in May, I started to develop pressure like pain in my buttocks after periods of sitting. The pain seems to be concentrated in areas (buttocks and upper thighs) which are supporting my body weight and not in the rectum. The pain is more or starts earlier when sitting on harder surfaces and also seems slightly posture dependent i.e. if I can lean back and transfer some of the weight to the back then I am less prone to pain. Also, getting up and walking around seems to temporarily help ease the pain. My bowel movements (except maybe for 5-10 days in May/June) have been practically painless. The pain is not a spasm like pain that people here report and if I am able to go about my day without sittings for more than 30 min. (on weekends), I can completely avoid the pain. Due to these reasons my GI feels that this pain is unrelated to the fissure and is probably something like sciatica. The GI (through my GP) has referred me for a pelvic MRI.
I am going to visit a CRS for a second opinion this week as I find it hard to believe that this butt pain is something else. I just wanted to see if someone here has experienced something similar or can shed some light on this.
Thanks,
Arbguy
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Re: First Post, long time lurker

Postby blackecho » 20 Jul 2013, 21:35

Hey Arbguy...
Not sure if it is the same thing..............I have had a fissure problem for the last couple of months but am on the way to healing .....diet/water etc all keeping stools soft ...and relatively painfree BM...but did notice after long periods of sitting or particularly laying on the couch that I would get a dull pain in the upper buttocks and lower spine area and was relieved... the same way just by walking around..... I tended to think was maybe caused by the tension of the sphincter muscle......
cheers
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Re: First Post, long time lurker

Postby arbguy » 21 Jul 2013, 00:53

Hi blackecho,
Thanks for your response. I start to get pain in about 20 min on a hard bench and in about 1-2 hours on a comfortable chair. I also feel that this pain is being caused by the tension of the sphincter, which is preventing the surrounding muscles from properly relaxing. However, my GI said that since there is no pain in the rectum, the surrounding pain is probably not from the fissure. Hoping that the appointment with the CRS will be helpful.
It turns out the pelvic MRI request was turned down by the insurance, I didn't buy that story anyway, but I still wanted to get it done to rule out any other issues. So I will have to see what to do there.
Arbguy.
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Re: First Post, long time lurker

Postby blackecho » 21 Jul 2013, 01:31

Hey Arbguy ............
Was wondering if you noticed any numbness type feeling around the sphincter?..
Nobody else seems to have that .................. Drs don't seem to fussed about it when I mention it either............
all the best with it bud
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Re: First Post, long time lurker

Postby arbguy » 21 Jul 2013, 09:47

I do get a numbness feeling in the surrounding buttocks (not in the sphincter) when sitting for a while. I guess this is normal, but it now seems to start much earlier than before.
I have also noticed external hemorrhoids appear and disappear, which is strange as I never had them before and now days I am taking extra care to keep my bms soft and avoiding straining.
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Re: First Post, long time lurker

Postby arbguy » 31 Jul 2013, 21:22

I visited a CRS on Monday. He examined me with me kneeling down with my ass up in the air, which felt quite weird. He said that it helps him see better. I have always been examined while lying on my left side. He said the could see the fissure and didn't examine me with an anoscope as he thought that might tear me up. When asked about the size of the fissure, he said that it was "typical" and didn't have a sentinel pile associated with it. He also added that going by the time it has been there it is probably chronic.
He told me to continue with the rectiv and asked me to put the calmol suppository before applying the rectiv. The calmol contains cocoa butter and zinc oxide and he said that it does not contain hydrocortisone unlike other hemmorrhoidal suppositories which can be disastarous for a fissure. He told me to see him again in 3 weeks. He mentioned the possibility of surgery or cauterizing the fissure if it doesn't work by then. Trying to hang in there.
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Re: First Post, long time lurker

Postby Please go-away! » 01 Aug 2013, 20:40

Hi Arbguy, sorry to hear, but at the same time this forum rock's, and will help you as it has helped all of us.
The calmol contains cocoa butter and zinc
oh please do tell me about this product, it sound's divine..what's one more product for my to try, I practically have a Drugstore in my place..lol.
Believe it or not, all though odd, by examining you that way, he can see with out being to intrusive, I think that is the word, the rectum drops, is more relaxed. something like that.
Some one else talked about cauterizing, and said it healed them much faster, sorry I don't remember who.Your Doctor sound's right on the ball and very knowledgeable.
Please re-examine your diet..look through the many post's here about soluble and insoluble,  we all have to change our way of eating now and it doesn't have to be a bad thing.
Heres an example of my day..
Breakfast #1, Oatmeal with diced/chopped 1/4 apple, raisins and or prunes or dates.
Breakfast #2, 2 egg whites with one yolk(yolk's don't upset me) sunny side up, sauteed
spinach /kale combo (season to taste, not too spicy) and sour dough bread or whole wheat..one slice.
I usually have my fruit fresh, before the meal or in between, easier on the digestive tract.
I do take Magnesium, changing it to the liquid form,(twice a week at night) along with Restoralax, during the morning only if I feel I need it(Canadian version of movical and miralax) plus a teaspoon  of ground Flaxseed every day as part of my breakfast.
Of course you don't have to follow me, you have to find what work's for you.
I find by writing in a journal, upon waking up, eating pattern,food's you have eaten, pain's, Bristle scale of BM's,your mood that day..even Question's you want to ask the Doc.
So yes we are all here for ya..and see if your diet need's to be re-adjusted..ok hun...take it easy and while aboard, read as many post's as you can in three week's..and believe me, theres alot ,even I haven't read them all..Image       
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Re: First Post, long time lurker

Postby arbguy » 04 Aug 2013, 11:55

"Please go-away!" Thanks for your reply.
Regarding calmol, I have been using it for about 5 days now, I am probably feeling slightly better (or maybe that is my imagination). I think the doc prescribed it for me because I mentioned the possibility of internal hemorrhoids and he didn't want to look deep inside for fear of tearing the fissure. I am not sure how useful they are if you have only a fissure. However, I will keep you posted on how it works.
Regarding cauterization, he said that cauterization basically converts a non-healing chronic fissure into an acute fissure which is capable of healing. He said that it burns and the recovery time(not healing time) is about 1-2 days. I have looked around on this forum and elsewhere it looks like cauterization is not a terribly popular procedure. This kind of raises red flags, like if it has a less recovery time compared to LIS and is equally effective, it should be more popular. In any case, the CRS didn't go into too many details and said that he will evaluate me in 3 weeks and said that I might not need any surgery after all.
I have made changes to my diet, water intake and miralax/citrucel etc. and  have been experiencing soft bms for the last two three weeks. I also use a heating pad for about 1-2 hours daily. Hopefully all these things will help.
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Re: First Post, long time lurker

Postby arbguy » 02 Sep 2013, 21:33

I went back to the CRS for a 4 week followup. The fissure is still there and doesn't seemed to have healed and the CRS doesn't think that it will heal. I got a prescription nifedipine from him, which I will try once my Rectiv runs out. He basically gave me two options:
The first option was to cauterize the fissure - he said he could do this right then, but I decided to wait - he said that this has a 50% chance of success. He said that it will burn for about 1-2 days, but I could go right back to work. I am not sure if this is worth a try, as it doesn't seem to be very popular around here or through any other research that I have done.
The second option was Standardized Anal Dilation. He said that he could do an LIS but he stopped doing them a few years back and that he does Anal Dilation now. When I asked him about incontinence, he said that the earlier procedure known as Lord's dilation where a surgeon dilated the anal canal with four fingers caused a lot of incontinence because the pressure was primarily located at the 4 fingers. However he uses Sohn's Dilators which ensure that there is pressure is evenly spread around the anal canal and that he has never had any incontinence issues. He said that he does about two such procedures a month, which means that he has probably done about 100 in say the last 4-5 years. Is this par for a CRS? or is it on the lower side?He said that he has had a success rate of about 90%, in the remaining 10% of the people, even though the anal canal is not tight anymore, the fissure wound still doesn't heal in those cases he does a flap procedure, which is basically covering the wound with skin from else where.
I searched around this forum and found these posts (below) regarding dilation, every who had it seems to have done well on it. It also looks like Standardized dilation is regularly done in Germany and Japan but not in the US. The CRS told me that I could have it done on Thursday and probably be back to work on the following Monday.
US
http://anal-fissure.org/t4737-pneumatic-balloon-dilation-and-skin-tag-removal-1-week-ago?highlight=dilation
http://anal-fissure.org/t4086-standardized-anal-dilation?highlight=dilation - this guy seems to recommend it very highly.
India
http://anal-fissure.org/t3341-hello-i-would-like-to-share-my-fissure-experience
there was another guy from India who I cannot find.
UK
http://anal-fissure.org/t2094-stretch-dilation?highlight=dilation
Here is some discussion of why dilation might be more risky compared to LIS
http://anal-fissure.org/t6393-controlled-anal-dilation?highlight=dilation
In any case, next week I will get a second opinion from a different CRS and see what he says. I am also considering getting a third opinion from the remaining CRS in our area.
At this point with a combination of diet, water, miralax and rectiv, I had managed to get the fissure to state where it is a daily nuisance (rather than a major problem), but it does not seem to be healing. And today after a gap of about two weeks, I noticed some blood and increased pain which seemed to have momentarily pushed me over the edge and made me seriously consider surgery (LIS or SAD) to put an end to this once and for all.
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