Should I do a colonoscopy or not?

Anal fissure with thrombosed external hemorrhoid

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Should I do a colonoscopy or not?

Postby Fissura anal » 22 Sep 2017, 08:37

Hello everyone

I would appreciate some advice from anyone who has had some experience with anal fissures AND a thrombosed external hemorrhoid.

I have an anal fissure ( or more) that started in the beginning of July and still hasn't healed. After I was diagnosed by a specialist I started doing the nytroglycerin Retogesic cream treatment twice a day, with stool softener Macrogol 4000 10 g powder for oral solution, 2 or 3 sachets a day. I drank a lot of liquids and was careful with my diet, eating a big bowl of whole grain organic cereal every morning with powdered linseed, wheat germ powder. I don't drink milk, only vegetable milk (oats). I ate fruit every day, avoided rice and bananas, and my stools eventually softened and became more regular.

After 9 weeks I felt better and, not being keen on being medication-dependent, and not being able to get hold of the doctor (he must have been on holiday) I stopped taking the macrogol sachets as often, and stopped doing the nitroglycerin cream twice a day, there might have been a day when I didn't do it at all. A VERY serious mistake! A couple of hard stool BM at the beginning of last week and the anal fissure, the same or a new one ( or new ones), was back. Since then, I have been to another doctor, a surgeon who does anal procedures but he claims that before doing any procedures I must do a colonoscopy, and an endoscopy!

For the last 3 or 4 days the pain is growing with every BM, and even though it is not YET as painful as before, it is slowly getting more painfully, i. e. the pain is stronger during the BM and lasts for longer after it. The colonoscopy is set for the 6th October, in two weeks time, and if things go on like this by then I will probably be in as much pain as before, and the thought of doing a colonoscopy (even if it is with general anesthetic) is frightening me to the point of making me consider canceling it!

Now for a bit of my history with anal problems.

I started having anal problems 7 years ago, in 2010. Up till then I had not really had real problems, except for the occasional pain in passing harder stools.

Ten years prior to that I had been a volunteer working in an African country, where I lived for 3 years and I had to take a lot of medication orally as it was an area with cerebral malaria, which can kill you in less than a day if you do not take some serious medication, the worst of which is quinine. I took a lot of medication in those 3 years, both as profilaxis (prevention) and as treatment, I even took quinine one (it knocked me down completely I was bedridden for a month, with horrible tinnitus - continuous tingling in the ears). As a result I became intolerant to both aspirin and peppercorn (of any color). I realized that when I started developing acute gastritis with terrible pain in the stomach, lasting for days every time I had taken aspirin or eaten anything with pepper. So since I have avoided anything with black pepper and taking aspirin or iboprufen is a no-no.

Which bring us back to seven years ago. in the summer of 2010 I was visiting friends in Sweden and I joined them in a traditional crayfish party. This meal is prepared by cooking crayfish in water with salt and pepper, but I didn't realize it until two days later when I started feeeling this unbelievable pain in my anus. At the time I didn't know what was wrong with me, I just assumed it was an anal reaction/inflammation as I had eaten something cooked with black pepper. Now I know I had developed an external thombosed hemorrhoid, which is basically a clot of blood on the skin just outside the anus. It's extremely painful, though not as painful as an anal fissure. As I was abroad on holiday and due to leave soon, I didn't go to a doctor there, and within a few days it had become less painful, so I treated it with the normal over the counter hemorrhoid creams, and didn't get seen by a doctor.

I avoided peppercorns like the plague and managed to stay clear of another crisis until a few years later, when I inadvertently had some food that had been sprinkled with black pepper! Again less than two days later I was in terrible pain. This time it was a lot worse than the first time so I ended up going to a specialist. I was told I had another external thrombosed hemorrhoid - the doctor explained that the first episode in Sweden had been one too because these external thrombosed hemorrhoid leave a skin tag when the blood clot gets reabsorbed.

I learnt then that when you have a thrombosed external hemorrhoid you have 72 hours from the onset to have it surgically drained, or else you will have to let it be slowly reabsorbed, or face some surgical intervention. I didn't want to have a surgery so I waited for it to heal. The pain came from the little, round (size of a fingernail) thing hanging out just outside the anal entrance. Very sensitive to the touch, and making every bowel movement painful. Walking, sitting, was painful but bearable, I remember it was around Christmas and I had to travel by plane and it was bearable.

This year, in the beginning of July again I ate something which I didn't realize had pepper on it and I had another external thrombosed hemorrhoid. I did not realize its seriousness until too late and did not try to have it drained. Then the pain became worse and worse and as a result of a particularly hard stroll where I had to strain a lot I developed an anal fissure, on top of the thrombosed external hemorrhoid. The pain was excruciating, I could not find any position that didn't hurt. The pain during BM was such that I cried like a baby. The pain after each bowel movement was continuous, incredibly strong, and did not respond to paracetamol so I stopped taking it. I laid in bed for nearly one month, only getting up occasionally. Eventually I started spending more time up, and by the second month I managed to sit on those special cushions with a hole in the middle for people with hemorrhoids. But I could not sit for long. It wasn't only really recently, about three weeks ago, that I could spend a whole day not having to go back to bed due to pain

I can guarantee that this was the worst summer holiday ever. No one in my family has ever had anything like this so there is little understanding or sympathy except from my husband who has witnessed all the pain from the beginning. He has seen me cry for hours. I discovered that crying uncontrollably, like a baby, eases the pain ( maybe explains why babies cry so much, it actually helps). This summer has been truly hellish. I had the month of august off as holidays, but in July and September I have had to take a leave from work.

But now it seems as things might not end soon. Yesterday I could still walk around without continuous pain, but today I have been in pain all morning, since my early morning BM. So, back to bed, and that explains why my post has been so long, as I have nothing else to do, really, other than search for information online. I found this forum whe I searched for information on anal plugs and anal fissures, as I have a friend who treated his by using an anal plug overnight to allow the fissure to form healing tissue. It seemed a bit too unconventional to me so I tried to find more infor on it before asking my specialist doctor about it. The thing is, I only managed to get an appointment in almost two weeks time and I would like to prevent getting worse until I go for the anal dilation, which some threads in this forum discuss.

Any advice is welcome, and I apologise for the long post.
:thankyou: in advance for all the help you can give me
I empathize will all of those in pain right now, and I assure you that even though the pain can sometimes seems too much to want to go on living ( it sure did that to me), it will go away eventually
Just find a way to keep your stools soft and to avoid straining.
All the best,
Elsa
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Re: Should I do a colonoscopy or not?

Postby patience_and_healing » 29 Sep 2017, 08:28

Hi there, you've certainly been on a very painful journey so far! Is there something suspicious that makes the doctor want to do a colonoscopy while you have an active fissure? And are you being treated by a gastroenterologist or a colorectal specialist? GIs are not the right specialists for fissure treatment.
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Re: Should I do a colonoscopy or not?

Postby Fissura anal » 29 Sep 2017, 08:32

Hi
Thanks for you reply
I am being treated by a gastroenterologist. I have already made an appointment to be seen by him before the colonoscopy.
The doctor who asked me to do the colonoscopy is a surgeon, he does anal surgeries. I suppose he asked because I have had skin cancer before, I had a melanoma. But is wason my hand, and I didn't even do chemo as I caught it in its early stages. I was very lucky.
Anyway I have kind of accepted that I must have it done by now... I would do in in three years anyway as in my country the GP asks you to do it once you reach your 50th...
2010 first external thrombosed hemorrhoid
2013 second external thrombosed hemorrhoid
2017 third external thrombosed hemorrhoid + anal fissure : treating with Retogesic 2x a day and stool softener but still not healed, considering colonoscopy
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Re: Should I do a colonoscopy or not?

Postby patience_and_healing » 29 Sep 2017, 16:25

I see. The colonoscopy is probably going to irritate the fissure, so just be prepared for that possibility. And you can confirm with the other doctor about why exactly he wants one done, like is it because of the appearance of the fissure, its location, etc.
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Re: Should I do a colonoscopy or not?

Postby Mypoorbutt » 30 Sep 2017, 17:19

Hi really sorry to hear your suffering
Just a quick note when you go for the colonoscopy tell them you have an active fissure and request the smallest scope. They are usually quite happy to do so as although it takes a bit more skill on their part it will help reduce the pain for you.
Also when you take the prep try and put some barrier cream on before your BMs as prep can make some people have quite acidic BMs which will irritate the fissure.
Good luck and it's never as bad as we think it will be
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