Sphinkter tonus normal, but fissure not healing

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Re: Sphinkter tonus normal, but fissure not healing

Postby dhc » 30 May 2022, 13:58

Do you have a "Squatty Potty"? Someone here recommended it and it has helped a lot. Not the answer to your problem but it might help.
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Re: Sphinkter tonus normal, but fissure not healing

Postby Rikku » 30 May 2022, 14:18

Yes I do. But it doesn’t help really. I mean, it helps me do the BM motion better but I still retear almost daily. I do not strain or anything. I am hopeless…

I think maybe the volume of BM could be the issue even if it is soft, but it looks like normal size poop. Maybe ‘regular normal’ is to big for the fissure, but I don’t know how to make it smaller/thinner. I hate that I cannot handle normal BM anymore.

I will go for a third opinion for sure.

I am guessing fissurectomy could be my only solution since it does not involve the sphincter but I have read horror stories about it and it is not so efficient. CRSs are telling me I will heal but it is just not happening and I am really on a strict regime with sitz baths, creams, walking, diet etc.
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Re: Sphinkter tonus normal, but fissure not healing

Postby Rich44 » 30 May 2022, 19:55

My CRS told me Botox is a temporary fix and in 9 months you'll be posting the same thing again. However, if you think Botox will calm things down a bit and allow your fissure to completely heal then try it. It's much easier than an LIS. I had it once but it didn't work because I had a mysterious muscle spasm issue at the same time that made things much more difficult. By the time I saw another CRS 5 years later an LIS was the best option.

However you said your sphincter seems to be normal which should allow normal healing of the fissure now.
Why do you think you have a re-tear every few days?
What tends to cause that?
Do you diligently treat the area every single day or do you take a day or two off when things are looking better?

I assume you had this detailed discussion with the doctor(s) and they said just keep doing what you're doing, right?

My suggestion remains to do what I mentioned for 2-3 weeks and if things are not any better, go back to the CRS or even try a third one. Sometimes we have to move on to the next step which for you could be Botox.
Fissure June 2014 - Oct 2020
Botox, skin tag removed - Feb 2015
Levator Ani Sep 2014 - Feb 2016 (left job, cured!)
LIS, skin tags removed - Oct 2020
Fissure 100% healed!
If you need me to reply to a post ASAP send me an email too
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Re: Sphinkter tonus normal, but fissure not healing

Postby Rikku » 31 May 2022, 00:25

I really appreciate your answers.

I think I retear because of maybe bulky stool, that it the only thing that comes to mind. Even though it seems normal size, so I really don’t know. But when I have a BM, I can feel it retear, so that is why it think maybe it is bulky stool.

For the last 6 month I have been extremely diligent. I stopped/weaned only for few days few months ago when I thought I healed. Other than that, every single day I follow my regime with sitzs baths, creams, pelvic floor excercises etc. But nothing works and I retear, usually with fresh blood, sometimes a lot of it. I do not have internal hemerhoids and CRSs told me I only had posterior fissures.

I will for sure keep going, I give myself another month and will seek a third opinion and ask about botox option. I just don’t know what to do anymore, it is so damn frustrating. I would have LIS without a single thought if I could, I am beyond desperate :(
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Re: Sphinkter tonus normal, but fissure not healing

Postby patience_and_healing » 31 May 2022, 21:14

Are you taking a stool softener like Miralax regularly? Try and reduce your intake of insoluble fiber if possible in order to reduce the size of BMs.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
On and off in pelvic physical therapy
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Re: Sphinkter tonus normal, but fissure not healing

Postby Rikku » 01 Jun 2022, 00:25

Yes, stool softener (lactulose) every day. I am watching on my fibre intake, I think that I need a bit thinner stool to heal but it is so hard to have that kind of stool for months. One bit bigger BM always comes. I will give my best to keep it thinner, I don’t know what else to do.
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Re: Sphinkter tonus normal, but fissure not healing

Postby Rich44 » 02 Jun 2022, 10:53

Rikku wrote:Yes, stool softener (lactulose) every day. I am watching on my fibre intake, I think that I need a bit thinner stool to heal but it is so hard to have that kind of stool for months. One bit bigger BM always comes. I will give my best to keep it thinner, I don’t know what else to do.
The irony is the longer this goes on (and I mean years) you will get to have an LIS because by then your sphincter will be much tighter from the softeners and mental stress you are going through.

I think you need to try one approach and stick with it for at least 2 weeks. If you've been doing the stool softener route and are STILL having issues - STOP. You should not be avoiding fiber because you want bulky soft stools, drink plenty of water, don't shy away from salt or electrolytes, have sitz baths a few times a day and give it two full weeks. Don't panic and run for softeners. I'm serious - you are on the verge of going to a third CRS (and which is what you may need to do) but I don't know you personally. I don't know if you can tolerate a little pain or a lot of pain. Maybe you should talk to a gastroenterologist and discuss your BM history. You might have IBS-C. Stool softeners and laxatives are for constipation.
Fissure June 2014 - Oct 2020
Botox, skin tag removed - Feb 2015
Levator Ani Sep 2014 - Feb 2016 (left job, cured!)
LIS, skin tags removed - Oct 2020
Fissure 100% healed!
If you need me to reply to a post ASAP send me an email too
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Re: Sphinkter tonus normal, but fissure not healing

Postby Rikku » 02 Jun 2022, 13:23

The only time I managed to heal is when I had thinner stools, and then I had a retear with one bulkier stool. So yes, I do not want to be dependant on lactulose but I will never heal if I have stools that are too big. At first I tried to heal with taking psilium but stools were too bulky, retearing me all the time and for weeks the spasms were horrible, unbearable. I could not handle it, screaming pain. Then I started taking lactulose and things got so much better, I managed to (I guess) heal, no spasms, normal life, even could handle bulkier ones. Then I decided to stop ntg cream and lactulose and unfortunately one bigger and maybe harder BM and I was back to square one.

I cannot see how bulky stool will help if it retears fissures every day. I would say my stools are normal size, not thin not bulky, so latculose helps. My doctor told me it is safe to use and recommended with this kind of issue. I do not avoid fibre, just careful with the amount of it.

My BMs prior to lactulose were normal, never really had any issue with hard BMs or constipation.

And I do stick to the same regime. It has been the same for months now. But there is always that one BM that retears me.

Right now I am just going with it and I will do it for another month or two so if I dont heal, will seek another opinion, dont really know what else to do.

Can you tell me how does a tight sphincter feel like? Like you can’t put your finger inside or like something else?

Btw, thanx for replying, it makes me feel like I am not alone:)
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Re: Sphinkter tonus normal, but fissure not healing

Postby patience_and_healing » 03 Jun 2022, 17:00

I agree that bulky BMs don't work for everyone, I know they didn't for me. My suggestion is to stick to the routine of laxatives and fiber that causes you least pain. Don't let up the routine even if you have a week of no pain because that may cause a retear. I don't know if you already do this, but a barrier ointment applied before a BM like Vaseline can help with the pain.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
On and off in pelvic physical therapy
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