Sphinkter tonus normal, but fissure not healing

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Sphinkter tonus normal, but fissure not healing

Postby Rikku » 13 Feb 2022, 05:11

Hi everyone. I got two fissures after childbirth two month ago and tried basically every conservative method (psyllium, diet, sitz baths, galons of water, creames, ointments, self-dilation etc.) but still have pain every single day. Ntg ointment helps only with the spasms, but my BM is still with great pain.

I went to the doctor for SAD (standardised anal dilation) but he told me my sphinkter tonus is great and normal and there is no use of SAD for me and to just keep going with conservative methods. But they are not working, I am in terrible pain every day. Every day!
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Re: Sphinkter tonus normal, but fissure not healing

Postby patience_and_healing » 14 Feb 2022, 01:26

Hi there, I think you should seek out a second opinion. Sphincter tone should be measured by a anal manometry to be absolutely certain of the level. That said, it is possible to have fissures with normal tone. Please take a laxative like miralax to keep BMs soft, and reduce insoluble fiber that can make BMs bulky and cause more pain.
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Re: Sphinkter tonus normal, but fissure not healing

Postby Rikku » 14 Feb 2022, 02:57

Thank you for the reply. I will for sure seek another opinion because it has been two month of therapy without any progress whatsoever. We dont have miralax here but I am using lactulose syrup and just have to get the right dosage to make my BM soft but not runny.

My doctor only used a finger to asess the sphinkter tone I think, but said it was completely normal. Could a normal sphinkter be an effect of ntg ointment I have been using?

If it is truly normal, does that mean I am not a candidate for LIS and Botox also? What would my options be? I am presuming fissurectomy... but as I have read, it is not as effective as LIS, and the recovery is terrible.
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Re: Sphinkter tonus normal, but fissure not healing

Postby patience_and_healing » 15 Feb 2022, 05:32

I think ntg ointment will not make the pressure completely normal, but it should reduce it some. As far as I know it only works for a specific amount of time after application so will not permanently affect pressure.

I'm really not sure what your options would be if pressure is normal. I imagine fissurectomy would be a possibility. It's best to get another opinion, from an experienced doctor if possible.
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 » 28 Apr 2022, 11:36

Just to add so anyone with this question can have an answer - yes, nitrogliceryn ointment can cause normal sphincter tone.

Just been to the doctor and he said my normal tone could be due to ntg oitment use (I used it for two months).

I managed to heal my two fissures but then I stopped with the ntg and had a re-tear with days of blood. Then it healed again with ntg. So I dont know what to think… Dr. said to keep using it for two more weeks and we will see.
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Re: Sphinkter tonus normal, but fissure not healing

Postby Rikku » 27 May 2022, 05:11

Second opinion - CRS told me again I have a normal sphincter tone and no need for any kind of procedure. Why have I not be able to heal my two fissures for 6 months then?

I have done everything. Please help me.
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Re: Sphinkter tonus normal, but fissure not healing

Postby patience_and_healing » 28 May 2022, 13:28

Did the second doctor suggest any treatment options?
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 » 28 May 2022, 14:04

No, just told me to procede with ntg cream 4-5x a day (as opposed to 2x a day so far) on the fissure site, and some hemerhoid cream inside rectum. And that it will heal.

But here I am with retears and blood almost every day :/

I am taking stool softener, drink water and did every conservative method. But I have not be able to heal for 6 months. I am on the verge of depression.
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Re: Sphinkter tonus normal, but fissure not healing

Postby Rich44 » 30 May 2022, 11:51

My opinion is a little different to patience_and_healing but I will give my thoughts anyway. Are your BM hard every time? If so you might want to make sure your sodium and electrolytes are more balanced. Too much water can throw things out of whack. If your BM are soft and you still have pain, stop taking stool softeners. Personally I am of the belief that you should not take laxatives or stool softeners to aid with BM for fissure relief. They are for constipation. My feeling is if you rely on having them to make your stool softer you will cause your sphincter muscle to tighten up which can inhibit proper blood flow to heal the fissure. I had an anal manometry test and I not only was off the charts too tight, I broke the testing balloon! It just confirmed what I thought - all the softeners and stress had tightened me up big time.

You've seen two people about this. If I were you I would continue the sitz baths at least 3x a day (they are so helpful), drink water, maybe get some electrolyte drinks, have fiber and foods with fiber and RELAX as best you can when you have a BM. Seriously try your best to calm your mind and let things happen naturally. Then immediately have a nice sitz bath. See what happens over the next few weeks. If nothing changes see another CRS for another opinion.
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Re: Sphinkter tonus normal, but fissure not healing

Postby Rikku » 30 May 2022, 12:16

Thank you for your reply:)

My stool is soft and good size I would say. I eat enough fibre, drink a lot of water and have regular BMs. I do not know why I tear every few days, and there is a lot of blood sometimes. My blood exam was also excellent. Maybe the volume of the stool is too big but it seems normal in size to me.

I am just looking for an answer why I didn’t heal in 6 month now if my sphincter is normal. Doctors just tell me to keep doing what I have been doing this whole time - ntg cream, sitz bath, fibre, water, regular BMa etc. But it just seems pointless when I retear every few days:(

I did manage to be painfree for a month with lactulose, then stopped for few days and retore. After that, I am retearing all the time.

I wish I could do LIS, I was ready for it after a few months of these fissures, but two different CRSs tell me I do not need surgery since the result of LIS is a normal sphincter tone.

Do you think botox would be an option for me? I guess it also relaxes the sphincter, which I already have… I am just lost… and desperate.
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