Hi everyone. I have had a nightmare of a fissure over the past 5 years.

Surgery 1 : Low dose botox and fissurectomy

Surgery 2: Another dose of botox

Surgery 3: LIS - Very conservative

Surgery 4: Fissurectomy and 80 units of Botox

Today: Fissurectomy and 80 units of Botox (6 weeks later)

I was sure I had a fistula/abscess as I have been having thick yellow discharge coming out and severe throbbing pain, i had an MRI and it said I could have a fistula but today after being discharged my notes say:

There is no fistula. There is a severe, large chronic posterios anal fissure with scarring and tethering to the sphinmcter and intra anal hemmaroids. The sentinel tag was excised and the fissure curretted and the edges lifted from the points of tethering to the muscle. 80U botox to the IAS. Note the sphincter is fine and not fibrotic and this can heal but note also the history and begin to consider an advancement flap if it does not improve.




So, I am kinda dissapointed overall. I had fissurectomy and botox by the same surgeon 6 weeks ago where she essentially did all of the above, and in the space of only 6 weeks, it seems the fissure pretty much healed totally wrong again for her to need to do all that YET AGAIN.

I am at a point now where i am feeling very defeated, I will push on and fight... I am against an advacement flap however, maybe it is the best option as by the sounds of things a LIS wouldn't even work because my fissure is fusing to my muscle. What a nightmare.


Any advice or thoughts on the above please say. Note, i've had three different CS surgeons.

First was very conservative (too much so, pointless LIS and pointless 20 U of Botox )
Second was a pelvic floor colorectal surgeon and is against LIS totally, thinks it was a muscle problem. Gave me botox with no fissurectomy....

Third is more aggressive who i had today. She is definitely putting work in down there... but my pain has increased since my op 6 weeks ago. I'm dreading this week OOF

Thanks for reading. Any questions or comments please contribute to this discussion. I will post updates to this thread.

DAY 1: Surgery done. Pain 5/10 with painkillers pretty numb down there.

Day 2: Not much pain today, the anaesthetic is still doing it's job i assume. Looked in the mirror... I have a huge gaping deep hole next to my but hole. I'm guessing this from laying it open (fistula?). The discharge notes talk about dressings, so i'm slightly worried that I was only given blue gauze to take home.. surely this isn't going to be suitable when I have a huge deep gaping hole next to my but hole.

Day 3: Had a loose BM (diarhea) a small amount after taking a ton of pain killers, no bright red blood which is assuring.. but will definitely need to go later today. Avoiding eating much to avoid issues.
Heading to the surgical ambulatory team to see what they say about the dressing... I doubt they will be able to put anything near/up or in there. It's a pretty large open wound.
Still unable to get through to my surgeon to find out exactly what I had done and why there is this large hole cut from the outside of my rectum... Annoying..
- Update - went to urgent care at the hospital, I did have dressing and a pack inside, she had to remove it and clean the wound, VERY VERY painful and put new one in. Said I need daily dressing changes, but my GP dont have any appointments. So I have to go to A&E every single day and wait 4-5 hours i guess to have them changed... ridiculous really considering i've literally just had surgery and having to go to urgent care every day in this condition is a joke. The NHS is so under pressure right now, it is an absolute nightmare to get things booked in.
The nurse said it looked like where the skin tag was removed, but it is SUPER deep - not sure exactly why.


Received letter from my surgeon today from my last phone call with her a month ago or so, it says that my fissure would never have healed by just botox/naturally which was what I was having done at another hospital because the fissure was fused/tethered to my sphincter. I am hopeful that the major surgery she has done this time in cutting the edges away from the sphincter will do something. On the plus side, I am not having noticable spasms just general pain from all the cutting they've done. Passing gas is at least easy and not having sharp pain like when my fissure was at it's worst. I've tried googling and searching here for situations where peoples fissure was fused to their sphincter etc so very interested if anyone had a similar situation. Worth pointing this out in case others are in a similar situation where their fissure is not healing, two other colorectal surgeons didn't pick up on my fissure being fused onto my sphincter muscle so I strongly recommend getting a second opinion from other surgeons.

What the heck man. They got to do something. Shouldnt take 5 surgeries and that it took until this new doctor to actually get the MRI. You are strong though and will get through this. Demand answers from the doctors though.

Day 2: Not much pain today, the anaesthetic is still doing it's job i assume. Looked in the mirror... I have a huge gaping deep hole next to my but hole. I'm guessing this from laying it open (fistula?). The discharge notes talk about dressings, so i'm slightly worried that I was only given blue gauze to take home.. surely this isn't going to be suitable when I have a huge deep gaping hole next to my but hole.

Oh yikes. Yeah sounds like it. You should definitely call the doc and see what they say to do.

Day 3: Had a loose BM (diarhea) a small amount after taking a ton of pain killers, no bright red blood which is assuring.. but will definitely need to go later today. Avoiding eating much to avoid issues.

Heading to the surgical ambulatory team to see what they say about the dressing... I doubt they will be able to put anything near/up or in there. It's a pretty large open wound.

Still unable to get through to my surgeon to find out exactly what I had done and why there is this large hole cut from the outside of my rectum... Annoying..

- Update - went to urgent care at the hospital, I did have dressing and a pack inside, she had to remove it and clean the wound, VERY VERY painful and put new one in. Said I need daily dressing changes, but my GP dont have any appointments. So I have to go to A&E every single day and wait 4-5 hours i guess to have them changed... ridiculous really considering i've literally just had surgery and having to go to urgent care every day in this condition is a joke. The NHS is so under pressure right now, it is an absolute nightmare to get things booked in.

The nurse said it looked like where the skin tag was removed, but it is SUPER deep - not sure exactly why.

Ay. Im sorry man. That’s tough. Praying for ya.

Day 4: Pain is better today overall, had my dressing changed and the lady said that fissurectomies can either be inside or outside the rectum.. which was a little surprising as i've never heard of anyone have an external fissurectomy that needed dressing daily!

After she packed it, she cleaned it and I felt alot better (at least compared to yday which was agony).

Overall i've taken less pain killers today and am coping OK. Had my first Bowel Movement which was painful but thankfully not of razor blade or glass levels (you all know what i'm talking about!!!)

I'm still unable to get hold of the Surgeon, and my next followup appointment with her is for November....

I'm at least glad in a way that i'll be seeing nurses for the next couple of weeks to keep an eye on the wound and see if it progresses or get's worse. I am having alot of fairly thick discharge with a distinct smell but perhaps that is just whatever antiseptic they used on Monday.

Problem I have is that if I want a Bowel movement, then I need to throw away the daily packing I get.. because it would just get covered in poop due to it's location. I'm hoping tomorrow I can go in the morning and not need to go for the entire day as i'm sleeping overnight with no packing in.. which can't be ideal.

It's rather disturbing to me that you had to go find out for yourself how to get the dressings changed by competent people. And the fact that you weren't able to get in touch with the surgeon, that's just unacceptable! I'm in the United States, so maybe that's the difference. But I hope you're healing well by now and not suffering like before. I have a follow up with my CRS Monday and going to ask for surgery, but it's scary to even consider with complications like yours.