Had no idea this place existed

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Re: Had no idea this place existed

Postby boxxer » 09 Nov 2010, 21:37

I don't think I have an abscess, since the seepage is decreasing. My BM's are almost pain-free, but the spasms are still killing me. I tried Sitz baths, but they don't seem to help w/ spasms. My doctor prescribed hydocodone, but I don't want to over do it. Just how do you manage w/ the spasms? My surgeon said (again) give it a few more days, then call if it gets worse. Well, it's still hard to sit and walk with the stinging and itching, any way to manage that?
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Re: Had no idea this place existed

Postby NeuropathicGuy » 10 Nov 2010, 02:25

Hey boxxer, when I had real bad spasms, hydrocodone or oxycodone worked quite well. They do cause constipation, but for me it wasn't anything a good stool softener (Miralax in my case AKA Movicol if you're outside of the US) couldn't handle.
Also, valium (diazepam) has helped a number of people here with spasms. I'm well known around here for preaching about the dangers of valium (because I developed a dependency on it which has been sheer hell to break) but it does help relieve spasms, and many people don't run into problems with it. Certainly worth a look for short term relief -- I know how bad the spasms can be and know I would've done absolutely anything to banish them in the days when my fissure was really kicking my ass.
Also, when I first got my fissure, I was also given just topical lidocaine and hydrocortisone for it. IMO they don't really do much. Maybe provide a few brief, fleeting moments of very mild relief and that's it, before being plunged right back into fissure hell. Nitroglycerin, nifedipine, or diltiazem ointment really are the way to go. They're more effective at treating acute fissures that haven't gone chronic yet, so the better you get on suitable treatment, the better your shot at beating the fissure without more invasive measures. Trust me here: early on I messed around with Anusol cream, prescription strength 2.5% hydrocortisone cream, lidocaine, dibucaine, Proctosol foam, hydrocortisone suppositories, all of that stuff, and all it did was delay proper treatment. If it's not working definitely give the fissure-specific ointments a go. The other stuff is just kind of general things doctors give for any kind of rectal issue.
BTW for what it's worth, the #1 thing that helped me the most personally (aside from invasive things like BOTOX shots and surgery) was Miralax. Before I started using it, the fissure was bad enough to keep me from standing up or walking after a bowel movement. But Miralax got it under control and tolerable very quickly; it didn't cure the stupid thing, but it did allow me to live with it and plan my attack :)
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Re: Had no idea this place existed

Postby boxxer » 12 Nov 2010, 12:09

On day 14 since my AF, my last bm was actually quite painless especially compared to my previous ones. The spasming pain was almost nonexistent, but there was increased burning and stinging from the skin around the anus. That area of skin is quite lump/inflammed and I apply hydrocortizone and lidocaine several times a day. But after my last bm, it hurt so bad that I took hydrocodone and that's after I used lidocaine. Is the light at the end of the tunnel or should I prepare for a long laborous mess? I mean, today's day 15...when can I ride a bicycle or use a public bathroom without fear?
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Re: Had no idea this place existed

Postby afugh!! » 14 Nov 2010, 03:18

You may be dealing with couple of things affecting your anus which is not uncommon.You may have hemmorhoids and and abcess I don't know.I really think you should go to a CRS no matter how far the distance is if it's really affecting you that bad.I'm not going to sugar coat things for you but most people suffer for months and such as myself I've been having anus problems on and off for nearly two years already.15 days in you have a chance to nip it in the bud early if you find a good CRS near you.
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Re: Had no idea this place existed

Postby NeuropathicGuy » 14 Nov 2010, 19:21

I would seriously consider not messing around with the hydrocortisone and lidocaine any longer and get something that actually works for fissures like nitroglycerin, nifedipine, or diltiazem.
Trust me, most of us have been there. A lot of doctors prescribe hydrocortisone, lidocaine, and docusate sodium when they encounter any kind of anal issue. That's what was prescribed to me and lots of other folks here. That regimen may temporarily reduce discomfort, but problem is none of those are very effective for fissures. Hydrocortisone is a mild corticosteroid. It might work for some cases of hemorrhoids but fissures don't respond to it. Lidocaine is a really weak analgesic that does nothing except mask pain, and is frankly not effective for severe pain like what comes with a fissure. And docusate sodium as a stool softener may work for some, but for many (myself included) it doesn't do much at all.
A lot of folks don't want to second guess the doctor and end up sticking to a regimen that doesn't work for far too long. I did the same thing. But at some point you have to look at the evidence and ask yourself if what you're doing is working or not. If it is, then stick with it for a while longer. If not, then change the regimen and try s something else whether your doctor thinks it's necessary or not; after all, it's your health that's at stake. IMO the lack of proper treatment in the early stages is what leads a lot of fissures to go chronic and require surgery. I'm personally a little miffed that I blindly followed my doctor's advice for so long before I woke up and did what made sense.
If I were in your shoes Boxxer, I'd consider the following:
1. If your stools aren't soft enough right now, consider an effective osmotic stool softener like Miralax. For some reason doctors don't suggest this much as first line treatment. But a lot of us here had trouble getting soft stools and found Miralax to be by far the most effective stool softener. In fact the main risk is that for some people it's too effective, but you would know that with a couple days of trying.
2. Replace the hydrocortisone and lidocaine with nitroglycerin, nifedipine, or diltiazem. This is probably the single best thing you can do if in fact what you have is a fissure caused by a tight sphincter muscle. The longer you have a fissure, the harder it is to treat, and the greater the risk that you'll eventually need surgery for it.
3. If you suspect you may have an abscess and/or fistula, get it properly diagnosed ASAP. These also get harder to treat with time. With time, fistulas can form more tracts or deeper tracts and affect more muscle, which increases the risk of permanent incontinence when you get around to treating it. Abscesses can potentially go systemic, and can be life threatening in some cases (rare but possible). I don't mean to try to sound scary or anything, but while fissures can get better with time, fistulas don't.
As for whether there's light at the end of the tunnel or whether you're in for a long mess, there's always light at the end of the tunnel :) But how long it takes to get there will depend as much on what you do as anything else... 14 days is nothing in the lifetime of a fissure. If you institute proper treatment, I'd guess that you still have a very good chance at beating this without any more invasive measures. But the longer you wait without proper treatment, the lower those odds become. I messed around with BS approaches like hydrocortisone and lidocaine on the advice of my clueless doctor for a couple of months and it didn't help one bit. Finally I tried other things that helped me make a lot of progress, but by that time, it was too late and the fissure was already chronic. A lot of members here have done the same. Most of us suffered for months or years before finally getting surgery to address the problem.
I'm sorry if I sound like kind of an asshole, but I just don't want you to go through the same thing so many of us did since you're still so early on in the course of the problem. If you feel like what you're doing right now is working, then continue with it, but if not, please learn from the experiences of other folks who have been there before so you can take your best shot at taking care of this before it turns into a bigger mess.
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Re: Had no idea this place existed

Postby afugh!! » 14 Nov 2010, 20:49

Ya I second the motion on the hydrocoritisone cream,for fissures it is really useless and prolonged use of it only makes it worse.Lidocaine is fine but like NG says it only masks the pain and it does absolutely noithing to healing a fissure.If you do have an abcess then you should take care of that ASAP.My abcess went to a fistula then a couple of weeks before I had my surgery I developed a second tract.I've had the fistula for about 7 months and I regret not taking care of it earlier.So best advice is to go to a CRS and get everything properly diagnosed before things get worse.
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Re: Had no idea this place existed

Postby sphinctersaurus » 16 Nov 2010, 17:24

Boxxer,
Find a Colorectal Surgeon as the others suggest. I messed around with hydrocortisone for months and while it provided some immediate relief (simply because it lubricates), it just made things worse in the long term. You stand to lose nothing by trying one of the other ointments already mentioned. Get on top of this now. Accept that, like mine, your doctor doesn't know squat about Anal Fissure. I have had my fissure for about a year and a half and it has come to control a large part of my life. Despite my very best efforts, I have been unable to heal it and now am just beginning to come around to the rather depressing conclusion that I'm going to need surgery, even though my CRS tells me that I personally have a high risk of permanent incontinence as a result. DO YOU WANT THIS TO BE YOUR STORY?
If so, continue on the same course.
I'm sorry to be so nasty, but please do as the others suggest ... Now!
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