Hi there,
First, I want to tell you that you aren't alone, and I'm absolutely relieved and comforted to know that I am not alone either. Anal fissures are excruciating (and hemorrhoids can be insidious as well). Mine became unbearable, but for years I thought they were just hemorrhoids, which explains, finally, why no roid treatment I tried worked. The only thing that gave me any relief was putting ice packs between my cheeks and even ice was a temporary fix compared to the several hours a day of mind-numbing pain. Each year, the bouts of pain would increase in number, duration, and intensity. It was truly debilitating. The pain can only be described as having broken glass and barbed wire grinding in there every day, for hours.
I did a ton of research and encourage others to do the same.
(I am a runner, eat about 90% organic and a high fiber diet.)
I concluded that my best bet was sphincterotomy surgery (and figured I might as well undergo laser removal of my hemorrhoids while I was at it). I must make it a point to note that choosing a great surgeon and surgery center makes ALL the difference. I read horror stories about painful experiences and recoveries. Even my surgeon warned me. However, I experienced immediate relief from that acute-chronic fissure pain right after surgery. I went to Laser Hemorrhoid Center in Phoenix and saw Dr. Stuart.
A summary of my experience:
- Repeating cycle of acute fissure pain where the pain was daily, severe and would last for hours (for 7 weeks +... consider surgery if you go through this for 6 or more weeks as you're likely building scar tissue which depresses your ability to heal on your own)
- I opted to have sphincterotomy and laser removal of all Hemorrhoids.
- The care I received was excellent; I opted to avoid typical Dr.'s and went straight specialists that performed this surgery or helped patients manage it day in and day out.
- I was put out (twilight sedation; they even numbed my hand so I didn't even feel the IV being inserted. I met each person involved, was comfortable, and don't remember a thing from the procedure). The procedure only took 20 minutes
- I was told my fissure was over a half inch long, 4 mm wide, and 3 mm deep.
- When I woke up, I was still numb (wears off in 2 hours) and felt zero pain.
- I was sent home with percocet, Valium and antibiotics
- I experienced immediate relief (same day) from the "glass and barbed wire" pain even after the numbing agents wore off. That night I was astounded that the glass and wire pain was simply gone. I did have trouble sleeping due to the pain meds. I felt woozy from sedation, and had considerable bleeding (which is normal), and I had trouble peeing since my parts down under were a bit numb, making it hard to urinate
- Day 2 after surgery, urination returned to normal, I bled considerably less (rest, rest and more rest if you want to hasten the end of the bleeding). Still zero glass shards pain, only a mild sensation I can only describe as a bruise. I took stool softeners, ate normally, blotted myself after using the bathroom with a wet wipe, and used feminine pads for the blood.
- My surgery center called to check up on me and see if I had any questions, and they made sure I knew I could call them at any time for any questions. I even was able to talk to a nurse (again, excellence in care). I had 2 questions for the nurse: 1)Why was my throat so sore? Answer: They didn't put a breathing tube down my throat, but they put one in my mouth to help oxygenate and control my breathing which made my throat dry and sore. 2) I explained I felt the urge to have BM, but I couldn't go without straining really hard since the meds are constipating. Answer: Try to avoid pushing. If I still couldn't have a BM without sweating it out with strain, then I should use a mineral oil at-home enema, which are available at drug stores.
- I did the mineral oil enema on the 3rd day, and within 30 seconds, I finally had a BM that didn't feel like a granite ping pong ball.
- The first (well, not counting the 2 granite rocks I labored out) BM with the enema hurt a little, but a lot less than when I tried without the mineral oil, and the pain from the first few BM's was totally different than the familiar ice-pick fissure pain. It was more like a throbbing, bruised ache. I bled with each BM, but didn't fret about it since my expectation was set that bleeding was normal. Every day the bleeding has lessoned considerably. I am on my 4th day after the surgery, and there is barely any blood unless I have a BM. I have been doing sitz baths 2-3 times a day, and I use Bag Balm after using the sitz bath and before and after a BM. I also don't use any soap on my booty to avoid dryness, and only blot using wet wipes. No TP, and no wiping!
I was absolutely terrified of this surgery after reading blogs, risks, and considering the fissure pain - I was afraid I wouldn't be able to handle it if the post op was more painful then the fissure. I am infinitely grateful that my experience has been just unbelievably terrific, and I attribute my excellent outcome to my Dr. and the entire surgical team. I knew them all by name by the time I left, and was sure to send a Thank You card. The surgery has increased my quality of life by leaps and bounds, and I'm only on day 4 post op!! I have read so many really difficult experiences from others who've had this surgery and I can only say that choosing the right Dr. and center, for me, has made ALL the difference.
I'd also like to add ... for those recovering or considering this surgery, or just dealing with the agonizing pain of fissures... it's not your fault. I've been eating an organic high fiber diet for over 10 years, am active (a runner), and sometimes there's just no rhyme or reason to why these things happen. I'm told it only takes one trauma to develop a chronic, painful, un-healing fissure. But I believe some of us are simply predisposed. Don't ever let any physician dismiss you or minimize your condition; your hemorrhoids, or your anal fissures. If I heard one more Dr. lecture me on fiber when I've diligently eaten a high fiber diet for years... or tell me to soak in a sitz bath after enduring 2 months of debilitating pain with no relief... or somehow try to subtly blame me for a condition over which I have no control - well - I can only advise to give them your best Spok eye brow lift, and seek a Dr. that can help you and does these surgeries and treats these conditions day in and day out. I can't stress enough how critical it is that you choose an excellent, experienced Dr. and team; one that makes themselves available to you.
The surgery is covered by most insurance. But if you have a deductible, or no insurance, just FYI, the cost for my laser hemorrhoid removal and sphincterotomy at my surgery center was around $1200. Absolutely worth it.
Before choosing surgery, I did try a muscle relaxant goo during a bleeding fissure episode a year ago. It didn't help. And I wound up simply avoiding eating thus avoiding going #2 (I now know that that's a standard symptom of a good surgical candidate). And upon consulting with my surgeon, she did offer me the option to try Nitroglycerin and another common goo to relax the sphincter and help numb the pain. After a lengthy discussion, it was clear my best option was surgery. When you have acute episodes in a chronic manner like me, it's certain that scar tissue developed which would continue to make manging the condition difficult, and with no end in sight. Hmm. Continue using medications that at best shorten the duration of episodes, at worst, do nothing, have side effects, and will never "cure" the condition, and accepting that I'll have to continue to manage the insidious condition?.... OR.... Surgery, where there's a 90% chance I'll not have another fissure and a small risk of incontinence which is associated with infection and thus can be mitigated.
I'm elated with my choice and surgical outcome.
Some stats for you:
-Less than 1% that have a sphincterotomy experience any incontinence (due to infection or abscess)
-More than 90% that have a sphincterotomy never have another anal fissure (for at least 10 years according to the study)
If you have had a sphincterotomy and have had a troubled recovery or experienced anything unexpected in your recovery, please feel free to respond. I'm interested in learning others experience in recovery and decision-making.
I am also curious if my immediate fissure relief post op is an anomaly, and if so, why.
(I have a sneaking suspicion the surgeon makes all the difference in post op experience and ease of recovery.)
I hope this helps anyone dealing with the insidious pain of anal fissures, recovering from or considering a sphincterotomy, or dealing with annoying hemorrhoids.
*Healing vibes to all*
E

Very happy for you! I am also pleased to have finally had the surgery after a year of this almost exactly. It has really taken a toll on me emotionally. I had a very conservative surgeon who when I finally went to him back in October (6 months into the fissure being with me), he wanted to try botox first. I was on Nifedipine ointment before that for most of that 6 months (it went away for a glorious month) and he wanted me to continue that as well. The first botox shots helped some but by then I had a very easily irritated skin tag and I still had some issues- basically the fissure had not completely healed. Round 2 of botox in first week of 2011 and by February, it was clear that although it helped some, I still had a fissure. Had the LIS and skin tag removal Feb. 17 (7 weeks ago). Things have been going ok lately- I saw the CRS on Wednesday and he said my fissure was healed. My only remaining issue (and it does annoy me) is that the spot where my skin tag was (which is right outside where the fissure was) is very easily irritated still. I am finally off the stool softeners which were beginning to make me have 4-5 loose, sometimes watery stools a day. Now off of those a week and I still am having 2-5 usually soft, formed stools per day. When I have more (like yesterday), the skin tag area feels like something is poking me (like a little needle) and is uncomfortable. I am still supposed to use the Nifedipine for another week and a half. I also have been putting some Calmoseptine or A and D ointment on the irritated spot to try to protect it. That seems to help some days and not others. I did finally start back to exercising yesterday and that may have caused some rubbing. Anyway- for the most part things are great! But I will be glad to have some tougher skin down there soon!
Bambi