Hi everyone
Hope you don't mind me coming on here but as the partner of someone suffering with an AF Im starting to feel absolutely useless. We also seem to be getting conflicting advice from the medical profession so also feel very confused as to what to do next!
My partner was first diagnosed with an AF on the 14th november by a CRS. At this point he'd already been in pain for quite a while but we were treating him for piles as thats what the GP had originally referred him for (without even examining him may I add). At that point he was prescribed (apologies if i spell these medications wrong) Diltizem and lactulose and was advised to eat a high fibre diet. He was told to go back in 6 weeks and that the fissure should have healed by then but that if it hadnt then there were other options. As far as pain relief went he wasn;t given anything other than paracetamol and ibruprofen. The next appointment that was sent in the post was not until the end of february and day by day his pain has got continually worse to the point where he now spends most of the day either jumping in and out of baths or lying in bed alternating ice packs and hot water bottles under his bottom. BM's are an ordeal and hes scared to eat as what goes in must come out and hes lost a stone in weight in 4 weeks.
In desperation we tried a private surgeon mid december but he cant operate until the 17th january (which he is booked in for provisionally) but again, in desperation, he also saw another surgeon to hopefully do something sooner and he was strongly against the LIS surgery and told him to just keep using the Diltizem cream. Its obviously my partners decision but from where I stand this seems to just be getting steadily worse. What was a 'bad day' a fortnight ago is now becoming a 'good day'! The only reasonable time of day is first thing in the morning before he has a BM then it all goes horribly wrong.
Sorry this is going on a bit and i know there is no magic wand and his long term health is the most important thing here but how can anyone carry on like this ? It could be like this for months and still not heal! Ive been reading some of your accounts about the surgery and they sound really optimistic and encouraging but Id hate to encourage him to do something that might not be right for him but at the same time this isnt living.
Thanks for listening. Just helps writing it down really! I feel for all of you. Im finding it difficult enough and its not even me thats suffering

just to add hes now on Diazapan, tramadol, diflenic (?), an aneasthetic rectal cream and movicol and still in horrendous pain

Hi Karen! As somebody who suffered with a fissure, I can tell you that your support and sympathy are really helping your partner more than you know. One of the worst things about fissures is how isolated they make us feel. It's really great that your partner has you in his life. :D
The pain and routine you describe are very familiar. The misdiagnosed hemmies, the weight loss, the pain, the horrible BMs and then finally the ointments - usually after months of suffering. Yep - I know that story very well!
I was prescribed Diltiazem too. It's a calcium channel blocker and a vasodilator, which means that it promotes blood flow in the butt. Once a fissure become chronic, the sphincter muscle starts to spasm - that's what causes the burning, cutting pain. When the muscle spasms, it cuts off blood flow in the anus, and that prevents the fissure healing. Special ointments for fissures are designed to stimulate blood flow. That's also why warm baths are prescribed as well, since they also stimulate blood flow. The problem is that once the fissure is chronic (e.g., older than 6 weeks), it is really hard to heal it with conservative measures. Now I won't say impossible, mind you, but certainly very difficult.
Is your partner taking diazepam, as in valium? A few boardies here were also prescribed valium for the spasms (since benzodiazepines also have muscle-relaxing affects). It's important to be careful with that, though, since valium (and other benzos) can be quite addictive.
Dealing with the pain is quite a challenge because serious narcotics are constipating - which is the last thing you want if you've got a fissure! A few of us dealt with the pain by taking muscle relaxants along with OTC painkillers. I used extra-strength Robaxacet along with Ibuprofen. That didn't completely eliminate the pain, but it really helped take the edge off. A good stool softener is also very important. Many of us here prefer Miralax (or Movicol in the UK). It may take a few days for the Movicol to fully kick in, but many of us found that it helps make the soft stools better than many other stool softeners. LOTS of water is also very important.
Many of us lost a lot of weight. I ended up pretty severely underweight and malnurished (I'm still getting vitamin B shots!). You might want to check out the forum here on Diet Tips and Supplements for some good ideas for 'fissure friendly' meals. Fissures are not life threatening, but they sure are life-altering and they do have an impact on your health after a while.
I don't want to push surgery on anyone - as you say, it is your partner's decision. I can tell you from my own experience that the LIS gave me my life back. I did have a complication: I developed a small abscess at the incision site that developed into a small fistula. That did suck, I'll admit, and it is a potential complication that you should know about. That said, the fistula was fixed with a very simple surgery and I have no regrets about getting the LIS. I am living my life, I'm not in pain, I'm gaining weight, and I'm happier than I ever thought I'd be during my dark fissure days. The LIS is considered the gold standard for healing a chronic fissure, so I think you might want to take a careful look at the surgeon who was so opposed to it. I don't think that a competent and knowledgable surgeon would be quite that strongly against it, even if s/he isn't inclined to prescribe surgery right away. But that's just my opinion.
We all understand your partner's pain - and we definitely appreciate the wonderful partners who help us through this ordeal! :D There are lots of great posts on here that can give you a great deal of insight into the various options many of us have tried and our coping strategies. Ask anything you want and feel free to share. There are lots of wonderful folks here who can offer good advice and moral support. :D

The thing that saved me was my support I got from my husband. He would say I don't know what to do but I will be here for you. Many times sitting in the hot tub crying it was the only hope I had. Some people have no support and would give any thing to have just a little. You are a good person just for being there. The best things that have worked for me are putting my feet out in front of me when having a BM and sitting in a hot tub. I do not know how my husband has been so patient for so long. I am a lucky woman.

thank you for your replies Hopetoheal and Sterlingbird. I feel much more encouraged about the surgery after reading your experience. And Sterlingbird, I can't imagine how anyone can cope alone. It must be awful. Your husband sounds wonderful!
My partner has had valium for about a fortnight now but he does try to only take his meds if he needs them. Im never sure whether to get him to take everything before the pain kicks in though! I will certainly look into the muscle relaxants though and after having a quick look on the diet tips, there are lots of things there we can try.
Have you or anyone else tried a tens machine at all? My friend mentioned it to me the other day, and i know its mainly known for pain relief in childbirth, but I wondered if it would be worth a try?
lets hope the New Year brings good things for everyone xx

Hi Karen! It can be tricky timing the meds; but after a while, and with a bit of experimentation, you can figure out what works best for a particular person. I really hope your partner is able to find the right combination of meds soon.
I haven't heard of a tens machine. Can you describe what it is and what it does? It sounds interesting!
I'm wishing you and your partner all the best for the New Year! :D

Hi again
Ive just copied and pasted this as it explains it much better than I can! :D
How do TENS machines work?
Transcutaneous Electrical Nerve Stimulator
Transcutaneous means 'through the skin'. TENS machines deliver small electrical pulses to the body via electrodes placed on the skin. TENS machines are thought to affect the way pain signals are sent to the brain. Pain signals reach the brain via nerves and the spinal cord. If pain signals can be blocked then the brain will receive fewer signals from the source of the pain. We may then feel less pain.
TENS machines are thought to work in two ways:.
•When the machine is set on a high pulse rate (90-130 Hz) it is thought to trigger the 'pain gate' to close. The 'pain gate' is a theory that says that when certain non pain-carrying nerves are stimulated then these can can interfere with ('close') signals from nerves that transmit pain. The TENS machine is thought to stimulate certain non pain-carrying nerves. This may then interfere or block pain messages sent to the brain. This is the normal method of use.
•When the machine is set on a low pulse rate (2-5 Hz) it stimulates the body to make its own pain easing chemicals called endorphins. These act a bit like morphine to block pain signals.
maybe you call them something else in Canada? But its just a small machine with 4 sticky pads attached which you stick onto your skin near the pain and the electrical signals blocks the pain as it describes above. I used one in childbirth and I think it helped and my friend says that its really helping her husbands bad back. I may try one anyway,,,anything is worth a shot and this is completely non invasive.
I've also ordered him a Sitz bath today! Well...you can't seem to get them in the UK so Ive had to make do with a portable bidet that sits on the toilet but the reviews say it does the same job so I'm on the case!
Thank you for this site. There is so much information here. Even in the short space of time I'ver been using it I feel like I've learned so much. Its a bit of a life saver! x

just a quick update...pain has reached new heights the last few days and he's had enough so he's booked in to have LIS tomorrow privately. Will let you know how he gets on. fingers crossed!

Hi Karen! Thanks for the update. We will keep our fingers and toes crossed, of course, but I'm sure the surgery will go brilliantly. :D
If you haven't already done so, you may want to stock up on some post-LIS supplies:
1. a good stool softener (such as Movicol) - especially since the prescription pain meds your partner might get will be constipating
2. Milk of Magnesia (in case the first post-op BM is a bit stubborn)
3. Some OTC painkillers - these are helpful for transitioning off the pain meds the doc might give. As I mentioned before, I used Robaxacet and Ibuprofen and they really helped.
4. Chemical-free baby wipes for gentle cleaning
5. Some fissure-friendly food. I had some scrambled eggs for my first post-op meal and they sat pretty good.
6. Lots of good movies. :D
I'm sorry if I'm being presumptuous - you probably have everything well planned already. Tell your brave partner not to worry - soon he will be on the other side and healing. And he shouldn't worry too much about the first BM either. It is scary, but the anxiety of anticipation is usually a lot worse than the actual event. For many of us, the first BM was surprisingly less painful than BMs before the LIS.
Good luck to you and your partner! Please let us know how everything went. Our thoughts will be with both of you tomorrow.
ps Thanks so much for all the great info on the TENS machine. I had not heard of it, but, since I have some friends who deal with chronic pain, I am now I'm looking into it. :)

Hello!
Thank you for the above info! I have everything in apart from the Robaxacet. I must confess I looked it up on google and the possible side effects scared me but I know if I read the leaflets for every med we were given they would all end up in the bin so will ask at the pharmacy when I go :D
He had his surgery yesterday as planned. As silly as it sounds, I don't think there has ever been two happier people waiting for someone to have an operation! He came home this morning and apart from some localised generaly soreness, he feels pretty good. Hes obviously anxious about his first BM but like you said, from what I've read, the thought of it is probably going to be much worse than the actual event! Even if it's painful at the time at least he won't be then suffering hours of spasms afterwards.
So...so far so good. I know its early days but we are both very optimistic and not unduly worried about the procedure. We have already discussed that assuming this does the trick, the one thing he cannot do is get complacent and will therefore have to watch his diet and stick to his new healthier lifestyle! But I cannot express just how relieved we both feel. The last 2 days have been the only pain free days he has had in over a month.
Will update again once he's up and about and he's had his first BM.
ps...he does know that I am talking about his bottom and he doesn't mind