Hi all,

I'm creating a new post here hoping maybe this can help someone.

My full story can be seen on my original threads - but basically I had two anal fissures for about 4 months, which I finally got to heal over, avoiding LIS. What hell!

Since the fissures have healed over, I have not had bleeding or particularly bad pain during bowel movements. In fact, I have a bit of pain relief when I do have a bowel movement as the sphincter is temporarily relaxed...before it tightens up again with a vengeance. Basically, my problem now is that my sphincter is chronically hypertonic - it is constantly tight, and when standing or sitting too long, I have a deep burning pain that is awful, and that is preventing me from living life at all. I sit sideways on a heating pad most of the day.

If anyone else has similar symptoms after being told the fissures were "healed", here is what my surgeon and pelvic floor physiotherapist have to say about what's going on:

- first of all, my mind was CONSTANTLY spinning about what the heck is going on...do I have something else wrong with me besides these fissures?! But after several visits to the surgeon and physio, we have all agreed that the lingering burning pain is simply from the constantly tight sphincter. Basically, the cycle is the same as when a fissure is open and active (but the pain is not as horrendous since the wound is not open). The area is still very sensitive, especially since the fissure was quite deep. It is very very easily aggravated. So the muscle is still in spasm because it is acting protectively - not what I want, but it is the body's instinct. In turn, the spasm puts more pressure on the sensitive site...causing more pain, causing more tightness.

- A pelvic floor physiotherapist is helpful in training the muscles to relax. I have found a very little bit of improvement from just a few sessions. The physiotherapist began by showing me how to properly breathe and relax the muscles of the pelvic as much as I physically can. Then we began to add in some gentle massage around the area, while practicing the relaxation, to try and dampen the muscle response. She is also able to do some massage through the vagina, but we have found that it is mainly just the sphincter muscles that will not relax.

- I'm hopeful that physio will really help, and am giving it two-three months. before I see my CRS again. If there is improvement, I will stick with it, but i'm thinking it may be a very long road to being painfree and able to exercise, let alone stand up for more than 10 minutes without pain

- My excellent surgeon has confirmed the above explanation for why I am feeling pain. She is confident that LIS would help if physio does not provide any improvement. Essentially, she explained the only difference between now and before the fissure healed is that the pain is not as intense. The problem however is identical, and therefore the same surgery should work. She believes that if the muscle was able to relax, I would have restored blood flow, and would very soon have pain reduction as the area is able to fully heal.

I also have a couple of questions at this point:

- I do have a "lump" that seems to come out when I have a bowel movement. It is hard to describe, but it is not hanging and does not have the appearance of a typical skin tag - the base is wide and it is more lump like. It seems to mostly disappear after a bowel movement, but not entirely. It does not seem particularly painful and does not bleed. I was told by my gastroenterologist following a colonoscopy that I have NO hemorrhoids. My CRS thought it was a skin tag from one of my fissures. My GP thinks it is an external hemorrhoid! lol....Anyways, it is possible that this is causing some of my pain? The CRS didn't seem to think it is an issue, but it is definitely bigger than I remember...

- Has anyone had any luck with physiotherapy for similar issues?

- LIS recovery: I do have ibs, and for the past couple months have had diarrhea every morning. There's not much I can do about it unfortunately. I also have lots of trouble having a bowel movement due to the tightness, and even with the D I typically use a small bulb enema with warm (never hot!) water and lots of vaseline. I am careful to massage the area before and apply lots of vaseline so that i am never forcing the bulb's tip. This has helped healing quite a bit i believe, as otherwise I would have to strain incredibly to have a bm. What i'm worried about is doing this right after LIS...i'm scared that it will damage area and make recovering from surgery difficult. Just wondering if anyone has had any similar experience?


Thanks so much for reading this HUMONGOUS post lol!!! I really just wanted to get it all out here at once, and hopefully help someone else who is suffering.

GG

Hi GilmoreGirl, I think have exactly the same symptoms as you. Basically a burning sensation after sitting for more than 30 mins. I also have the 'lump' thing you describe after a bowel movement, that disappears almost afterwards.

What position is your fissure? Mine is 12 o'clock (anterior) - not sure if that makes a difference.

In my case I believe I have the symptoms of a 'chronic' fissure, i.e. the spasms subside (for most people but not all) and you are left with swelling and burning pain. I believe what has happened here is the fissure has partly healed forming a surface over the tear, but this site isn't properly fully healed, kind of like when you expose the second skin surface if you burst a blister - there is skin there but it's still painful to the touch.

The lack of blood flow means that this can take an age to heal, or not heal at all.

I was using Diltiazem, but after several months I feel it made the 'lump' problem even worse and started giving me hemerrhoids. I still don't know what the lump thing is, but I think it could be something to do with the muscle and how poop is pushed out. If this is swollen then it may be more noticeable. Once thing I have noticed is since stopping Diltiazem the lump has become smaller - quite a bit. I don't think it's cancer or anything - at least not in my case.

At the moment I am simply using anusol and medihoney, and that has made the pain more manageable. My CRS tells me it's definitely a fissure, and I think I can at last see it in the mirror, and to me it does kind of look like the surface of the wound is partly healed, but still leaves me with this problem.

Anyway thanks for sharing your story. It's good to know someone has exactly the same symptoms, and it will be good to know how you fair. My CRS is due to examine me again on the 10th of March, and tells me botox is the next step, and a procedure where they kind of exfoliate the wound so it has a better chance of healing with the reduced pressure due to the botox. I'm hoping I will have made some improvement before I see him, but I somehow doubt it.

Anyhow, good luck!!!
LemonMan

Gilmore Girl, mine is still very similar to you, the lump and the pain tightness and burning is the same for me still. I am healed 3 weeks now.. Ibs yesterday was crazy so many times... in bed the whole day, I have a physio appt tomorrow and ACTUALLY a phone conference with a prominent Colorectal Specialist that was featured on a National TV program and I am going to ask him about all of these issues after fissure healed problems, mine is still achy and the more I try to do the more I have issues. The initial fissure pain is much better, for me the spasms were constant, but after botox and just from fissures in general is inflames the whole area, and there are sometimes thrombose and prolapsed internal hems that are located up higher and can become severly swollen and could take 3 months or 6 months to simmer down they can be strained from the tightened muscles being in spasms for so long and the internal sphincter which we have no control over remains in hypertonicity your right. It sometimes expands into the other tissue and connective muscles and pulls on all of those area's and pull up to the tailbone and all of this inflammation and swolleness need lots of time to relax and simmer down certain Physio can actually tighten up other areas and hard to tell where the actual trigger knots are. I too have to spend most of the time on my side, Laying down helps the most, Gravity does not help this condition due to pressure on veins and muscles etc.. When we are anxious the body shuts down it's healing capabilities. So the muscles only really get to heal during our relaxed states, that is why sleeping helps build new cells and it can relax a bit, everytime there is a surgery or procedure it affects the nerve endings further and it causes tenesmus but once everything calms the tenesmus will go away this is only a symptom. Surgeries and hemmrohoid surgery further causes more of this.Even the Botox Injections procedure inflames everything in there and can cause thrombosed internal hems which can be located very high up. It takes so long but we can get back to normal for sure, Prayers are helping miracles do happen, and I am going to address all of this with this specialist and find out what his recommendations are.. Will keep you posted, Its good for the medical profession to know how serious and widespread this condition is and hopefully they can try to come up with new effective pain relief and treatments for speedy healing.. for the future. If we can ultimately help others through getting through this ordeal some good can come of it at least.. We will overcome...

Hey LemonMan,

Sorry to hear you're in the same boat...what a pain this whole thing is!

Funnily enough my fissure is also anterior. I also had a more mild posterior fissure that developed secondary to this one. I had a fissure in the same posterior spot about 1 year earlier, and the lump appeared around that time but was not super noticeable. Since the two new fissures it has become quite large.

I think your line of thinking is correct...It seems as though my surgeon and physio agree.

I'm using nifedipine - which does help expand the blood vessels so it would make sense if that is making it swell a little. I'm kind of thinking it must be a skin tag, because I feel like it would be much more painful if it was a hemorrhoid? Dunno.

Please keep me updated on how you're doing! And i'll let you know if I get any more info on my end.

Thanks for your reply!!

Mamafizz - that sounds great about the CRS! Please keep us updated on how you fare!

The physio should not cause other muscles to tighten if they know what they are doing. When I first started going, several of my pelvic floor muscles were very tight. Now, the physio says (and it's obvious to me) that I am able to relax most of them quite easily, just not the sphincter.

GG. thats good news as alot of my connecting muscles are giving me trouble after all this time... I am ready for complete relaxation.. I am typically flying all over the country book tour, Food Network. I have been housebound for 7 months.. Once I can sit again and this is over, I am on an island... can't wait!!!! i will update once I speak to the Specialist. I suppose in the old days, they just waited and waited until this healed, our bodies are designed to heal themselves. Praying for more patience.

GG, any better days? I speak to the specialist on Friday.. Did your Surgeon happen to say that the pain does go away once the muscle and tightness subside? It seems that no one ever says that the pain burning tightness actully goes away after awhile.,, I think we would all recover alot faster if we knew the pain DOES go away eventually. They always say muscle relaxes, spasms stop, fissures heal, hemmrhoids get better, but does it stop hurting,, ?! Pain free is what I am talking about.. lol I am trying to find those that have had similar experiences that actually are pain free after all of this long time pain and suffering.. So that the clamped tight muscle actually stops hurting after its relaxed.If you see any or your Dr can confirm the patients are actually pain free, and not just technically healed but that the result is pain free, since it seems it is tied to the brain after having pain for so long... Any news let me know I will do the same!

PS The Botox which is considered a Chemical Sphincterotomy that heals the fissure and relaxes the muscle has technically healed the fissure and healed two weeks ago but still have granite tight muscle this thing has got to relax, it has to be tired of doing that by now.. it's 6 months... had botox 1 month, as you said horrendous fissure pain not there but that awful burning, throbbing aching, tight rock muscle is still doing its thing... As soon as mine stops and the pain is gone,I will be sure to let everyone know so they can relax and get better sooner..than later...:)

Well, she couldn't tell me for sure the pain would stop, but did say that if it didn't after the surgery, we would do everything we could to figure out what's going on.

However, she was pretty confident that the surgery would relive the pain. She suspects the area is sensitive and sore in general - and can't really get a break to fully heal because the muscle is so tight and pressing against it. And then the pain causes the muscle to tighten even more.

Remember - these are sphincter muscles. It's really no different from the other sphincters inside our body - like the cardiac sphincter at the top of the stomach that prevents stomach contents from coming back up. They won't really tire, because their normal state is closed. Our problem is that the "normal state" has become too tightly closed - but the muscle won't tire.

That's the idea behind LIS - it does a small cut in the muscle which forces back to the regular tightness. It won't make the muscle completely loose.

Question mamafizz - where exactly was your Botox injected? In what muscle?

From what I've read, Botox is not always successful in relaxing the muscle - but your fissure has healed over so that is positive! Are you continuing To use nifedipine or NTG or something?

I had two shots of Botox in the inner sphincter on either side of the fissure, he said, but I think it must have been a very mild dosage just enough to relax that little part, and it did work! Very quickly actually, my 2 week check up it was healed, so it is now 4 weeks and I am just now continuing to use NTG alittle outside to help things calm down, after the procedure everything flared up and swollen and two pretty swollen or thrombosed hems higher up that really need to heal as well. I suspect this is all part of the course. I did read a few things I found that some people on here who said pretty much what your Dr said was that although it is healed the underlying fissure tissue is not fully healed and so the chronic tightness pain and spasm still continues until you are fully healed and then the nerves and muscle as you said will automatically spontaneously relax. It just takes a long time. Especially when we keep having continued testing and or procedures more stress and anxiety adds to the overall process. Our bodies are designed to heal themselves but this is a highly nerve related area compared to others. The good news is that they reported healed and back to normal and now they are no longer on the forum, also I am sure there are tons more people who have experienced the same as us and have healed and cured as well and just not on a forum. Almost a quarter of a million people a year suffer from this, so the odds are in our favor to overcome this. I am still a prayer warrior!!!

Hi mamafizz and GilmoreGirl (love the name -- I consider myself a Gilmore too!). I was wondering if either of you have an update to share?


Long story short -- I was blood and pain free from a fissure I developed over a year ago after giving birth. It's been a solid 4-5 months without any setbacks -- and this morning I retore worse than I can remember in so long. Oddly, there wasn't a ton of pain, but so much blood. So. Much. Blood. And now I'm sore back there -- no crazy spasms, just a general ache. I'm trying not to freak out.


In the past, I've healed things with diltiazem, Miralax, and essential oils. I'm really tired and frustrated by this cycle of retearing though. I'm no longer breastfeeding and not planning to be pregnant again for at least another year (I really want to heal this before I get pregnant again!), so I'm in the perfect spot to consider Botox. I'm wondering how you're doing after Botox, mamafizz. GilmoreGirl, did you try Botox or LIS? I'd love to know your experience.


Thank you!!