Chronic fissure of 8 years, finally healed.

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Chronic fissure of 8 years, finally healed.

Postby London56 » 17 Feb 2019, 14:58

Hi everyone,

Just wanted to share my story as I often found comfort in reading other success stories whilst I was in a bad spot, and to let people know no matter how bad it feels at the time that it does get better.

So really I suffered in silence for a good four years, I was so afraid of discussing my fissure with anyone that I for some reason just accepted the daily pain that went with having the condition. Then comes university, and I realise that enough was enough and I needed to see someone. Over a few years, I tried various creams, ointments, laxatives, dietary changes and felt little to no benefit, probably due to the severity of the fissure.

So about two years ago I saw a colorectal surgeon in the UK, who recommended that botox was not likely to help the chronic fissure and recommended LIS. I was prepared to do anything and everything to get healed and so I agreed to whatever he thought was necessary.

My pain on a scale of 1-10 during a bowel movement was about an 8/9 at this point.

So the first surgery that he ended up performing was an advancement flap surgery, instead of LIS (as he hoped this would be enough) and sentinel tag removal. Although this made my bum look a lot more normal, my fissure didn't heal and I was experiencing a lot of pain still (probably an 8/10).

So I was back to nitroglycerin ointment for the time being until a few months had passed and the colorectal surgeon then recommended LIS, who assured me that this would be it and I would be pain free in a few weeks. The surgery went fine, however what they don't always discuss when talking about post-surgery care is how much opioid medication can induce significant constipation. As a result, I couldn't pass stool for 6 days after LIS surgery - which caused additional fissures to form in pain I can only describe as being close to childbirth. However, weeks passed, and the pain definitely got better - and decreased to about a 3/10 on good days.

Unfortunately, that familiar stinging feeling never went away and after 3 months I was so frustrated. Although the chronic fissure had healed, I now had two new fissures to deal with. At this point, I really felt hopeless - that I was somehow that 2% that didn't fully heal from LIS.

I decided to see a new CRS, as I felt a second opinion would be helpful and would re-assure me. He recommended botox, but when I told him about my history and asked about what options would be beyond this, he said there was nothing more he could try - which devastated me.

So I went in for botox, which I barely noticed any post-surgery pain from (in comparison to advancement flap and LIS), and saw great improvements in pain score over 6 weeks (down to 0.5/10 at the best point). But again, there was always that ever so slight sting that would remain. Eventually as the botox wore off, the pain slowly increased to a 1, 2 and then seemed to stay at about a 3 after this.

At this point I had just started a postgraduate research course (which you don't really get formal holidays/sick days for) and I felt so hopeless that I would be stuck with this forever.

But I kept trying different ointments; applying nitroglycerine twice a day for 6 weeks (then stopping), then tried sudocrem and finally proctogesic. Day by day, lubricating before bowel movements with vaseline and making sure everything was clean after, the pain got better.

Eventually, I got to a point where I could try anal dilation. I think this was the real solution to my fissure. I just applied some proctogesic and vaseline to my finger and massaged the outside and then gently inside, every day.

Today is the first day where I can say I am pain free. It feels amazing!

For everyone still going through it - I understand how you feel and how it can feel like there is no end to the pain. I think for some reason I always thought that it could be 'cured', and that after a surgery I would magically feel better.

What I have come to realise is that for all of you suffering from a chronic fissure, maybe try and think of it as a long term journey.

For example, my journey over time went something like this:

(Pain score out of 10)

Advancement flap: 8/10 (2 years ago)
LIS: 5/10 (0.75 years ago)
Botox: 1/10 (4 months ago)
Conservative measures (ointments/laxatives): 0.5/10
Anal dilation: 0/10!

I would just like to let you know that if you are suffering, there is an end to the pain, no matter how hopeless it feels at times, and there are always more options to try!

And thank you to all of you who have shared your stories on here, it has helped more than I can ever describe.
London56
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Re: Chronic fissure of 8 years, finally healed.

Postby dmcff » 18 Feb 2019, 11:47

Thanks for this account of your progress, London56. I think it's interesting how so many times in discussions of AF the words 'journey' and 'process' come up. Also, It seems AF can rarely be described in terms of a linear sequence - it's nearly always a series of advances and retreats, a circular back and forth between healing and re-tearing. Yet in spite of that it does seem to be possible to reach an end to the cycles of pain and discomfort, even if it takes a long time. I'm not there yet, but I hope to be.

In your post you mention proctogesic - is that another name for rectogesic (glyceryl trinitrate)?
2014 Anal fissure
2015 CAT scan, EUA and sigmoidoscopy, 2 MRI scans - 4 hospital stays - severe to low pain
2016 Anal fissure - pain severe then moderate to low
2017 Return of moderate pain
2018 Physiotherapy and pain management
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Re: Chronic fissure of 8 years, finally healed.

Postby Abu » 18 Feb 2019, 12:03

London, please tell me, do you feel that the flap, LIS and Botox helped in any way since the conservative measures were the ones which prevailed in the end? I would like to know if you feel any regrets of going this route instead of trying the manual dilation in the first place.
I ask this because, in my case, it was a decision which I regret taking - mainly to undergo a hernia surgery 5 years ago - that led to the occurence of this chronic fissure.
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Re: Chronic fissure of 8 years, finally healed.

Postby London56 » 20 Feb 2019, 16:09

Hi Dmcff,

Good luck with your journey!
My apologies, I meant proctosedyl - it helps with short-term pain relief and helps keeps things clean down there - but I found this helps in just two weeks of use, once a day.

Hi Abu,

The flap / LIS / botox were instrumental in the healing process, there is no doubt in my mind that my fissure would not have healed without them. I feel the surgeries improved the healing of the fissure, albeit slowly, and got me to a point where conservative measures/dilation where perhaps now able to make an impact. I have no regrets with my decision to undergo surgery, as I don't think anal dilation would have been able to heal my fissure had I started it in the first place (as the fissure was quite severe).

Ah I am sorry to hear about the surgery causing the fissure (I can relate as I had the same after my LIS). It's difficult with hindsight, but I'm sure your decision to get the hernia surgery was probably the best choice to make with the information you had at the time. Are you considering surgery for your chronic fissure then?
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Re: Chronic fissure of 8 years, finally healed.

Postby Abu » 20 Feb 2019, 22:53

Thanks London for your honest feedback. I personally do not consider surgery as I am not in pain and rather deal with this only with conservative measures.
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Re: Chronic fissure of 8 years, finally healed.

Postby missy moo » 21 Feb 2019, 16:48

Does the gap between the first an second dose of Botox matter? Does anybody know? I had my first dose a year ago was told I needed more then the hospital droped the ball I've been waiting 7 months for a second Botox appointment but now after calling them they have given me an option to have it done next week or next month up to me but it's been a year should this second dose of been done much sooner?
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Re: Chronic fissure of 8 years, finally healed.

Postby whatsherface » 24 Feb 2019, 21:51

thanks for posting your story. i really needed to hear this! was feeling like crap that nothing is working for me. but i refuse to give up hope!
Fissure since January 2012
Botox December 2015
Botox May 2018
LIS October 2018
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Re: Chronic fissure of 8 years, finally healed.

Postby trillo » 25 Feb 2019, 19:21

I've read elsewhere as well that self-dilation with a finger has a better cure rate for AF than using a dilator, but I don't understand...I've read that this should be done for ten minutes at least once a day, but it seems that would be extremely uncomfortable for your arm to be twisted behind your back at that angle for ten minutes. Am I missing something? Are there any instructions for exactly how to do anal self-dilation to help heal anal fissures? Thanks!
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Re: Chronic fissure of 8 years, finally healed.

Postby patience_and_healing » 26 Feb 2019, 12:46

Please take a look at the self dilation sticky thread at the top of the forum. If you're going to try this, go slow, never force your body to do more than it can handle at one time.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter
Currently in pelvic physical therapy
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Re: Chronic fissure of 8 years, finally healed.

Postby trillo » 26 Feb 2019, 12:54

I'm sorry, I don't see the self dilation sticky thread at the top of the forum. Would you please tell me the link? Thank you very much!
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