NOTE – I am not a doctor. Please consult with your physician before trying anything. This is merely an account of my story.
Still, I won’t lie. I had a difficult experience. I don’t think it’s that way for everyone. In addition to the physical challenge, it can be a mental challenge and, for me, it lead to other things, like an eating disorder and mental fatigue. According to my doctor, these problems are pretty common.
In fact, he said, it can be so psychologically and physically challenging that in Canada they have an entire institute that’s dedicated to helping people with the different aspects of this issue. It’s called the RUDD CLINIC. I’m not affiliated with it but I thought I’d pass along their info in case it helped:
http://ruddclinic.com/patientinfo01.html
http://ruddclinic.com/resources.html
He said that’s it’s normal that it takes long to heal, from 6 months to a year. My healing process due to complications took about 12 months. It was a challenge but, like I said, you will get through it. Here’s my story. Hopefully, there’s some info in it that will prove helpful:
AT THE END OF APRIL…
-My stool became hard. It was the result of my unhealthy habits (constipating food, excessive alcohol, stress, etc). To pass it, I kept straining. This was over several days, then one time I strained too much and I injured myself. I felt something give. There was blood and I developed a fissure. (Also, I had a chronic hemorrhoid and a polyp) I waited two weeks before seeing my primary care doctor. It got worse. When I finally saw him, he recommended:
- -SITZ BATH - I should sit in a warm tub of water, twice a day, for about 5 to 10 minutes. Nothing super hot. Just warm. This helps put pressure on the hemroids and pushes them back in.
- MORE FIBER - I should take Citracel rather than Metamucil. It’s better. Adding fiber will help retain water in my stool and make it softer to pass.
- SUPPOSITORY - He gave me a prescription for a suppository. I should take it for a week only at bedtime. If it’s not better after the suppositories and the treatments, I need to come back and have it scoped so they can find out what it is.
- AVOID OATMEAL – Sometimes, it can constipate
- AVOID TUCKS – It has witch hazel in it.
- AVOID BABY WIPES
I tried these things but the situation only got worse. I passed progressively more blood and ended up in Urgent Care. They sent me back to my primary care doctor who recommended I visit a colorectal surgeon:
THE COLORECTAL SURGEON
I needed to get in quickly. My primary care doctor recommended that I tell them that I’m in a lot of pain and I need to see the surgeon right away. I did and the colorectal surgeon saw me the next morning.
He recommended the following.
SITZ BATH:
-When I have a BM (bowel movement), I should wipe with soft toilet paper
-Then, I should take a lukewarm sitz bath afterward for about 10 to 15 minutes
-Then, when I got out, I should dab it with a paper towel (I shouldn’t let it air dry)
DILTIAZEM OINTMENT
-After the bath, at least twice a day, I should apply a DILTIAZEM ointment.
To apply
-I put on a latex glove,
-Cover the tip of my index finger up to the first knuckle with ointment,
-Then insert the index finger into my rectum all the wall up to the first knuckle
-Gently rub the ointment back and forth once (since it’s an ointment, it doesn’t get absorbed. You don’t have to over rub)
-Then, as I pull the index finger out, rub the ointment again on the opening of the rectum
-I should do this twice a day
-After two to three weeks, I can do this once a day
Regarding the ointment:
-It’s a special ointment. I have to go to a compounding pharmacy to get it. They make it there.
-You might have to call the compounding pharmacist the day before so they can get it ready. (Luckily, the first time I went they just happened to have an extra one on hand)
-You should keep it at room temperature.
-You shouldn’t rub it. You should apply it just once. It’s not going anywhere and rubbing it might just irritate it
Ointment Purpose
It’s to get blood down there and help with the healing. It’s also relaxes/loosens things up and helps with the spasms
SPASMS
I developed involuntary spasms in the rectal area. My body would slowly clench up my sphincter and then slowly release it, over and over and over again, all night long. My doctor said that the fissure had created a lack of tension down there and that my body was trying to fix this problem by clenching up and creating tension. Unfortunately, it was clenching up right where the fissure pain was located. I followed the doctor’s advice and applied the DILTIAZEM ointment twice a day. It helped and the spasms eventually went away. I won’t lie. The spasms were a challenge but I got through them. It was a mental battle, too. You need to do things to focus your mind elsewhere. Breathing deeply, repeating positive sayings, etc. really got me through it.
CONSTIPATION - PASSING HARD STOOL THROUGH A SMALL OPENING
I encountered an issue where I would get the urge for a BM. My bowels would attempt to move but the BM wouldn’t be able to pass through the opening (possibly because the opening had swollen, making it smaller than usual). So, an hour later, my body would spasm again and again, it would try to pass the stool without success. I didn’t want to strain since that brought about the fissure in the first place. So instead, I would just suffer through it until eventually the BM would pass (Sometimes many hours later). (Taking a deep breath and holding it seemed to help because it stretched my torso and pressured the bowel)
Also, according to my nutritionist, stress can cause hard stool, too. She did a little illustration pointing out that there’s little gate keepers in your rectum. When you get stressed, they lock up – and they make the stool very hard to pass. She seems to think this might have been happening when I had those spasm days. She really emphasized the point that the mind controls the whole body. If it’s stressed, it locks everything up down there. As a result, stool would get hard.
In hindsight, I should’ve gotten a stool softener at the pharmacy (like MiraLAX) and that probably would’ve helped (although it might take a couple of days for it to take effect). My anxiety was also causing problems and causing the stool to pass slower through my system. Once I got on anti-anxiety medication, it seemed to help (This takes a little bit of time to take effect too). These days, I’m recovered. The fissure is healed. I don’t take stool softener or anti-anxiety medication. I do drink plenty of water to keep the stool soft. Also, before I go to bed each night, I drink a little bit of prune juice. The sugar in prune juice helps retain moisture in the stool and keeps it soft. When I wake up in the morning, I’ll drink a glass of water and, about fifteen minutes later, I’ll have a healthy BM. Again, if you’re having trouble passing stool, ask your doctor if you should try a stool softener (like MiraLAX. You can buy it off the counter). Sometimes doctors don’t think of these things. I didn’t know they were out there. I wish I had.
Regarding adding more fiber to my diet…
CITRACEL
It’s a fiber supplement. It should help your stool retain water and make it soft. When you take it, you should make sure it’s been dissolved throughout the glass, then after you drink it, you should drink another glass of water (Citracel can constipate too if it’s not used properly)
WEIGHT LOSS
-Due to the pain while passing stool, I had drastically cut back on eating. As a result, I developed an eating disorder and lost a lot of weight. Not a good thing. If I was going to get over this thing, I would need to be healthy. Instead, I looked gaunt and weak. I saw my primary care physician about it and he told me to resume eating everything, especially fruits and vegetables. He says that if you fast too long you’ll get constipated and when you finally have a bowel movement it will blow away everything. Eventually, I took action and asked my primary care doctor to recommend a certified nutritionist. I visited her and she tailored a diet for me that really helped. I needed to put on weight. So, she created a diet with healthy fats. Unfortunately, she didn’t tell me to ease into it. My body tried to reject the sudden increase in fat and I got diarrhea. Once I dialed things back and eased into the new diet, things were fine and I eventually put on weight. If you are dealing with weight loss and fear of eating due to a fissure, I would highly recommend seeing a nutritionist. It helped me. (More on that later)
___
Regarding the fissure, I tried the DILTIAZEM routine for about a month and a half. I kept wavering between getting good and getting bad. I kept reinjuring the fissure due to hard stool.
I would need to get surgery after all. It was decided to schedule…
SURGERY – lateral internal sphincterotomy and a hemoroidectomy
TIME AWAY
-With my employer, I had to set up my time away from work. I would be on short term disability. They told me that I might want to take a full month off work.
ABOUT A WEEK PRIOR
I went to the medical center where my surgery would be performed and I had a PRE-REGISTRATION session. Basically, I did a bunch of paperwork, gave some contact info regarding who would be helping me and a nurse took my readings and answered my questions.
FIVE DAYS PRIOR TO SURGERY
PRE-OP
-I went to my primary care physician and got a PRE-OPERATIVE CONSULTATION. (This was requested by my colo-rectal surgeon)
On the night before the consultation, I would start fasting – no food. Then, the day of the tests, I could drink water only. They would take a bunch of tests (blood, EKG, X-Ray, etc) then my primary care doctor would go over the results. If they looked good, he would clear me for surgery. (If you need to get a pre-op consultation, set it up RIGHT AWAY. The logistics were a bit tricky. I had my tests done on one day. Then, my doctor looked them over the next day – and then, he had to get the info back to my surgeon and the medical center before the surger. Again, these things take time and they don’t want to do them too far in advance. Plus, trying to find a time to see your doctor on short notice can be difficult. So, set this up right away and allow yourself enough time)
-Also, I called my surgeon to see if I could get the prescription for my post-op pain medication pre-filled. That way, it would be ready to go after my surgery.
TWO DAYS PRIOR
-Stop using the DILTIAZEM OINTMENT.
-Before the surgery, I had to clean out my digestive track. Two days prior to surgery, I started taking COLACE 100mg – TWICE A DAY. It’s a stool softener and it made my stool easier to pass. I will be taking it to primarily avoid constipation from the pain killers.
On the day of my surgery, I shouldn’t take it.
After surgery, I should resume taking COLACE for two weeks.
DAY BEFORE SURGERY
-My doctor didn’t want me to do an enema (Might cause more problems)
-Eat a normal breakfast and lunch
-After 2pm, nothing to eat – stay on a STRICT LIQUID DIET
-After 2pm, I will start drinking GOLYTELY. It’s a powder that comes in a jug. They give you instruction on how to fill it with water, shake it and mix the solution into the water.
-You’re suppose to drink all of it. It’s an instant laxative that causes you to pass everything out of your digestive tract in preparation for surgery.
-I can take 4 hours to drink it. They normally have you do 4 liters. I will drink 2.5 liters. This is about half of what they normally do.
-I will start passing. It will be painful but I have to do it.
-After taking Golytely, don’t take any more Colace stool softener.
-Shower night before
-After midnight, don’t eat or drink anything. No food or water after midnight. Nothing in your mouth. I can brush my teeth but that’s it.
DAY OF SURGERY
Don’t take Colace the day of surgery.
-Wear glasses – no contacts
-Don’t bring valuables
-Wear comfortable clothes & shoes
-Bring insurance card and picture I-D
I was told to get to the surgery center at 7am.
-I will fill out some paperwork (including the surgery order that I’ll okay)
-They’ll take me back. I’ll strip, get in gown. They’ll put me in bed 20, hook me up to heart monitor, give me IV. They’ll wheel me into surgery, put me under at some point and they’ll do the procedure.
Surgery was at9am – 10:30am on a Friday morning. I was in for a half day. (Surgery itself was about an hour)
-Procedure – sphincterotomy and a hemoroidectomy - They cut into the internal sphincter to fix it (Of course on the initial paperwork, they had the wrong procedure written down. Again, go over all your paperwork and double check everything. Follow up and be assertive)
-The surgery went fine. They said they found what they thought was a benign polyp, and they sent it out for a biopsy. They said everything looked good and I should be okay.
-After surgery, they slowly wake you up.
They wanted me to urinate before I left the hospital. I tried a couple of times but I couldn’t urinate. So, they put a catheter in me and drained the urine that way. (Regarding the catheter, Doc said to do it in a half hour. The nurse waited an hour. After that, she finally had to do it.) With the drugs and everything else that I had been through, it wasn’t painful. They drained the urine and sent me home. If I had trouble urinating again, I would need to be catheterized in an ER. Luckily, this didn’t happen.
PROBLEMS TO LOOK FOR POST-SURGERY – Go to the ER if I experience any of the following…
-severe rectal pain/bleeding
-persistent nausea and/ or vomiting
-fever
-chills
-abdominal pain
-chest pain
-shortness of breath
-inability to urinate
-excessive diarrhea
-unable to have a BM for more than 4-5 days
Prior to surgery, I spoke with a nurse and asked the following questions regarding possible post-surgery issues:
DRIVING HOME
-How can I be comfortable? Can I sit?
A: Yes, I can probably sit. Or, I can lay. Pillows may help.
-I have stairs. Any advice on climbing the stairs?
A: Take my time
DRESSING
-Are there stitches? A dressing?
A: Not sure about stitches. The nurse said it might be more of an open wound.
For dressing, I will probably have a pad (almost like a female pad)
-When should I remove the dressing? (12 or 24 hours?)
A: I can take it off whenever I feel comfortable. I might want to leave it there initially. It will act like a buffer between the wound and clothes. I can take it off that night if I want.
-How should I remove the dressing? Is it easy to remove?
A: It sounds like it’s easy to remove and it should just come off.
-How soon can I have a sitz baths in the water? (12 hrs? 24 hrs?)
A: I just take it for comfort. I don’t have to have the pad on when I take the bath. DON’T USE EPSON SALTS – It will draw fluid away from the wound.
Should I do it day of surgery with dressing? Can I get the dressing wet?
-No. (I’ll get a packet with more details) Don’t get it wet.
-Do I need to apply a new dressing? Put in more packing?
-Once it’s off, you don’t need a new one
-How soon can I plan on bathing after surgery?
-I should wait around 2 days after surgery. She said I could probably do it late Saturday or Sunday
STOOL – FIRST ONE
-What can I expect?
-It will be tender and some pain. They’ll give me a spray bottle to use to clean it and I should do sitz baths to relieve pain.
***NOTE*** According to her, on average, it takes 12 hours for food to go from mouth to anus.
-Can I expect blood? How much? For how long?
-I’ll maybe have a little on the tissue or stool. (Having too much would be a bowl of blood. Then, contact the doctor)
-Can I use anal lube in the area to ease the stools?
-She wasn’t too keen on this. If I had to, make sure it was water soluble. Just wash the area with water.
-What should I do after passing stool?
-Dab area and take a sitz bath
-Can I expect SPASMS? What should I do if they occur?
-That’s what the pain pills are for.
SLEEPING
-Is there a preferred position for me to sleep in and sit in? Side? Back? Lay on stomach?
-Whatever’s comfortable. I’ll probably be pretty knocked out the first day.
Should I set an alarm to wake me up to take pain killers?
-She didn’t feel there was a need. My body will wake me when there’s pain. There’s no need to wake up. (Plus, they don’t want me to overdue it and I get constipated)
PAIN KILLERS
Once I take one, I need to wait four hours before taking another, right?
-Yes. They don’t want me to overdue it. (Like with Tylenol, you don’t want to take more than 3000mg a day)
What if pain killers are not working? Can I up the amount?
-Call Doctor and tell him right away
ANAL CREAMS
-Do they recommend a local pain reliever like Amercaine or Nuper Canal?
-Doctor will probably want to try pain pills first. I should ask him. That stuff might be by prescription only
-I’m not taking Colace the day of surgery. When should I resume taking COLACE twice a day?
When I start eating anything other than the clear diet.
CITRUCEL
-I was taking a teaspoon of Citrucel each morning. When should I resume?
-Citrucel only adds fiber. Again, wait til you’re eating and you feel you need fiber.
DIET
-By the day after surgery, can I start switching from clear diet to low residue?
-Sure. Do it gradually. The important thing is they don’t want you to get nauseous. So, do it when you feel you won’t be nauseous and eat whatever you feel won’t make you nauseous.
-When can I add eggs and protein?
-Friday (the day of surgery) is a clear day per Doc. Saturday morning I could eat eggs. Again, just don’t eat too much.
-Incontinence?
It can happen but he’s never had a patient that’s had it afterward
-Complications?
Infection, bleeding, incontinence, etc. (He’s does this all the time. It shouldn’t be an issue)
INFECTION
She didn’t seem to think I have to worry about it. An infection usually takes 4, 5 to 6 days to get going, then it’s foul, green puss and it’s red and tender. (Within that time, I’ll be seeing the Doc. So, he’ll be able to tell)
-If I don’t have a fever, I shouldn’t worry.
-The fact that’s it’s a bit swollen, changing shape and draining clear liquid and some red is fine and it’s normal. It’s also good that I don’t have any pain.
END OF NURSE NOTES
-After surgery, I need to stay with someone for 2 to 3 days. They don’t expect anything but just in case I pass out, there’s someone to call 911.
THE AFTERNOON/NIGHT AFTER SURGERY
PAIN MEDICATION - HYDROCODONE
My doctor said I would experience the most pain following the first couple of days post-surgery. After that, it should subside.
During the surgery, they administered some pain medication which would last about 4 hours, then I was instructed to start HYDROCODONE (which is the generic name for VICODIN). They said it was okay to take the stool softener with the Hydrocodone, as Hydrocodone causes constipation and the two together will alleviate issues.
-I should take it at first twinge of pain. Don’t wait for a lot of pain or you won’t be able to bring your pain level back down. Take when I start to feel pain.
-Take pain medication every 4 to 6 hours. I don’t have to be militant about taking it every 4 to 6 hours. Just don’t take two within four hours.
-I should take them as needed. If the pain isn’t as much, I can cut back.
-I should eat food before I take it. (Jello is fine. I just need something in my stomach)
-In the prescription, they gave me 40 pills
(Need 42 pills for one week, 84 for two weeks if taking every 4 hours)
If I need more, they can give me more in the follow up.
-I should avoid aspirin and ibuprofen.
-Digestion – The anesthetic and pain killers will slow down my digestion and make it harder to pass stool. That’s why the doctor wants to me to start out with a clear diet then graduate to low residue foods diet. (And it helps being cleared out the night before)
-After surgery, I wasn’t really in pain. I was taking the pain killers every four hours. On Sunday, I tried stretching it to five hours (but over night I did 4 hours)
Turns out, I didn’t really have an issue. I guess, the pain medication really did the trick. I never really felt much pain post surgery.
-After surgery, I resumed taking COLACE twice a day. I should continue doing this for two more weeks. It combats against the constipation caused by the pain killers.
PACKING
After surgery, I had lots of packing over the wound. I was told to keep it there until my first urge for a BM. Then, I could untape it and remove it. (They said if I didn’t have a bowel movement in a couple of days I could try prune juice. Again, luckily I didn’t need to)
-Friday night (the night after my surgery) around 9pm, I felt like I was going to pass a BM. I decided to pull out the gauze. This was about a foot long and bloody. Instead of passing stool, I passed a whole bunch of water, which I suspected was left over Golytely. After that, I seemed to be incontinent. I would get the urge to pass and I would start squirting water out my butt. There was blood with this at first. Then, mid-day Saturday (the day after surgery), it slowed to just clear drainage with light colored blood.
-My anus had swollen and it changed shape over time.
-Sunday night, after I did a sitz bath, the upper left of the anus seemed to be a bit red and swollen. (I consulted with a told me to stop looking at it. It would turn out later that this had been infected.)
DIET
-Friday, post surgery, I was on a clear diet (lots of liquids basically). Avoid citrus and spicy foods.
-Then, I could gradually increase what I ate.
-On Saturday, I started transitioning from a clear diet to a low residue diet (Baby food, apple sauce, Jello, soup, toast, cereal/fiber/water).
-On Sunday, I started eating a bit more regular (1/4 cup all bran, spinach, sweet potatoes, lima beans, yogurt, cereal bar)
-On Monday, I had a ½ coffee cup of prune juice.
-Sunday night, I had some spasms but there were brief
-Four days after surgery (Monday), the medical center called and followed up.
-The nurse’s diagnosis: I was doing great
-As of Monday, I hadn’t had a BM yet.
-According to the nurse, if I didn’t have a BM by Thursday, that’s when I should worry.
I then spoke with my doctor and here’s what he said:
-Drainage - I have an open wound. There’s going to be drainage from it for about a month
-Incontincence - I probably won’t have good control for about a week
-I should keep the area clean
-Do the sitz bath
-After each, make sure I dab it dry so it doesn’t get an infection
-Swelling – Yes, there will be swelling
-Eating – I can eat just about anything. (Fish, chicken, etc).
-Yogurt – He said yogurt was good and I could eat 2 to 3 a day
-Bad food - Nuts, rice, spicy
-Spinach – he wasn’t too keen on me eating spinach. Because of the iron, he said it could constipate. I should probably stay away from it.
-Regarding blood, the nurse said that the time to become concerned is when you’re passing so much blood it’s filling the toilet bowl and stuff.
POST-OP ASSESSMENT (7/12)
-About a week after surgery, I visited the Doctor for a post-op assessment. On the morning before the visit, I finally passed a large amount of stool. This caused bleeding. To stop the bleeding, the surgeon did a procedure that I believe he called a “sulfur burn” and he put gauze in. The gauze will come out. I shouldn’t do a sitz bath that night (unless I have a BM).
-Regarding the fissure and hemorrhoid surgery, they look like they’re healing but it’s hard to tell with today’s wound.
-PAIN KILLERS –
He didn’t want to give me a new prescription. As I run out, I can start cutting back. Take two a day (or something) then I can start substituting regular Tylenol. DON’T TAKE TYLENOL AND HYDROCODON AT THE SAME TIME. As I cut back, I can alternate between the two. Don’t take more than one hydrocodon every 6 hours.
-Some people only need pain killers a couple of days. Others maybe a month
-For me, I should take Hydrocodon at night before I got to sleep, then 1 during the day.
-If I have a little pain, I can take a Tylenol. If I have a lot of pain, take a Hydrocodon
-Even now, I can try alternating between the two.
-BLOOD –
It’s okay if it’s dark blood that’s draining. I should be worried of it’s gushing or bright red. It’s going to drain for awhile. I should go to the emergency room if it’s gushing but other than that don’t worry. It’s just going to drain.
-BATHING –
-Over the weekend, I should avoid doing a sitz bath where I would be sitting. Instead, he suggested showering and dabbing the area. I can a resume sitz bath on Monday.
-DIET –
For now, don’t eat bran or eat it in smaller amounts.
For breakfast, I could eat eggs, bread , strawberries, raspberries, blueberries, etc.
For lunch, yogurt (It’s good for the GI—gastro intestinal), salad, fish (salmon okay), cantaloupe, green beans, lima beans, rice (just a little. It could constipate), stay away from spinach, stay away from lima beans (too high in fiber), stay away from anything that’s going to give me too much fiber, stay away from nuts and anything spicy
-Regarding a dietitian, he didn’t seem to think I needed one. If I wanted one, I could ask my primary care physician for one. (I eventually would and it would help immensely).
-Most patients take about six weeks to three months to heal
TWO WEEKS SINCE SURGERY
-After 2 weeks, 95% start getting back to normal and soreness starts to go away. I can also start eating things like chicken.
-I am off the Hydrocodon. I took a Tylenol this morning and I only need to take it as needed.
-For two weeks after surgery, I kept taking COLACE (the stool softener). After two weeks, I was instructed to stop.
-According to the nurse, I can take the COLACE up to a month but if I could start tapering off, that would be great
-She suggested I cut it back to one a day for the next week and see how that goes and slowly taper off. That would be fine.
-Multi-Vitamins – I shouldn’t start taking them yet. I should wait until after my next doctor visit and the Doc gives his okay
THREE WEEKS SINCE SURGERY
I had a follow up visit with my surgeon. He said the fissure and hemorrhoid looked okay. It will take a bit to heal completely. The results came back from the polyp biopsy. It was benign.
-RECOVERY TIME – He figures 2 to 3 weeks. Before I return to work, he will give me certification. I asked about any restrictions and he said that he isn’t going to give me any. I told him that I would need that in writing for my employer.
-When I return to work, I should sit on a cushion
-SITZ BATHS - I should continue them and I should make sure that I dab the area.
-INCONTINENCE - I don’t really have that any more. I will continue to have drainage and mucus for some time.
-GAUZE - I asked him if there was an issue with me putting gauze between my butt cheeks to deal with the drainage. He didn’t have a problem with that.
-EXERCISES – He wants me to do toning exercises each day. Basically, you tighten and contract the rectum for 10 seconds, then release. Do this 10 times each day.
-ERECTILE DYSFUNCTION / SEX - I shouldn’t have any issue with erectile dysfunction. I should hold off on any sex until I’m healed.
---ACTIVITIES –--
SITTING - I can sit but I may want to put a pillow beneath me.
STAIRS - I shouldn’t do a stair master but it’s okay for me to take stairs to get my mail.
DRIVING - He had some restrictions in regard to this. I told him that I wouldn’t do it just yet.
----DIET-----
Citrus - It’s okay to drink cranberry juice and eat oranges. Just stay away from spicy foods
MULTI-VITAMIN - It’s okay to take a multi-vitamin
-After 6 weeks to 2 months, the wound should heal. Again, the soreness will go away in about 2 weeks but it won’t be healed for 6 weeks to 2 months.
FIVE WEEKS AFTER SURGERY
I had trouble passing stool. My body kept wanting to go but nothing was coming out but small drops. This went on all day. Finally, at about 7:30pm, I had two small nuggets. Then, at 8:30pm, I had a large bowl movement. The next morning, I immediately had a medium sized bowel movement when I woke up, then an hour later, I passed one more normal sized stool.
I called the doctor and spoke with his nurse. I asked if these spasms were normal. She gave me her advice and she spoke with the doctor and said the following:
-They wanted to see me this week.
-It should be okay
-This is fairly normal post surgery and it’s fine.
-It may happen for a couple of weeks
-The muscles down there get tense. They don’t stretch and they spasm. It happens.
-She told me to drink a lot of water, take COLACE twice a day and take fiber.
-I told her that it seemed the stool was already kind of soft. She had thought that this wasn’t the case since I initially said that it was sort of harder.
-She said that if it seemed like it was already soft don’t take the COLACE.
-She said that you needed to take the COLACE for a bit for it to take effect. You can’t just take one and expect results.
-The sitz baths should help relax the muscles down there.
-She said that you should be doing about 30 grams of fiber a day.
-Three days after this call, I visited the doctor. I had a little flare up in the morning (My bowels wanted to pass but my sphincter wouldn’t open) Eventually, it did. Here’s what the doctor said:
-I am doing pretty well. The fissure and hemorrhoid look good.
-He checked the strength of my sphincter by sticking a pinky inside and having me squeeze. It was tight and the tone was good. I don’t have to do the exercises any more.
Regarding my other questions:
-Lumps on anus – What are they? / ETA for lumps to return to normal shape?
The lumps are hemorrhoids. They will eventually go down in size to nothing. This will probably happen in another month.
-Anus heal – How long? October or beyond?/
He felt in another six weeks it should be healed. Maybe 3 months total? Like he said, these things take some time.
Blood how long?
I’ll have a little blood for awhile. If it’s just a little on the tissue, that’s fine.
-Sphincter tightens/ stool won’t pass – normal? / How long? / Treatment?
This is normal. It may take a couple of weeks before it stops spasming
In a week or two, if it continues to spasm, I can apply the DILTIAZEM ointment that I have. Just put it on the outside. It relaxes the muscles.
Don’t take it if I don’t need it.
-Is this possibly the result of some IBD (Irritable Bowel Disease)? (Ulcerative colitis? Proctitis? Form first?)
-No. He didn’t think this was the result of any of these. They would’ve shown on the colonoscopy report that I gave him and they didn’t. I specifically asked about ulcerative colitis and proctitis. He said “No.”
-Should I continue taking stool softeners?
I can continue with these as long as I need them.
Activities –
-Walking is okay
-Driving is okay if there’s not pain
-Pushing a shopping cart I should avoid. It’s too heavy
-Laundry basket lifting – If it’s less than ten pounds, I can lift. Otherwise, no.
-Push ups – No. I shouldn’t do these.
-When can I go back to work? (Certification or extension?)
He said I could try it as long as there was no pain. I should use a cushion. I should alternate between standing working and sitting working, maybe every 20 minutes. I shouldn’t stand all the time or sit all the time either. He’s giving me no restrictions and she gave me a certification paper.
DIET
-He told me to avoid too much rice and bread. Eat plenty of fruits and veggies and water. He also told me I could drink prune juice. I told him that my bowels were fine. It was my anus that was the problem and I preferred to avoid prune juice all together.
-What can I do to avoid this in the future?
Fiber, fruits, veggies, and water. I can resume this as normal once healed.
METAMUCIL
Don’t take it now. I shouldn’t take it until I’m healed.
He wants to wait a month before seeing me again.
A MONTH LATER – NINE WEEKS AFTER SURGERY
It’s been one month. I had gone off of COLACE two days ago. A couple days prior to that, my stool had been diarrhea. Today, I was just passing nuggets in the morning. The doctor checked me out, stuck a finger up in there. He said that the stool that he felt was a little hard but not bad.
Here’s what he said:
-It’s healing nicely – but it’s still not healed. There’s no fissure or hemorrhoids
-There’s still an open wound that’s healing. The wound is almost closed.
-Scar tissue could tighten it but he wasn’t alarmed by my scar tissue
-Drainage & Blood - I will have drainage and blood until it closes. . Another month maybe two or more. Drainage comes from the wound.
-Hemorrhoid lumps – They may get smaller or they may stay that way. They won’t completely go away. They will only become a problem if later on I get constipated and push. At that time, I can have them removed.
-SCAR TISSUE - There will be scar tissue but he didn’t seem to think it would be an issue. Scar tissue will never go away. He didn’t say it was too tight or too wide. It was just a little tight. He felt it was healing nicely.
-He didn’t feel that it had healed too tight.
-Anus heal - It may not take until November. We’ll see.
-Sitz baths – At this point, they’re not promoting any healing. I can keep taking them for comfort if I’d like and to just soothe. Just be sure to dab dry avoid growth and infection.
-Difficulty passing stool - He didn’t seem to think it was the result of spasms. When he stuck his finger inside, he didn’t encounter any spasms.
-He seemed to think they were more diet related (Not IBS or spasms).
-STOOL SOFTENER - I could continue taking it but if it’s causing diarrhea, I should not take it
-Fiber supplement - He wanted me to start taking fiber. I asked if Citrucel was okay. He said “Yes” but I should take less than the dose they recommend (take half of what they say). It will bulk but bulk shouldn’t be an issue. I need to take two glasses of water with it and water should soften it. (If you don’t take it with lots of water, it could constipate)
-DIET – I’ve had such issues with hard stool and finding a diet that works. He said it’s really up to me to experiment and find a diet that works for me.
-Eat plenty of fruits and vegetables. I can eat chicken and fish, maybe even some meat once in awhile.
-Are there any positions that I should avoid?/ Will it be irritated if I sit or lay on my side? – He didn’t have any restrictions in regard to positions. Again, he said if I sit I can use a pillow. I told him it was more comfortable without one
-What can I do to avoid this in the future? - Avoid constipation
When I got home, I had a teaspoon of Citrucel and two pints of water. I immediately had a large BM.
ELEVEN WEEKS AFTER SURGERY
It was about a week and half since my last visit with the colorectal surgeon. I was still having trouble with hard stools and I had other questions. I paid another visit. Here’s what he said:
-My fissure is healed. However, my sphrincterotomy is still healing. It should be healed by October. Again, if you have hard stool, there will be pain normally. It looks more healed than last time. There could always be more bleeding with constipation though.
-HARD STOOLS –
-He suggested I visit the people who did my colonoscopy. They handled gastroenterology, liver disease and other aspects of digestive health.
-He thinks the hard stool is diet related. I need to drink more water.
He didn’t seem to think it was a sign of a bigger problem and that was a low chance.
-COLACE – I wondered how long I could take it without causing damage to myself. He said, “You can take it for a long period of time, three months or so. I had been having issues with diarrhea. When I stopped the COLACE, the diarrhea stopped.
Also, I had been having an issue where the skin around my right testicle began to droop while the testicle stayed ascended. This stopped as soon as I quit taking the COLACE. Odds where, it wasn’t the fault of COLACE. It was caused by an infection that was swelling my lymph nodes or something.
INFECTION
-I had some soreness and swelling on the left side of my inner buttocks, near my anus. I thought, it was just inflammation from the surgery. Before I left the office, I mentioned it. The doctor took a look and discovered it’s something more serious. It appears to be the beginning of an infection where the sphincterotomy incision is located. It has created an ANORECTAL ABCESS. It appears he caught it early. It’s still a bump.
-He says it’s a perirectal abcess
-There’s not much distance between the sphincterotomy wound and the abscess.
-There is a fistula tract. It’s superficial.
-I asked, “How did this happen?” He said the wound from the sphincterotomy became infected (despite the anti-biotics they gave me in my I-V at the time of surgery). When they made their incision, it was in the outer muscle (?) The one closest to the interior wall. He said that possibly the fissure closed too early and formed an abscess that became infected.
-It’s possible the infection could have come from a piece of stool getting clogged in a gland. He didn’t really know.
-He cut it some. He drained it a bit.
-They’re trying to take care of it so it won’t become something worse.
-He said that it looks like if I had to get surgery it would be pretty superficial.
-WHAT WILL IT LOOK LIKE IF IT WORSENS? – If it worsens, I should look for fever, chills, redness, swelling or excessive drainage
-GAUZE – He put gauze on it. I should keep the gauze on it until tonight or my first BM. (He even suggested I could take it off at 4pm then do a sitz bath)
ANTI-BIOTICS
**WARNING*** Over prescription of anti-biotics by doctors has lead to a rapid increase in the cases of C-Dif throughout the country. I know because it happened to me about a year after this in an unrelated incident. Anti-biotics kill the bad bacteria in your system. They also kill the good bacteria. When you stop taking the anti-biotics, there’s a chance the bad bacteria might start growing back faster than the good bacteria and out number it. Your body tries to flush the bad bacteria and you get constant diarrhea. If it isn’t treated, you could die. Again, if your doctor prescribes an anti-biotic, talk to them about the dangers of C-Dif and precautions that you should take to avoid it (like taking a pro-biotic that adds good bacteria to your system). I can’t stress this enough. The doctors are trying to help you but sometimes, they don’t think two steps ahead.
-C-DIF WARNING SIGNS – Diarrhea would be a sign. He said, I should eat plain yogurt to help combat this (If you have C-Dif, it will take a lot more than yogurt to combat it). He said it’s okay to have 2 to 5 BMs a day, as long as they’re not diarrhea.
-Now, getting back to my infection story…
-The doctor gave me two prescriptions for ANTI-BIOTICS (FLAGYL & CIPROFLOXACIN). I will start taking them. It may give me diarrhea.
-There is a 50/50 chance that the anti-biotics will work.
-I will see him again in two days. He’s going to do a procedure where he will make an incision and drain the abscess.
-On that day, I will need to have someone drive me and I will need to take the next week or two off.
-If this procedure and the anti-biotics don’t heal it, I will need to get surgery. For the surgery, they would stick a probe up my ass and a probe up the fistul and they would make a cut. Hopefully, they won’t have to do this. Hopefully, it will heal.
-When I had my initial surgery to fix the fissure, he had said there was a 5 to 10% chance that I would get an infection. I guess, I fell into that 5 to 10%.
-Sitz bath – I should keep taking them two times a day and after each BM.
-At work, I should sit on a pillow.
TWO DAYS LATER – ABCESS DRAIN
-The doctor performed an in-office procedure to drain the puss out of the ABCESS. It went very fast.
-He injected an anesthetic into it to numb it. Then, he cut an X over the area and drained it.
-He gave me a doctor’s excuse to take the next week off from work.
HIS INSTRUCTIONS POST ABCESS DRAIN PROCEDURE
-Keep the packing on it until the next morning or until after my first BM. (When it came time to remove the packing, I didn’t realize that the packing wasn’t just on the surface. The packing was actually a long strand of gauze that was packed down inside the wound. Pulling it out was like a magician doing a scarf trick. I had to pull a long strand of gauze out of the hole where my wound was. They hadn’t warned me of this. It wasn’t painful. It was just a little shocking to discover)
-Keep redressing the surface with gauze until I see him again in five days . I don’t need to tape it. I just need to keep the mess off of my clothes. I can just stick some gauze between my cheeks.
-At the first sign of pain, I can take an Extra-Strength Tylenol. He gave me a prescription for Hydrocodon if I need it. Again, I may not need it. I can take them with food and they won’t interfere with my anti-biotics. The Hydrocodon can constipate.
-I should continue to take sitz baths. According to the nurse, they are to help with the pain. I should dry the area afterward. Spread my cheeks and dab area dry.
-Don’t put creams or rubbing alcohol on it.
-For the next three days, don’t put much pressure on it. Lay on side that doesn’t have abscess.