Fissure, Fistula and Kenalog Repair...My Experience.

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Fissure, Fistula and Kenalog Repair...My Experience.

Postby My only post » 10 Feb 2019, 11:47

I am posting this as I hope it will help some people on this board. 2 years ago I had a chronic anal fissure and underwent the kenalog injection procedure by Dr. Feingold at Columbia in NY. I wish I had done it sooner. I hope this encourages some people on this board to stop wishful thinking, using dubious self cures and seek real help. As you might guess from my tag line, this will be my only post and there will be not follow up.


My condition: I’ve had a fissure for about 5 months. I had tried niphedirpine and hot baths, lots of miralax, but to no effect whatsoever. I lurked on this board for a while and found some helpful information such as the finger support method, and more importantly, I read about Dr. Feingold at Columbia and his Kenalog treatment method for fissures. If you had not read about this before, Feingold treats a fissure like any other persistent wound or lesion. He dilates it slightly, cleans it out and then electrocauterizes it shut. He also injects the area with Kenalog which is a steroid to aid in healing. There is no cutting of the internal sphincter and therefore minimal chance of resultant incontinence. I liked this very straight forward and logical approach.

So I made an appointment to see him. He examined me EXTERNALLY only. He stated that clearly I had a fissure, and it could be that I also had a fistula, based on the amount of swelling. If there is a lot of swelling in the area over a long period of time, apparently your body tends to create fistulas. Following the exam, I made an appointment for surgery 2 weeks later. He performs the surgery on Tuesdays and Thursdays only. I selected the very first time available on a Thursday figuring that it would give me Friday and a whole weekend to recover. Dr. Feingold, explained that I could also expect a lot of pain and that I should give myself 5 days off of work to recover and, so you can see the logic in the Thursday timing. Dr. Feingold is very straightforward in his explanations. He answers all of my questions. If he doesn’t know, he says so. I asked him how many times he has performed the procedure and he says over 250 times with great success and low recurrence.

It should be noted that my insurance (United Health Care) was accepted for both the visit and the surgery.

Day 1-Day of Surgery- Arrived at Columbia t 6:30 AM. Had the surgery at 8:30 AM and woke up in recovery at around 11:AM. By 12:30 PM I was sitting on my porch…so it all goes very fast. In the after-surgery consult, Dr. Feingold advised me that I had a deep “angry fissure” and a small fistula and he corrected both. They also took a small biopsy to see if I had Crohn’s disease. I can expect a longer recovery as a result of the deep fissure/fistula combination. I would have to baby the area for at least 6 weeks followed by a longer period of more moderate recovery. He noted that most people are pain free by 2 weeks and then notice another significant improvement after an additional 2 weeks. However, again, because of my fistula, my recovery is going to be longer. Dr. Feingold advised me to eat fiber, take miralax, frequent HOT (not warm) baths and otherwise I could do whatever I wanted EXCEPT ride a bike. DO NOT RIDE A BIKE because of the direct impact to the area. I asked him if I could do karate, which is my sport. He said yes. However, in all fairness to Dr. Feingold, he doesn’t know that most of the practitioners at my dojo kick harder than a horse and hit like a wrecking ball, so I decide to avoid sparring and impact training for a while. HOWEVER, after the surgery there was NO PAIN, contrary to Dr. Feingold’s prior estimation, so I guess I got lucky. I relax at home for the rest of the day reading and watching Netflix . They prescribed me pain relievers and ketorolac as an anti-inflammatory. Although I took the pain meds twice, I really did not need them. After the first day, I never took them again, but I took the ketorolac for 5 days to keep the swelling down. There was some bleeding and seepage from the surgery. I would describe this as a mixture of blood and drainage from the fistula with some fecal particles, because of course, it is draining out of the anus. In the grand scheme there is not much quantity of effluent, but enough to make your underwear messy. At the hospital they gave me gauze pads to stuff in my underwear. These worked, but inevitably slide around and you get a self-induced wedgie of gauze. I would later (on day 7) switch to menstrual maxi-pads which adhere to the underwear and are far, far more comfortable. Another avenue I considered was Depends briefs. There is also a product called Butterfly which seems to be made exclusively for fecal incontinence, but the men’s size is often sold out, so I didn’t use it.

Note for Men: The maxi pads won’t work on boxers in my experience, but will work on briefs or other underwear. I position them a little further to the back that they would otherwise be intended.

Note for Women. I’m NOT sure that maxi-pad method would work for you. Consider that effluent that the pad catches is far from sanitary and I would be concerned about UTI or other resultant infections.

Later that night before sleep I could feel an itch around the anus…but that was about it.

As a general rule for the next month I take miralax two or 3 times daily, eating 35-50gms of fiber, using a bidet and taking a hot bath 3-4 times a day. I use alcohol free wipes when I need them, mainly to clean up seepage and blood between BMs. I should note that they also gave me a sitz bath at Columbia to take home. I prefer regular baths. So I didn’t use it.

Day 2. Still no pain. Still bleeding /seeping. I rest and go for walks around the neighborhood. A peak at the area reveals that the cause of the itch was that my hemorrhoids had swollen to a prodigious side. I did feel like I needed to have a BMW, but could produce very little. It was almost as if there was so much swelling I couldn’t go. I wrote to Dr. Feingold and he said the swollen hemorrhoids are typical that it was the swelling which caused the sensation of needing to go, but in fact I probably didn’t need to go at all and to take some more miralax. He was correct. I scheduled a follow up appointment with Dr. Feingold in a month.

Day 3-4. No pain. I have 4 bowel movements in the course of 16 hours. I dial back the miralax a bit. Still bleeding/seeping. Dr. Feingold says the duration of the bleeding /seeping is highly variable. I do some manual labor around the house and in the garden and go for long walks.

Day 5. No pain. I go back to work on day 5 and have my first karate session since the surgery. It is only Kata (forms) and therefore no impact. No issues. Still bleeding/seeping.

Day 6. Hemorrhoids have subsided. After a night time BM, I have a bit of pain I would almost qualify it as a spasm, or half spasm because it seemed concentrated on 1 half of the anus. It doesn’t last too long however and I go to sleep with no issues. Still bleeding/seeping.

Days 7-8. No Pain . This is when I switched to the Maxi Pads from the gauze. The flow of blood/seeping is greatly reduced. Perhaps I had been doing myself a disservice with the gauze wedgies. About this time I begin to notice a few drops of blood in the bowl after a BM. Also I have a pronounced itch, centered on the site of the former fissure, after BMs which will last a few hours. It’s sometimes accompanied by the swelling “need to go feeling” so I take an anti-inflammatory. I notice that I spot blood a few hours after taking the anti-inflammatory. Nothing big. Perhaps a few drops.

Days 9-13. No Pain. Some itch after BMs. The entire time above I was on miralax and taking hot baths 2-3 or 4 times a day.

Eventually, after about two months, I tailed off the miralax completely and then tailed off the tub sessions. The quality of life improved enormously. Things could only have been better if I had sought him out earlier. Again, no matter what you decision, it is best to get your problem sorted out sooner rather than later.
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Re: Fissure, Fistula and Kenalog Repair...My Experience.

Postby dmcff » 10 Feb 2019, 16:28

Thank you for your post. It's always good to read of positive outcomes where treatment of AF is concerned.

Dr. Feingold and his Kenalog procedure have received favourable notices here in the past, though other users have reported mixed results.

On a general note, it's helpful if posters will indicate their geographical location, as this is an international forum, and by no means all of those who visit here are in the United States.
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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