My nearly 2-year journey: fissurectomy, Botox, PT

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My nearly 2-year journey: fissurectomy, Botox, PT

Postby Amwill » 06 Aug 2018, 22:51


I’m a gay man, early 30s, and I was diagnosed with a chronic anal fissure about 1.5 years ago. I’ve had four anal surgeries over that time period. My healing is the best it’s been thus far, but I still have issues with pain, irritation, and bleeding with bowel movements on occasion (currently having a flare-up, which means blood every day). I’d love to hear from any other gay men who have been able to resume any kind of sex life after a fissure and/or surgeries. It’s been the most challenging health issue I’ve had - not life threatening, but certainly has led to depression, chronic pain, and exorbitant medical bills. And it feels like it will never get better.

Long version

I was diagnosed with anal warts (HPV) in October 2016. By the time I learned they were internal, they had spread and required electrocautery surgery in December 2016. At the time, I was told I would feel well again - and could even resume sex - in four to six weeks. In the meantime, I endured the worst pain I’ve ever had, during bowel movements, including significant blood, sphincter spasms, and stenosis. I remember drawing a hot bath so I could immediately jump into it after I went to the bathroom.

By the six week mark, I was definitely not fully healed, but I had to travel for work for one week. That, plus continued stenosis (with stools as narrow as a pencil at times), contributed to constipation and as a result, an anal fissure.

So every bowel movement then consisted of pain (throbbing/spasm) and blood, with continued pain throughout the day. After a few weeks, I would feel better by morning and then repeat the cycle every single day.

My doctor basically gave me Calmol suppositories, told me to take fiber and sitz baths, and sent me on my way. After about 6 weeks, this had not helped, and apparently I had developed a small anal fistula (apparently related to the fissure) as well.

So I went in for surgery: the Kenalog procedure, as many on this board refer to it. Recovery was about the same - severe pain for about 10 days, then it started feeling a bit better. I never stopped bleeding though, and by about 6-8 weeks, felt like I was in the same situation as before. The surgery didn’t seem to work.

So once again, in June 2017, I underwent a full fissurectomy with Botox. I was advised that LIS was not appropriate for gay men, and there was reluctance given my age to cut the muscle.

Honestly after the surgery itself, the Botox made me feel pretty good. It masked any issues I had - after a couple months, very little pain and if there was blood, it would heal in a day or two. I was also using dilators at this time, for better or worse. I felt *almost* normal. Hooray!

Except not. Botox wears off after 3-4 months, and I vividly remember in October 2017 having a bowel movement that led to new significant blood. I should say that I was taking, and still take, stool softeners (low dose of miralax for a while, and now dulcolax + fiber). So this wasn’t an abnormal bowel movement, but instead I think my muscle was back to “normal” - tense after Botox was gone.

My doctor said at this point, the fissure was “healed” but scar tissue had formed and it was “irritated”. Scar tissue is now my enemy because it doesn’t stretch, and it bleeds in one particular spot.

So fast forward to December 2017 when I had a final round of Botox (with cauterization of the scar). Again, I went through a painful surgery recovery, and then felt pretty good with Botox. Until it wore off in March 2018 when I had a setback - daily blood and irritation.

So back on diltiazem I went, and 3-4 weeks later felt better. I’ve since had two other setbacks lasting a few weeks at a time (May 2018, July/August 2018) and have healed with diltiazem.

My doctor also recommended internal pelvic floor physical therapy with trigger point therapy, along with using dilators again. So I’ve done that since May 2018 and seen some improvement in the texture and durability of the scar tissue.

But alas, I’m not there yet. In my pursuit to feel normal again, I want two things: to go indefinitely without blood and irritation, and to have sex again one day. But as I write this, I’m not here yet.

What a journey this has been. I would have never imagined something so seemingly simple could be so difficult and expensive to fix. Luckily I have a very understanding and patient partner who has been supportive through the ups and downs.
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