by Lauren12 » 09 Nov 2012, 14:11
Hi Charlie,
Ever the Optimist has done a very good post. I'd only add a few things. Firstly, when I first had appalling anal pain and went to my GP, the GP that I saw examined me and diagnosed haemorrhoids, even though she couldn't see or feel a thrombosed haemorrhoid on her examination. She therefore prescribed me treatment for haemorrhoids. It was only when this did no good whatsoever and I got to see a colorectal surgeon, that it was discovered that in fact I had an anal fissure. The GP hadn't spotted it and it took a specialist to be able to see it. So in my experience, GP's aren't always adept at spotting fissures.
I'm surprised you haven't had a rectal examination at the GP's surgery. Bright red blood in the toilet bowl following bowel movements, as you describe, can be symptomatic of haemorrhoids. 14 years ago I got bright red blood in the toilet bowl on several occasions. Again, I saw a colorectal surgeon at that time who recommended a haemorrhoidectomy, after which, no more blood and no more pain (until I formed an anal fissure over a decade later!)
So blood and anal pain can be symptomatic of both haemorrhoids and anal fissure.
Secondly, during the treatment for my anal fissure, I had scans and investigative procedures to see if there was anything further up the bowel that might have been causing the pain. There wasn't, but they did ask about the symptoms for IBS, in case that might have been a factor. There are certain conditions which tend to cause fissures. One is Crohn's disease, but don't worry, if that was a factor I'm sure you'd know about it and the GP would have picked it up. I don't know, however, if IBS is particularly associated with fissures.
As to what causes fissures, even the colorectal surgeon who cured me gave a wide variety of possible causes. I'd always been constipated for instance, but didn't develop a fissure until the age of 55. Ever the Optimist is right however, in that people of both sexes and all ages develop fissures. What led to one developing for me was an attempt to cure my tendency to constipation and establish a regular bowel habit! I tried prune juice for the first time in my life. Unfortunately I didn't read the container, where it recommended only 200 ml a day, and thought of it as like a standard fruit juice. I liked the taste so much that I was drinking pints of it at a time! I thought the more the better. Big mistake! There was a very sudden and dramatic change in my bowel habit and stool quality. For the first time in my life I was producing large, bulky stools at least once a day and sometimes more often. After about a month of this, I developed the fissure. It also happened to be during hot weather and my CRS has said a couple of times that dehydration can be a factor. As Ever the Optimist has said however, diarrhoea can also cause fissures.
Someone else I know was due to take a long haul flight back to the UK. Unfortunately, the day before the flight, he ate a hot curry and developed diarrhoea. So that it wouldn't be a problem on the flight, he took imodium to control it. On returning to the UK he then couldn't have a bowel movement for a couple of days. When he did, it was so large and hard that it caused a fissure.
The only two other people I've heard of in my day-to-day life who developed fissures healed spontaneously, I think with the help of one of the creams, as it sounds you may have done when you said a few months ago the pain with bowel movements cleared up with the use of ointment. One of the people I know took six weeks to heal and the other ten weeks. Neither of them has ever had a recurrence. I think most people with fissures do heal this way.
As you're once again bothered by anal pain however, you do need to pursue it, in my opinion. It's not satisfactory for your GP to fob you off. It's good that your stool samples were all healthy. I never had a stool sample tested by the way, so it may be your GP was testing for IBS, rather than focussing on the possibility of anal fissures.
If you're registered with a group practice, is there another doctor in the practice you trust more, who might give a different response? It's also sometimes possible to find out from a surgery's website, what the areas of special interest are for all the GP's in a practice. For example on completely different issues I've consulted a GP about, some GP's seemed clueless but others very well clued up about the condition I was consulting about and prepared to progress things.
If you're anywhere near London and have health insurance or can afford a private consultation, I can recommend the Colorectal surgeon who finally cured me if you like. He deals with both the upper and lower gastrointestinal tract, so would be informed not only about conditions of the anus like anal fissure, but also conditions like IBS. He does have an NHS practice and you can ask for a referral to any doctor in the country. However, with the NHS, you stand the chance of seeing a junior when you turn up to the appointment, even though the referral was to the Consultant. If you book privately, then you're guaranteed to see the Consultant you want to see.
All the best with things, and I wish you speedy relief. There's lots on the board about what kind of diet can keep your stools soft and regular, thereby making bowel movements easier and giving the anus a chance to get better.