The Fissure King seeks advice

[davhill]

Having a strain four weeks ago, I left the pan full of claret. This was the beginnings of the flaring up of
the haemorrhoid I was born with, accompanied by an anal fissure. Cue vicious pain and a couple of professional fingerings.

The first pro (male practice nurse) said the hem had scarred over and prescribed Proctsedyl suppositories. For all the good these did, I might has well have shoved them up my arse. The second pro was a lady doctor - petite so she has tiny fingers. She declared the hem was accompanied by a fissure and prescribed Rectogesic.This contains Glyceril Trinitrate which encourages blood flow and promotes healing.

Trouble is, If I'm on my feet for any length of time, I feel like I've been rogered with a thread file. I've heard of a 16 stone rugby player weeping with the pain and can understand why. I'm quite good re pain threshold but this is fking agonising.

Do an anally experienced PHers (you know what I mean) have any hints/tips for coping. I've tried Germoloids (anal 303 rounds with Gemolene), Germolene cream, Anusol (the once-a-year bot cream)and Sitz baths. All practical advice gratefully acknowldged.

[Mr Pointy]

Go back & request a referral to an arse consultant/surgeon; it's been going on for a fair time now. Surgery is one option, but it can involve cutting your ringpiece & the seal afterwards may not be too good (& this can be permanent). Oddly enough Botox is also a possible alternative: this reduces the tension & allows the fissure to heal, but has the advantage of wearing off after a month or two.

If you have private medical insurance, use it.

[Farmerpalmer]

Mr Pointy said:

Go back & request a referral to an arse consultant/surgeon; Oddly enough Botox is also a possible alternative: this reduces the tension & allows the fissure to heal, but has the advantage of wearing off after a month or two.

If you have private medical insurance, use it.

This - botox is really the only treatment which has a good chance of working. Rectogesic or diltiazem cream have poor results. Take a regular laxative (e.g. movicol) to prevent straining, as this will make the fissure open up and prevent healing.

[davhill]

Thank you Gentlemen,

I chased up the doc and have a phone consult in the morning. I'll request a referral then. Meanwhile, it'll have to be the arse cream, Lactulose, baths and gritted teeth.

[snood]

Update time!

It's 10 weeks since the nurse practitioner's diagnosis and eight weeks using Rectogesic that the doc prescribed. I still have pain and can experience a bleed, especially if I get my Fybogel/Lactulose/food mix wrong. The pain isn't quite as bad but I still resort to Paracetamol from time to time to control it.

Off to see another quack day after tomorrow. Given it's been a while and my exhaust port ain't fixed, I'm thinking of requesting Botox. Any thoughts, experiences, warnings or jokes?

Thanks, F.K.

[55palfers]

I had a fissure repair a good 9 months ago.

Cold comfort time. Sorry.

Took ages ( 4 months) to heal but I still get a little spotting on the stationery from time to time.

Pain is better than it was though. Not 100% better but a strong 80% I'd say.

Proctologist did say it was a tricky job.

[davhill]

Really? I could do with a strong 80% improvement in the catflap.

What was the procedure that you had? Local? General? Time in hosp?

Your answers would be valuable, you understand

Edited by davhill on Monday 3rd November 22:44

[55palfers]

No problem

I was a day case under heavy sedation and a local.

Went in about 10:00 hrs., exam, enema, procedure, home at about 20:00 hrs.

Given painkillers and some tablets to ensure a soothing loose stool for a few days.

Very sore bot for about 5 days and bleeding on the paperwork stage. Didn't do much cycling!

Stitches were dissolvable. Took ages (6 weeks) to heal "properly".

Short term discomfort - but worth it.

PM me and I'll give you the name of my Consultant. If you are near Solihull / West Mids of course.

[davhill]

55palfers said:

No problem

I was a day case under heavy sedation and a local.

Went in about 10:00 hrs., exam, enema, procedure, home at about 20:00 hrs.

Given painkillers and some tablets to ensure a soothing loose stool for a few days.

Very sore bot for about 5 days and bleeding on the paperwork stage. Didn't do much cycling!

Stitches were dissolvable. Took ages (6 weeks) to heal "properly".

Short term discomfort - but worth it.

PM me and I'll give you the name of my Consultant. If you are near Solihull / West Mids of course.

Cheers!

Given I've had 10 weeks pain and minimal healing, I could do that. I'll quiz the quack tomorrow.

[55palfers]

Good luck.

[davhill]

Thanks. Can you recall the name of the procedure?

Bell ringers could be (courtsey NHS) ...

Lateral sphincterotomy
A small cut in the sphincter muscle to help reduce the tension in your anal canal.

Advancement anal flaps
Advancement anal flaps involve taking healthy tissue from another part of your body and using it to repair the fissure, thereby improving blood supply to the site of the fissure.

It looks like botox injection may be the post Glyceryl trinitrate (as I'm on now)and pre-sphincterotomy. As you migh have guessed, I like to know the score

[55palfers]

No, sorry Davhill. I guess I wasn't paying attention.

[davhill]

The latest development is a consult with colorectal surgery on 8th Dec. Still on with nasty pain and occasional bleeding. The young lady doc I visited couldn't see anything but thought a hem might have prolapsed downwards. New supplies of Lactulose and Laxido (Fybogel equivalent), and keep using the Rectogesic oinkment.

All I want for Christmas in....... (fill in as applicable).

[Kiltie]

OP, last time I had a bad fissure, my consultant gave me "Anoheal". Superb name.

I was just googling for it and found this.

I hope you find a way through this before too long.

[davhill]

Thanks!

I had been warned that Rectogesic might not do the trick, which it clearly hasn't so far. If I don't get the mixture (i.e. food eaten, Lactulose and Fybogel *exactly* right, I get blood and a sharp pain for hours, necessitating painkillers (Paracetamol).

I know Dilitiazem is an option - it worked for 75% of the patients in a 2001 study. Then there's Botox. In fact, I'd rather not have surgery if at all possible.

[zetec]

One of the tips I was given by my Dr was to apply Vaseline before doing a poo, will make it easier to go and less pressure on the fissure itself. Also to use unscented baby wipes instead of toilet paper. Neither will make the fissure go away but will make life a bit more comfortable as you won't be aggravating it every time you go.

[davhill]

zetec said:

One of the tips I was given by my Dr was to apply Vaseline before doing a poo, will make it easier to go and less pressure on the fissure itself. Also to use unscented baby wipes instead of toilet paper. Neither will make the fissure go away but will make life a bit more comfortable as you won't be aggravating it every time you go.

Thanks, zetec,

I'll give both of these a try. I'm using rectogesic, which has lubricating properties but it also promotes blood flow in the area so anything on its way out, no matter how soft, is causing bleeding. Hope that isn't too much detail The baby wipe idea sounds promising though - I'll get some.

[Hoofy]

Maybe it's best to use that blood flow promoting gel after rather than before going to the toilet? Ask your consultant!

Can you push anything back in? The sphincter would compress the wound to stop bleeding after you've finished with the toilet I'd have thought?

[davhill]

Hoofy said:

Maybe it's best to use that blood flow promoting gel after rather than before going to the toilet? Ask your consultant!

Can you push anything back in? The sphincter would compress the wound to stop bleeding after you've finished with the toilet I'd have thought?

Thanks, Hoofy,

It looks like the gel has a long term effect on blood flow-or the 'split ring' is weak enough to bleed anyway. I use the gel twice a day, applying it after downloading. This helps with the pain.

There isn't anything to push back in, though. The blood (on the paper and in the pan) stops post - movement. Unfortunately, the pain doesn't.

Ah well, only 3 weeks to the consult...I'll hang in there.

[Hoofy]

Is the fissure visible? Or is it inside? Normally a wound stings more when it's open to the world.