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.

[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.

[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

[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.

[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

[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).

[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.

[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.

[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.

[davhill]

Hoofy said:

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

The doc said there's nothing to see, and the first doc diagnosed by feel so it has to be internal. I'd take a look but I can't get round to it

Apparently, there's a structure in the area called the pectinate line (or dentate line). This is about 1/3 of the way up one's exhaust manifold and any problem south of it (e.g. an external hem) will be painful.

This suggests it's external (but not as we know it).

[davhill]

bad company said:

I have had 3 fissures. Tried lots of ointments but for me surgery was the only way to fix them. Each time the soreness went about 5-6 days after the op. The operations were all done by the same general surgeon.

A couple of years ago I saw a specialist 'arse doctor' (I'm sure there is an official title.) He put me on medication for irritable bowel and told me to stop using all ointments. With the medication and some changes to my diet I have been able to control matters and no more fissures.

My advice is to see a professional 'Consultant Arseologist' and NOT a general surgeon.

Good luck mate.

Thanks!

AFAIK, a 'Consultant Arseologist' is called a proctologist. But I can't for the life of me figure what leads anyone into this profession

The appointment I have will be with 'Colorectal' at the hosp. It's with a Miss C. Bronder, or a member of the clinical team. I really couldn't care less who I see, provided the outcome's good.

[davhill]

Hoofy said:

Pray that she's not hot. Having a semi while your arse is being fingered is going to be awkward.

Not too sure I'd rise to the occasion in those circumstances.

[davhill]

"Just a little update", he bled...I mean said. The appointment's next Monday afternoon

[davhill]

Update time! Just been to local hospital. Nice lady doc gave me a professional fingering. "Fissure in ano", she opined. I've been to the services at Easton in Gordano (Bristol way) but Fissure in Ano? Never.

Next to try is Diltiazem...a ring-relaxing calcium channel blocker. Then, a firkle around under general anaesthetic (for me, not them), and probably Botox.

So it's a fissure in a bad place, probably a risk of living in Beatrix Potter land. But I'll probably end up with a catwalk-quality botty.

The adventures life presents!!

[davhill]

IroningMan said:

Will they bleach it for you as well?

Perhaps, if I ask nicely.

[davhill]

Another update. I went to collect the Diltiazem but it'll take 10 days for the prescription to be filled in.

Seems it's unlicensed by NICE, so the 'scrip has to be a special one, assuming the doc's happy.

It also seems it's £78-odd per tube and usually two tubes are needed for an 8-week course, cos it goes off 2 weeks after it's opened.

Upside, in a study of 43 sufferers, it was effective on over half. Only three needed to go for surgery.

[davhill]

Mr Pointy said:

Just be prepared for a bit of 'leakage', especially if you go for the Botox. An absorbent pad in your trolleys for a few days might be a wise precaution.

I understand leakage is a potential problem. I'll have to get some Tena Lady thingies if need be (my stupid mate thought a Tena Lady was a very inexpensive prostitute).

[davhill]

Davey S2 said:

Don't forget to avoid wearing cream coloured chinos for a while.

No danger! The last light-coloured trousers I had were binned in 1978. Been man in black ever since.

[davhill]

Coo, ta. I'm happy to say I hive no experience of such things!

I got a call from the surgery this morning. Apparently, fingers have been pulled out (no pun intended)and I should have the new topical cream by tomorrow evening.

[davhill]

55palfers said:

Hope the new medication is effective.

Thanks! No problems with it so far.