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   Hemorrhoidectomy (Bowel Disorders board)

13th November 2003
Please help!! I have been reading your posts for several weeks now and they have been very helpful, but I need some help. Iwent to a doctor in late july for removal of a hemorrhoid. The doctor banded it and the next day, the band fell off. I returned a week later and he surgically cut the hemorrhoid off??? He never told me to take stool softeners nor did he put a stitch in. Needless to say, the next day my first bm I was in severe pain. I ended up in the er where another doctor(under anest) had to fix the damage. He said I tore on the inside from my bm and had to have stitches and he removed a hemorrhoid. I was in such pain that night after the surgery I returned to the er for morphine. It has been 4 months now and I am not fully healed. I went to a colorectal surgeon last week who said I have a fissure. I can see the cut on the outside of my rectum which continues inside. The bleeding has stopped over a month ago, and I do not have pain during or after bm. It just feels sore to the touch and sometimes like it's just raw. It does not sound like a fissure from what I have read but I guess from what it looks like it is. The doctor did not do a internal exam. I have tried nitro-glycerin but it did not help. I am know using diltiazem, does anyone know how long it should take to notice a difference??? I am so afraid to have botox injections or any other kind of surgery. I lost all faith in doctors and worry terribly about incontinence as a result. I feel depressed and can relate to all of you who feel like this will never end. I just started using goto kula. Does anyone have any other suggestions??? Please help. Thanks
15th November 2003
Tammy, Thank you so much for your reply. I have been reading everyone's post but especially yours. I too had a second surgery to repair the first mess (not as bad as yours) but enough tha t I wish I could turn back time and never had had my hemorrhoid removed. The recovery was so long and painful and now with this fissure, it never seems to end. I am so terrified of a sphincterotomy. I don't know how long I have had this fissure because when I had the pain and bleeding with bm, I thought it was because of my hemm surgery. I don't remember when I first noticed this cut on the outside of my anus. How did you know you had a fissure and what is the difference between these "cuts" you talk about and a fissure??? I am using the diltiazem for a week now, I am not sure if it is helping because I don't have alot of pain during bm. I am sore though on the outside where the cut is. Right inside I have what looks like a small ulcer but it does look a little better this week (maybe wishful thinking).I am using an ointment (from echard) daily. My doctor also recommened botox injections if the diltiazem did'nt help. How di d you know your fissure was healed?? I feel as if my world revolves around my butt!!! I have sympathy for everyone who is going through this and I pray for all of you, I know how it feels.I don't know if i'll ever get better. thanks so much for your reply and your help!!!
15th November 2003
Anitraw,
I have been reading your posts and can relate. After months of trying to recover from hemm. surgery, I still don't know for sure if I have a fissure either. I had bleeding from my hemm. surgery for 2 months after. This feeling I have now continues as a raw feeling or soreness on the outside but looking inside it is red and split. The outside looks like a cut. I have tried the nitro and I am now using diltiazem. Can you see a cut on the outside of your anus or is it further up in? I also had burning along with bleeding after my bms for the first couple of months after surgery so maybe you are just not healed yet. I hope you are feeling better. Let me know if I can help.
15th November 2003
Quote from lbp35:
Anitraw,
This feeling I have now continues as a raw feeling or soreness on the outside but looking inside it is red and split. The outside looks like a cut. I have tried the nitro and I am now using diltiazem. Can you see a cut on the outside of your anus or is it further up in? I also had burning along with bleeding after my bms for the first couple of months after surgery so maybe you are just not healed yet.


lbp35,

I know what you might be feeling. My rawness feels like broken glass is shoved my my hole. It seems quite a few people are experiencing the "cut" complication. I suspect it comes from the re-healing process while the body reforms tissue (scarring). My scarring caused the very outside of my butt hole to become extremely taut to the touch -- less now. The scars are not as flexible as the original skin tissue and cracks producing these cuts. I suspect Tammy has the right idea keeping the area greased up. This probably keeps the tissue from drying which promotes cracking. I suffer from cracking fingers during the winter months and always rub baby lotion on my hands to keep them lubricated. I think this might be the same phenomena. I'm just hesitant to use the A&D ointment on open wounds. The strange thing is I experience no bleeding (at least none detect on undergarments) during the day. I only experience the bleeding at BMs and wipe ups. The pain, burning, and itching probably is like when you have a cut on a finger where you keep opening it from use. Therefore, causing the healing to take a longer than usual time. I can not visibly see my cuts from the outside. There are visible by slightly pulling the rectum apart. But I gotta tell you it hurts when I do that so I stopped looking.

Is this diltiazem you take a pill? A search indicates it's a "calcuim-channel blocker" use to treat high blood pressure. I take coreg (beta-blocker) for treating my migraine headaches. The normal use of coreg is for hypertension, heart attack or heart failure. It also lowers blood pressure but I have seen no help with my butt hole from it.
15th November 2003
Quote from lbp35:
Anitraw,
I have been reading your posts and can relate. After months of trying to recover from hemm. surgery, I still don't know for sure if I have a fissure either. I had bleeding from my hemm. surgery for 2 months after. This feeling I have now continues as a raw feeling or soreness on the outside but looking inside it is red and split. The outside looks like a cut. I have tried the nitro and I am now using diltiazem. Can you see a cut on the outside of your anus or is it further up in? I also had burning along with bleeding after my bms for the first couple of months after surgery so maybe you are just not healed yet. I hope you are feeling better. Let me know if I can help.


Ibp35- I don't have a cut on the outside that I can see but I have one futher up inside like right past the opening of my anus. I really don't know how to explain where it is. I have really no pain after my BM's that is why I really don't want to go back to surgery, I just feel like why should I make things worse then what they are now. I just have bleeding after my BM's and before like I said to Tammy the first push to get things going. I am going to try what Tammy said and take another colace and see if this helps. So I read in your first post that it has been two months for you! I can't get over that you are still having blood too but like Tammy said it is going to take time. I am not at the point that I think it will take at least four months to feel better and have no bleeding. If I am still having bleeding I will then have the doctor take a look but until then I am going to give myself sometime. Thank you for your help and continue to heal and stay in touch, please let me know as well if I can help but as you can see I am the bad one:) I do everything wrong... Take care.
16th November 2003
wjpjr,

I too had bleeding just at bm and on the tp at 2 1/2 months. The bleeding just stopped at 3 months. I continued my sitz bath(in warm water)to help with the burning but that has since gone away. The diltiazem i'm using is exactly what you said. It is used to treat heart problems. I am using it in a cream form though, to relax the muscle in my rectum to allow the fissure to heal.So i'm praying this helps!!! No more surgery for me. Thanx for your reply, let me know if I can help!! Praying for a quic recovery for all of you!
18th November 2003
Tammynoska,
I understand what your saying about my mental state, I am trying so hard about being positive about my fissures. I have seen a colorectal surgeon and she gave a diltiazem (calcium channel blocker). I have being using it for two weeks and have not seen any results. Is the rx you used to treat your fissures stronger than that? I am also using vitiman e on the visible cut on the outside. I try everyday to be positive and read everything I can on the surgery (for fissures) but everything I read talks about incontinence as a side effect. It scares me to death! My fissure is not that painful, I don't feel it at all during bms. I can't understand why I can't get it to heal. It just feels like a open cut and sore to the touch. Did yours feel like that too or did you have alot of pain with bms? I have also heard there are side effects with the botox injections, which my doctor wants to try in 3 weeks if the diltiazem does'nt work. I don't know how to think positive anymore, I don't know how you do it. I have prayed so hard for this all to end. I know taking drugs for depression is not the answer but sometimes I can't even sleep at night because I am so upset. Any advice you can give will help! I'm sorry to ramble..... thanx!
18th November 2003
lbp35, first of all you have to rethink the healing time it takes for fissures. With medication, it takes an average of 2-4 months. Here you have tried something for only 2 weeks, and you are distressed your fissure didn't heal. You have to stop thinking of your fissure like a regular cut that heals in 7-10 days. That doesn't apply to fissures generally.

Second of all you NEED to read this file:

[url]http://www.facs.org/spring_meeting/gs06oliver.pdf[/url]

It details the prescription med I am using call nifedipine you asked me about, and gives full details about how long it takes to work (average 2 months), and how effective it is versus other treatments, including surgery.

Education, lpb35, you need education on what you are dealing with.

Next you need to stop the vitamin e oil pronto. Vitamin e oil can cause increase bleeding, and studies have shown it not to help scars soften...but, most of all, vitamin e oil therapy is meant to apply to scars---scars, not open wounds. It has been shown that ointments, like the over-the-counter antibiotic ointments, can slow down healing considerably. Putting an oil on it can also slow down your healing.

I suggest you first rethink what is a normal time it takes for ANY therapy you use to work effectively. 2 months minimum. I never used the diltiazem, and haven't heard about using this for a fissure, so I have no comments on it. Why your doctor would give this to you to heal a fissure, I don't know.

I have to tell you that that nifedipine cream has given me good results in 2 weeks, but it is meant to be used for 2 months to really get rid of the fissure. I think that study above also compares botox to nifedipine and shows the nifedipine to be more effective.

If I were you, I would ask your doctor to prescribe the nifedipine cream at 0.2%, and give it a real try for 6-8 weeks. You use it 3 times a day, putting in a pea-size of cream each time. You absolutely do NOT rub it into your fissures, or rub your fissures at all, as this rubbing can reopen your fissures minutely, slowing down healing. You just dab it on.

My new cut I got last week doesn't hurt with bms, and no longer feels sore, because I think it is responding well to the nifedipine. However, I also make sure not to touch, prod, poke, or stretch my cut at all, as I know these actions can pull it open and slow down the healing. You should stop doing that too.

Finally, you can't get your fissure to heal like a cut; you can though, get it to heal like a fissure, which usually takes 2-4 months. No matter how much you try, you will not get it to respond like a normal cut and heal in 7-10 days. Relax, change your frame of healing time reference, and give the nifedipine a try.

You will have to find a pharmacist in your area that can compound this for you, because it doesn't come readily available and has to be made. It cost me $45 to have a tube made; I don't know what your pharmacy would charge, you have to ask.
19th November 2003
[QUOTE]
I never used the diltiazem, and haven't heard about using this for a fissure, so I have no comments on it. Why your doctor would give this to you to heal a fissure, I don't know.
[/QOUTE]

This is interesting. I saw the surgeon I had my second opinion from back in October. I went because the appointment was a day earlier than tomorrows. Back in October he said everything looked fine even though I was complaining about like sitting on glass and standing with a broken bottle shoved up my a%ss. Well today he said I have a really big fissure. I still believe there are two but he only spread my butt cheeks a little and observed the big post-anterior one. The other fissure was diagnosed as being anterior by the surgeon I saw last week. Since he did not perform an inside look I suspect that is why he didn't see it. I brought up the use of nifedipne ointment but he has not use it. He prescribed the same diltiazem 2% cream lpb35 is using. He indicated only a 30-40% healing success rate :(. He did think I should see some relief. I suspect more surgery will be needed down the road. My minor problem has just tuned major with a capital M. Its really going to be hard coming to grips with yet more surgery and starting this cycle all over again. The diltiazem has to be compounded so I won't get it until lately today from the pharmacy.

Now the big question. Should I keep the appointment tomorrow with a surgeon known to use nifedipine? Or should I give the diltiazem a chance?

How do you manage to stay active and keep off your butt while you heal your fissures? Mine might be a little worst than yours because I'm in constant pain and agony. I use to get a little relief at wake up but even that has all but diminished.

My advice for anyone contemplating surgery for hemorrhoids is "tread lightly with extreme caution". You may end up with more problems than you began with. I have never had fissure problems in my life. But now I end up with two.
19th November 2003
wjpjr, I know what you mean, I have never had a fissure in my life until I got the hem. surgery. To think about another surgery is devastating to me. The diltiazem as worked very little so far if at all. I don't understand my fissures though, because i don't have pain during my bms or after. I don't have the broken glass feeling you describe just it's very sore to the touch and the cut is visible on the outside. I don't feel like I'll ever be better again. Surgery fo rthis scares me because of the risk of incontinence. Did you doctor suggest anything else? I have an appointment with a doctor who does laser surgery on fissures, but my consult is'nt until jan. I am also using vitiman e on the cut. Hope this helps.
19th November 2003
Tammy, Thanks so much for the info on healing time for fissures, I guess you were right and I was treating this like a regular cut and trying to speed it up. I know I need to quit pulling it apart and looking at it every day also that it so obsessive and I'm sure it won't help my healing. I keep thinking if I look i'll see some healing. My colorrectal surgeon says she always uses the diltiazem for fissures, should I try it first for a few weeks and then call to see if she'll switch to what your using? Also the vitamin e came from a doctor who does laser surgery on anal fissures, do you really think it's a bad idea to use it? I am desperate, I'll try anything????? Thanks so much for the info on healing time, I keep thinking I should have some results by now, but I guess I was wrong. I'll try harder to change my attitude about it. thanks again!
19th November 2003
Quote from anitraw:
Walt- How are you doing? I have not heard from you in a while and I was just wondering how you were healing... Well I hope you are getting some rest with your time off and hopefuly less pain. Take care and I hope you are ok.


Anitraw,

I'm still here. I went to a surgeon today (see post). I've been struggling in constant pain and discomfort. I'm not even getting the little 20 or so minutes I had been getting after waking and before my daily BM. My butt starts aching right after getting up. I'm trying this diltiazem 2% cream lpb35 is using. I don't have much faith in it though since it only has 30-40% healing success rate. It was specially compounded with 2% lidocane so maybe I will get a little numbing effect. I'm fearing more corrective butt hole surgery once I see the surgeon again in a month. That is going to be difficult dealing with mentally. By this time I expected to be recovered not expecting more surgery and starting over again.

If I could take this surgery back I would in a heart beat.

I hope you are doing better. Take care ...
19th November 2003
lpb35. yes, I think it is a bad idea to use the vitamin e. First of all that is why my last hemorrhoid bled so badly, because I used vitamin e oil on it, and it caused me to have super bad bleeding, and for the other reasons I told you. And just think about it: why would a doctor who does laser surgery on anal fissures recommend vitamin e if it worked and kept new patients coming to him for laser surgery? I think because it doesn't work, and he feels confident you will come back.

And for the same reason, I wonder about your surgeon giving you a drug that has poor track record of healing fissures? Again, in confidence you will come back for surgery and bring money to her that way?

If you think you won't get discouraged trying that diltiazem for a few weeks, then give the nifedipine a try, then do it. I just don't know why no one here is bothering to try the nifedipine. My new cut no longer even bothers me, and that is just after 5 days of using the nifedipine. I plan on using it for a month, but I have had fantastic results with this.
20th November 2003
Tammy,

I kept the appointment today with yet my fourth surgeon. He didn't offer any quick solution to my problem. After reading over my operative report he concluded the surgeon may of done a four quadrant hemorrhoidectomy. He thought this might be the reason why I now am dealing with fissures. He indicated maybe to much lining (skin) was removed therefore preventing total wound closure. He would never perform more than a two quadrant surgery for that reason. He thought my surgeon might be a little inexperience as a reason why I had four quadrant surgery -- finally a doctor willing to speak out against another.

He gave me a script for the nifedipne. It's now being compounded and I will have it in a few hours. His opinion of diltiazem was not to high. If I don't heal within 3-4 more months (6-7 months normal healing) I may be facing anal plastic surgery. Basically they would need to perform a skin graft to close the wound(s). The though of that is pretty damn scary. As is the prospect of 3-4 more months of healing in my current state. I'm hoping the nifedipne helps me heal. He offer some hope. He also thought I should be doing two warm sitz baths a day to promote blood circulation (healing). I'm kind of apprehensive about sitz baths. My feeling is they promote bleeding. Any thoughts?
21st November 2003
Tammy, I'm having a little difficulty judging the right amount of nifedipine. The first dose I apply last night gave me a moderate migraine. The migraine could of been coming on ayway -- hope so. I cut back a little when applying the bedtime one and this mornings. I did not get a headache but I'm not sure I yet have the right amount. Unfortunately, the container the pharmacy placed it in was not a tube like the diltiazem the other pharmacy did. I'm trying for the bb size. The first time I dabbed my pinky finger into the ointment to gather up a little. With the next applications I used the wooden end of a q-tip to dip in and dab that on my pinky finger before gently dabbing on my butt area. What's your technique? Do you get in your three ring circus position like applying gota kola?
7th December 2003
Quote from anitraw:
Walt- I am glad to hear that you are going to have some time off I think that you right about it being a blessing. I hope that with this time off your fissures start to heal up and you can start to get on with your life. I hope you have a nice holiday and can enjoy some of the food and fun. Take care.


Anitraw, Boards seem to be very quite all of a sudden. That means either others are getting better or loosing interest. Unfortunately, I don't seem to be getting any better. The one fissure I'm battling has tuned into to a very painful ulcer. This is right on the skin leading into my butt hole. Because of the location it becomes extremely difficult to sit and even stand. Neither of the ointments diltiazem or nifedipine have helped much.

I start to see each of the three colo-rectal surgeons this week. Not sure what they are going to say or do but living in my current condition is a living hell. I doubt I'll be celebrating the holidays this year. It's a struggle just getting through each day. I'm afraid more corrective surgery is in my future :(.

I hope you are doing well and soon will have yours behind you. Take care ...
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