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   Should I get surgery for my anal fissure? (Bowel Disorders board)

14th June 2007
I just wanted to chime in here with a bit different experience. Two months ago I thought I was going to have to have the surgery because I was so miserable with a chronic fissure. I had what felt like a huge inflamed tag that was the most painful part of it. BM's were not that bad...I do kind of remember a discharge some days, if this makes you feel better to know you're not the only one. I've tried a lot of things. The two main things that I believe had made a difference are the prescription nifedipine cream and taking Miralax. For me, excess fiber was not a good thing, but the miralax has really helped. I'm to the point now where I'm pretty comfortable, comfortable enough to not risk surgery, though I know from my reading that this could change at any time and I could be headed back to the butt doc. Good luck, Lynn
3rd July 2007
qball

i am glad you finally doing you surgery i had both procedures done and you
will be fine its a lot less painfully then hemmriod surgery and you will recover
more quickly. make sure you have soft propelling bms load up on co lace or
miralax till you feel its okay.the worst thing is impacting your stool.eat
veg soups,lots of water ,teaspoon of flaxmeal with mangoes in blender.
no breads,junk food or nuts. stay semi liquid for two weeks and add solid slowly.make sure its done by a board certified colorectal surgeon.

good luck you will be happy after you heal and live a normal life again
21st July 2007
i had a harmonic scalpel hemorhoidectomy, 4/23/07, for external hemorhoids. The general surgeon removed 3 tags, a pea size, 2 rice size. I NOW have a fissure at the 6 o'clock or unhealed wound, 1/2 inch deep in from the mouth, and 3 tags/roids- double its original size.

for the last 4 weeks, i've using topical ointment, diltiazem/channel blocker with anamantle, 3 or 4 times a day. I feel it's working but not quick enough and (I think) anamantle is weakening my tissues 'cause I bleed more when using that so i think i should stop using.

i've been drinking enough water, at least 64 oz, eating healthy - greens, plus 2 stp flax oil, 2 tsp benefiber, and 2 docusate sodium. my stools are good although a little hard when it first come out, and i don't know how to change that, making them all evenly soft, but i guess that it's normal for everyone. when the stool stay at the colon area the colon absorbs a little bit water, which cause the stool to get a little harder than the rest. I am training to have bm twice a day, AM and PM, which means I have to eat more than I should. other than that I am having Bm consistently on every AM but I still bleed only during bm, and the pain and spasm kicked. The pain subsided after 4/5 hr later.

I am seeing 2 colorectal surgeons and 1 general surgeon, and here are my surgeon's recommendations:
1. physical therapy - anal dilation? no clue what she will do!
2. anal advancement flap - re-cut the tissues and staple/stitch back together
3.cutting the tag to reduce pressure for the fissure to heal (suggested by the general surgeon) - most conservative method

i feel good with these drs but after the fiasco I experienced w/ the surgeon who operated on me i have difficulty trusting any dr again. I am going to do it right this time by doing my own research and ask questions with people who had gone through this ordeal. i learn from this healthboard that many drs do not tell their patients the truth, especially the one who operated on me. My goal is to find the RIGHT ONE to operate on me, but i am clueless on how to accomplish this.

so, here my questions:

1. I live in Orange County, CA, and I notice that there are many ABCRS certified surgeons, but what kind of question should I ask them without offending them?
2. Does any one know a referral in Southern California? I plan to join the local colorectal support group so I can get information from them but this will take time which will delay my plan
3. What should I do w/ the recommendations from my surgeons above?
4. in WATCHOUT's thread - all her dr. did was removed a tag/roid that run deep into her fissure, which caused the fissure from healing
5. Should I have the real thing by having fissurectomy, anal advacement flap, a substitution for LIS, where the dr. will have a small incision into the sphincter muscle helping it to relax? or should I have a full LIS procedure? what i fear is the side effects with the LIS. If I have incontinence my career is over!!!!!
6. Should I take the most conservative approach first such as recom #3

Every morning before having a bm I am pain free and didn't even know I have a health problem. In summary, I need to seal this fissure/unhealed wound so that it can no longer retear during bm, causing bleeding, inflamation to the roid/tag. i notice too that the biggest roid, a pea size, is located outside the fissure area. i can honestly say that i can live w/ the roids i have. i want the fissure and the bleeding to stop.

fyi...i was a healthy person and I didn't need a hemorrhoidectomy because I didn't go through any physical pain and my so-called problem then didn't cause me to have tear on my eyes. The reason I decided to have the hemorrhoidectomy was I am about to turn 40, so i want to take care whatever "problem" i have now and hope for the best in the future. Little that I am causing a BIGGER problem for myself. I can never imagine the situation I put myself in!!!!!

I know that my fissure is 90% healed and if i can stop the bleeding for a week I am confident that the bleeding will be gone. I 'tried to fast' for 3 days by eating only activa yogurt, dried prunes, and drinking water. What a mistake! I had constipation resulted doing that. right now I am clueless on how to make treat the final 10% of my fissure!!!!

I've been taking 1 or 2 docusate sodium daily, plus 2 stp benefiber for the last 3 months, and I stopped taking the DSodium las night because I am worry that my body might get used to stool softener medication, only 2 stp of benefiber yesterday - one at breakfast and dinner. My BM movement as of this morning is OK, still had the same bleeding!!! I am trying very hard to train my colon so i can have 2 bm a day, am and pm.

What are the side effects of taking Colace, docusate sodium, miralax? I took 1 stp for miralax for couple days before bedtime and I felt my body did not like what it is in miralax although it was doing its job, so I stopped.

Contemplating to go under the knife for advancement flap, LIS (to eliminate future recurrence of fissure), but before having the 2nd surgery, I plan on trying some of these natural/the unpoplar treatments in hopes to heal my AF/unhealed wound.

* Athlete's Foot Cream Tinactine
* Neosporin
* BF&C ointment
* Hamamelis and Zinc cream
* Wheat Germ Oil, Gotu Kula & Wheat Grass
* Lansinoh
* vitamin E suppositories and oil
* oil of oregano
* Hamamelis and Zinc cream

Many people healed their AF by using the mentioned home remedies above. I know in my situation is a little different because my problem was cause my mankind, not nature! but a crack is a crack, right?

Did anyone on this board have success trying these treatments? and what are the results?

What are the best way to train your colon so you can have 2 bm a day? what are the natural foods/fruits/drinks so i can make this happen? should i drink plenty of prune juice?

What would you do if you were in my shoes?

Please advise....
14th May 2008
Hi :wave:Mrspuff,
I've been suffering with a fissure for several months now.

There are several ointments available by prescription that will allow the area to heal and relax the anal sphincter muscle so it doesnt go into spasm so the fissure can then heal on its own. It may take a few days to a few weeks to help, could take several months to completely heal.

The next option is botox, which is injected to relax the sphincter muscle. This option could take a week to relax the area, and then several months to heal.

Usually the LIS operation is the final option after the more conservative treatments fail. I wouldn't want to have the operation first, since there is a slight risk for uncontrolled gas and/or stool. This risk may be up to 10% depending on the study you look at.

It is very important you keep your bm's soft and moving. Some take milk of magnesia or miralax and also some type of fiber (metamucil, benefiber or fibresure) if there is a problem with hard stools. Definitely ask the Dr. what he would recommend for you.

Hope you get some good advice from your Dr., you may want to be seen by a colo-rectal surgeon (CRS).

Best wishes for a speedy recovery. :angel:
7th June 2008
Hey,
Sorry things are healing slowly for you and you still have lots of pain.

I never had the surgery for fissure but the hemmoroid surgery which was extremely painful. That area seems to heal very slowly and there are alot of nerve endings there. I did have the spasms though. It is good that you do not have the spasms anymore, you now need to heal from the incision and fissure. You should have less pressure in the anal canal now which should allow the healing to progress. The pain should subside some every day, hopefully a week from now you will see some definite relief. I know the pain seems non ending while you are going through it. Hot baths after bowel movements helped a little, although not enough. Pain pills are constipating, it seems darvocet is less so than vicoden and others. Miralax daily seems to help me alot to soften bms and help things move along for me. Fiber is also important to me.

Hoping you have relief very soon.
12th June 2008
Hi AMW,
Sorry to hear about your setback...I've been there.

Are you taking any stool softner? I was told it is VERY important to keep things really soft or you can have a set back. Hard stools are painful and set you back to start healing very slowly again. Milk of Magnesia and/or colace helps many, I like miralax.

How about extra fiber? I think you need extra fiber in your diet unless you are getting lots right now. Most people do not get the fiber they need. Add fiber supplements gradually because they can cause gas. I take one dose of metamucil daily and also some type of fiber I add to drinks and also my oatmeal/flax. Make sure you drink lots of water, otherwise fiber can cause constipation.

It takes a long time to heal a fissure. Even when you feel it is better you need to be cautious and continue with a good diet and treat your butt like it still has the fissure. I have used the ointment now 3 months. Once you have a fissure it may take up to a year for the tissue to gain its strength. The tissue/fissure area is very sensitive and can re-tear easily.
13th June 2008
Hey AMW,
Hope you feel like you are healing again.

There is a few different types of fiber that you can put into your water bottles. Some are sold by the drink mixes, they flavored and have 3 -5 grams of fiber. Kellogs has the Special K0 protein water mix, and they also have a Kelloggs fiberOne mix, althought I can't find that one at my store anymore, it had like 8-9 grams of fiber!. Crystal Light also has one called live & active with fiber. They are flavored with lemonaide, strawberry kiwi, green tea, etc.

There are also clear fiber that you can add to water with no taste. I believe benefiber make some in little packets that you add to your water bottle. This is sold by the laxatives.

I'd start with 1-2 servings of fiber and see how that affects you.

I take miralax in my coffee every day or two to keep things moving for me and soft and it works great for me. I only go once a day, usually in the morning, but not always. Don't really have any tips on how to go in the morning but if you search I am sure you can find tips on how to do this.

I know others take the colace (stool softner). I tried this and quit because it didn't seem to help me.

Lifting is supposed to be kind of tough on your bottom area cause it could contribute to hemmoroids (maybe fissures also? not sure).
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