Waiting

Here is why my doctor wants me to wait:  

Surgical therapy is usually reserved for acute anal fissures that remain symptomatic after 3-4 weeks of medical therapy and for chronic anal fissures.

it's BEEN 3-4 weeks already, though.


A newer therapy for acute and chronic anal fissures is botulinum toxin (BOTOX®). The toxin is injected directly into the internal anal sphincter and, in effect, performs a chemical sphincterotomy. The effect lasts approximately 3 months, until the nerve endings regenerate. This 3-month period may allow acute fissures (and sometimes chronic fissures) to heal and symptoms to resolve.[7] If BOTOX® injection provides initial relief of symptoms but there is a recurrence after 3 months, the patient may benefit from surgical sphincterotomy.[8, 9]

In a review of 4 prospective, randomized, controlled trials, Shao et al concluded that surgery, specifically, lateral internal sphincterotomy (see Intraoperative Details), is more effective than BOTOX® treatment for healing chronic anal fissures.[10] In their analysis of the studies, which involved a total of 279 patients, the investigators found that the absolute benefit increase rate was 23% for the surgical patients in comparison with the BOTOX®-treated patients, with BOTOX® therapy associated with a lower fissure healing rate and a higher recurrence rate than was surgery. However, minor anal incontinence occurred more frequently with lateral internal sphincterotomy than it did with BOTOX®.

I read that the people who suffer the most are those whose sphincter muscles spasm, which I think is what happens with me.



It doesn't happen with everyone, and I do not know what makes the difference.

This information (minus my comments) came from here.

RECTIV

How to use RECTIV
from here.

Rectiv, or nitroglycerine ointment, "is the first and only FDA-approved medicine for the treatment of moderate to severe pain from chronic anal fissure."  There is a limited amount of somewhat useful information about anal fissures relatively easily found on the site using tabs.

However, this ointment's sole task is to treat pain.  Symptomatic relief.  I want something that will heal the problem, make it GO AWAY!  I DO want the pain to stop.  But jamming a finger up my butt and wiggling it around when it's in so much pain already doesn't seem like a good way to heal it.  :-(

I read that some people can't take the side-effect headaches.  (I have not tried this, so I cannot report about the headaches.)

broken glass

YES!
:-(
this is from here.
click image to view larger

Yesterday and the day before were terribly bad. I feel slightly improved so far today. Not well enough yet to do my exercises or prepare and eat breakfast (at 10:24 AM).  But I'm not in the agony I was in yesterday so far, knock on wood.  Unfortunately, I had too much pain last night to sleep until after 2 AM, the first time it's been that bad at night.

Pain

Pain
this is a digital painting by me

How much pain can a person take?

NO, really, the question is, how much pain am I WILLING to take?

It is 11:27 AM, I have not had breakfast because I've been sitting on
the heating pad. Little by little, I've been doing my exercises. I
have to stop in the middle sometimes and seek relief--a hot washcloth
applied directly to my anus.

I finally decided I needed to eat and went downstairs to make
breakfast. I laid out the pan and get out eggs and vegetables, but
the pain was too much for me. I am back up on the heating pad,
without having actually started breakfast.

The pain was too much. (I am at my lowest weight in several years.
This is a good thing, but the pain and hunger are not.)

I have become an invaid. I can't go anywhere, do anything. I am
canceling appointments, classes, activities. I feel sad.

What the doctor said

I had my poetry class tonight and waked at St. Clair Park between the doctor and the poetry.  

So I didn't have time to write about what the doctor said.

I was disappointed in what he said.  I was hoping for an easy solution.  Nope, no such luck.

I wrote about this in more detail on the Psion, which I will download as soon as I can, but not tomorrow, maybe, because Keith has his colonoscopy.  I have to be there to drive him etc.

Here are my options, briefly:

1)continue to endure and hope for the best.  No heavy duty painkillers.  The body, he says, will heal.  But when?  It's been a month.  

2)get shots of botox in the anus. 70% chance of solving the problem.  Must be done at hospital under anesthesia. 1% chance of anal incontinence.

3)have an operation.  95% successful.  1% chance of anal incontinence.  VERY PAINFUL, long recovery time (2 months of pain, no heavy duty painkillers allowed.)

I opted for part one.  If it continues to worsen or becomes unendurable, I will try 2. If that doesn't work, then 3.  Like I said, I was hoping for something better.  A better medication, for example.  Something more healing.

My pain was bad this morning, subsided some in the afternoon (with ibuprofen) and subsided more in the evening (with more ibuprofen) and right now hardly hurts, only a little.  BUt the cycle starts over every time I poop--and I only pooped once today, very early.

I saw baby owls in the wild at St. Clair park today, got a very good look at them, no camera though.

Questions for Dr. Barbe

Anal Fissure Again:  L

After being free of anal fissures since I last saw you, I contracted, in the last week or so of March, an intestinal “bug” that caused fairly severe diarrhea (“squirt poops”).  My husband Keith also had diarrhea at the same time.  I had six days of diarrhea and my butt was getting sore.  I’d been avoiding taking anything for the diarrhea for fear it would cause constipation, but after about 5 days, I decided to try Pepto Bismo—in small doses.  I took a half dose after several attacks of diarrhea and the next thing that happened was terrible constipation and an anal fissure.

Anal Fissure Questions:

Ø  What dose of Canasa?  I am currently taking 1000 mg as prescribed by Dr. Beeai.  It is NOT working.  It improved from the beginning, but there has been NO FURTHER IMPROVEMENT and I have been on it for 18 days.

Ø  Am I doing something wrong, or not doing something right?

Ø  (Why did it work last time but seems to be not working this time?)

Ø  Dr. Beeai said not to push or strain when defecating, but IF I do NOT the feces come into the rectum, stall there, and do not come out.  They just stay there hurting, and eventually, they retract back in.  This happens over and over multiple times until I find myself inadvertently pushing even though I’m not supposed to.  L

Ø  Should I be taking a stool softener?  If so, what kind?  What about bran?  The stool softener Dr. Beeai recommended seems to give me a bellyache.  (This bellyache happened twice, but has stopped now. ) (Even flatulence hurts, and there isn’t anything much softer than gas.)

Ø  Is bran hurtful or helpful?  If hurtful, how do I wean myself off it without causing severe constipation?  I started taking it after the last event to keep the stools soft for fear of causing another anal fissure.

Ø  What should I do to properly care for my anus, rectum etc and promote healing?  What regimen should I follow?  Do you have a sheet of recommendations to follow?

Ø  Should I use any other suppositories during the day such as Preparation H?  Would it assist healing or impede it? I have been, but don’t know if I should.

Ø  What about externally?  Prep H, an anesthetic ointment, diaper rash ointment? Would it assist healing or impede it?  I tried using it, and then stopped, not knowing what to do. It seems to burn, as does the Lidocaine ointment, which I do NOT use (because it increases pain).

Ø  Should I use a sitz bath? (Dr. Beeai recommended I do this, and I have been).  A hot pad?  If so, for how long and how often?

Ø  What about painkillers?  Ibuprofen?  Acetaminophen? Or?  I’ve been taking Ibuprofen. 

Ø  Is there any way to prevent this from happening again?

Ø  I read that one should not ignore the urge to defecate.  I read that that doing so can cause constipation over the long-term.  But since I’ve had this anal fissure, I feel like I have to defecate all day long.  Then, when I get on the toilet, either nothing happens or only a little comes out.  So I find myself sometimes ignoring it (since I’ve had this anal fissure) so that I am not on the toilet all the time.  L  (I do not normally have a problem with any of this when there is no anal fissure.)

Note to self later:  The doctor did not even glance at this.  NEXT TIME, if there is a next time (I hope there isn't), make a brief outline of trigger words for myself.

Butt Report 4-23-13

I walked to the library yesterday, after five in the afternoon.  I only pooped once yesterday, early in the morning, and by 5, the pain, while still present, had subsided to the point where I could walk, with two ibuprofens.  (The day before, I pooped 3 times--awful! )  (It felt as if someone was pinching me--hard-down there-with every step.)  When I got there, I sat on the wall in the sun and the heat of the sun-warmed wall soothed my butt for the walk home.

Keith is fasting today for his colonoscopy tomorrow mornings and I am worrying terribly about the pain of my being there--I am required to be there.  My mornings are torture.

Today I am going to the specialist--it is NOT the same doctor I went to 2 1/2 weeks ago.  That doctor, my GP, gave me NO instructions, other than to take the suppositories and a stool softener.  She said to take them for 15 days unless I had a relapse--I'm still taking them--I didn't have a relapse because I didn't get better.  OH, and she also said not to push when I defecate.  Impossible.  If I feel a poop coming on, and sit on the toilet, it moves into my rectum, which hurts like mad, and then hangs out there.  It sits there and sits and there and sits there and doesn't come out until suddenly I can't help pushing.  I've really tried hard not to push, but it NEVER works.  The poop won't come until I do.  I've tried waiting 15 or 20 minutes.  If I wait too long, it retracts back up inside and then 5 minutes later, I have to go again.  Meanwhile, I had 20 minutes of pain.  I have pain all day, but the pain of pooping is worse, a lot worse.

But I have a whole BUNCH of additional questions.  I am wondering, for example, of the GP gave me the same DOSAGE as Barbe gave me last time (2 1/2 years ago, or whenever it was.) 

This is painful, I am sitting on a heating pad which only partly relieves the pain.  For the ten minutes after I pooped, I was crying.

But THAT last time was worse, verging on unbearable.  JUST terrible pain.  I don't want to go there again.

The Red-hot Poker

The red-hot poker
This is not my image.
I got is here.

OK, I admit, it is a BIT of an exaggeration.  But I couldn't find a red-hot poker at the exact correct degree of heat.  So, imagine jamming that thing up your butt.  (Only not QUITE that hot!  (HOT, but not THAT hot!))  That will give you an idea of what an anal fissure feels like--to me.  Especially while pooping and for a good hour afterwards.

I had a perfect exercise day yesterday--though I was in so much pain that it took all day to get the exercises done. I did get a little extra walking in, but not a lot. Today I lept up and did the exercises as fast as I could before I pooped.

I had just barely got them done when I pooped. My pain and bleeding was worse than yesterday, which was worse than the day before. I sat in the tub for 42 minutes and had to leap dripping out to poop a second time.

I am embarrassed to say that I howled so loud from the pain I was afraid someone would call the cops.

(I am really ANGRY at that receptionist who not only wouldn't let me come in to see Barbe, but also wouldn't even lat me talk to him on the phone.)

Then I sat in the tub again, and now I am sitting on the heating pad. I took two acetaminophens. NOTE, in case I haven't previously mentioned it, you can't take codeine-based pain pills--they worsen the problem.  (Something is worsening MY problem even though I am NOT taking codeine-based pain relievers.)

Keith is at work. He, ironically, has a colonoscopy scheduled for April 24 with Dr. Barbe (My proctologist). He is now on a special preparatory diet. He is pleased because he can have mac and cheese and beer for three days, then beer the day before the event. I am worried because I have to take him for the procedure in the morning when my pain is at its worst, and when I may have to poop without access to a tub etc. I don't want to be sitting there screaming and howling in pain. I do not want to be without access to something that helps soothe the pain.

First and most important, I want to heal from this terrible pain. I hope on Tuesday at 2:30, Dr. Barbe will be able to help me.

Red-hot Poker Plant
This is not my image.
I got it here.
THEY got it here.

When I was looking for an image of a red-hot poker (a real poker), I kept finding instead the red-hot poker flower.  Unlike reporters from the Miami New Times, I DID know there was such a flower.  This plant is pretty, but does not have the power to evoke the pain I am experiencing.  My pain is somewhere between the image above and this.  Maybe halfway between, or slightly more toward the actual poker.