I'm writing to let you know about anal fissures from a spouse's/significant other's perspective: they are a huge pain in the butt! (you can use "they" to mean the patient OR the anal fissure as you like!) Our story( I say "our" because it is not only the patient who is involved in this quest - the whole family becomes involved when all conversation shifts from its normal mode to queries about assholes, farts and BM's and pain levels) began when my husband's back went out while playing his best round of golf ever (at least he has that to look back on). A visit to the primary care physician yielded not much more than an appointment with a physical therapist, muscle relaxants and a prescription for Tylenol with codeine and the advice to take a lot of the pain meds to manage the pain but no warning about the constipating effect of the meds. The result was that the back pain was shadowed by a new and even more debilitating pain in the ass! This must be the theory of acupuncture because my husband's leg went numb and he didn't even think about his back pain! He started using Preparation H, Anusol, and even soaked a Tucks in witch hazel and held it between his cheeks all day. He had a lot of bleeding with his stools and unbelievable pain! After 2 days of nearly passing out while driving to and from work ( he came home and collapsed on the floor and crawled into the bathroom for a Sitz bath!) he decided he couldn't work until his hemorrhoid was cured. He kept an appointment with his primary care physician for his back and when he told him about the rectal bleeding and the acute pain was told that he had a 'roid without so much as a look. Meanwhile the kids and I are thinking that he must have an extremely low tolerance for pain and I even made remarks about how lucky it was that women had to endure the pain of childbirth because there would be no babies born if it were left to the men, etc...... I brought my husband to the local convenience care center (of course these things flare up the most on weekends) where the doctor on duty told him that he had more than a 'roid and that he had never seen anything like it - he suggested Nupercainal and other than sympathy didn't offer anything else. We waited out the weekend and on Monday I tried to make an appointment with the primary care physician's office but they were booked solid. I tried to make an appointment with a colo-rectal specialist but found the "self-referring" clause in our health insurance contract meant we had to wait 4 weeks for an appointment unless we were referred by the primary care etc.... our only alternative was to visit another urgent care center. Finally we found a doctor with a diagnosis - anal fissure - and got a next day appointment with a colo-rectal surgeon. Now that we had a diagnosis I did some research on the Internet and found your self-help page and all the links to the other sites: Eureka! A gold mine!! I printed everything and the pages became our Bible for the next 6 weeks. I finally realized that my husband wasn't just a pansy with a low tolerance for pain - that he was dealing with unimaginable pain!
We visited the colo-rectal surgeon the next day ( I say "we" because my husband was unable to drive himself anywhere but could lay down across the back seat of our mini-van and more or less tolerate the ride) - yes it was indeed a fissure and would probably need surgery but the DR. prescribed the nitroglycerin ointment to use first before making the decision for the surgery. We by now were familiar with the therapy because of your pages and were comforted that the DR. wasn't determined to operate and seemed more or less to be on the cutting edge of AF treatment!
Let me back up a little and tell you about my husband's daily routine - stay in bed as long as possible in the morning because he knew that he would have a BM (which he likened to childbirth) soon after waking and then 12 hours of hell dealing with the pain. He drew a Sitz bath which he seasoned with aloe juice or chamomile tea and paced the floor waiting (and dreading) the eventual pressure from his bowels. No more sessions with the newspaper while sitting on the throne...instead he locked the door and screamed and cried, cursed his primary care physician who hadn't warned him about the constipation, contemplated throwing himself off a building, prayed ... screamed some more and then finally a splash when he plopped into the tub...more crying as the after pain hit him. After an hour long Sitz bath he was able to gather himself together enough to walk to the bed and deal with the pain which he likened to alcohol burning on an open wound. The day consisted of bed to bath, couch to bath, bed to bath, couch to bath. We had no family life at all - in fact we had no life except trying to figure out what we could try next to alleviate the pain. The kids couldn't have guests over because their father was pacing around in a half naked state running to or from the bath...we won't even dwell too much on his crabby attitude and generally negative outlook on life and us and the world in general.
Armed with the Nitro cream we returned home and realized we weren't clear on how the stuff should be applied. We decided that it should be applied directly to the fissure yet his was so deep he had no means of reaching it without suppositories. He tried coating it on a Fleet gel suppository ( which he thought would soften his stools as well) - the result was not especially good. I e-mailed DR. Gorfine who stated that he should try more frequent applications (our Dr... said 2x's/day) and apply it mostly to the muscle. He experienced the headache but compared to the butt ache was not too much to deal with. Still not much change but we thought perhaps the result would be cumulative applications so were hopeful that time would heal. Meanwhile we tried each of the remedies listed on the self-help pages - hopeful that every new twist would bring the fissure to its knees. There was no way my husband could work through this ordeal - his job consisted mostly of out of town visits to company facilities throughout the US. He did manage to work though his company's cc:mail via a laptop he could operate while reclining (sitting was out of the question). He had to explain to his co-workers about his ailment (which was embarrassing at first) most thought it was his back problem that was preventing him from working ( an MRI made during his fissure hell revealed that he had 3 ruptured discs and one had fragmented and was resting on his sciatic nerve and would probably need surgery) but he didn't even feel his back problem anymore - that was manageable but the fissure was not!
He modified his diet, although by American standards his was already very high in fiber (he is European and I am American)...little meat, lots of fruits and vegetables, bran cereal and breads, he supplemented with Citrucil AND Metamucil (in case the Citrucil which tasted better wasn't doing the trick) and finally when I located it, Kondremil. He tried bitters, he spritzed aloe juice directly on his butt in addition to drinking some of the stuff and bathing in it. He was determined that Chamomile tea bags soaked in a little water and micowaved for 15 seconds, cooled and placed between his butt cheeks would be the answer (he found it soothed the pain but did not CURE the fissure). His BMs were softer but they were HUGE because of the increased fiber. I bought a little wire basket for the bathroom vanity for him to place all his creams and wipes etc. in which we could easily remove when guests came.
We had planned a vacation to visit my parents for their 50th wedding anniversary celebration across the country which was an unthinkable journey for my husband because he couldn't even imagine tolerating the 3 hour plane trip. The colo-rectal surgeon was also on vacation so the follow-up visit was delayed by a week. The kids and I made the trip, leaving my husband to suffer his plight alone. He'll probably hold this against me for the rest of our lives but I think we needed to get away from each other! Anyway, his routine continued more or less the same while we were gone. He ate lots of boiled potatoes and zucchini from the garden - he had a good day and decided the therapy was working and then the next day would be pure hell. He did the follow-up visit to the colo-rectal surgeon and found that the fissure had not healed significantly and would probably need the surgery after all. He scheduled it for two weeks in the future because I wouldn't be home in time for the first opening the next week (by the time he talked with me and I said I'd come home early the slot had filled!) He dreaded the surgery and hoped that by some miracle all of the therapies he was trying would come together and cure him.
We returned from vacation (had to take a taxi home because we arrived in the morning at that was the worst time of day for him) and found him having a pretty good day after his BM and Sitz baths. I prepared a REAL meal for him that night - lots of fiber, little meat and also pasta. The next morning his pain was terrible - as bad as the first day- and I was blamed for serving him pasta (I wished I were still on vacation!) He had his instructions from the DR. which included having a Fleet enema the morning of surgery. This worried him a lot so I bought an enema which he thought he would try (and by now a new patient history was on the self help page touting enemas as the way to recovery)...his BM was violent but much less painful (I think it was because there wasn't anything, not even fear that could keep that movement from coming). He even imagined that he could avoid the surgery by enema therapy (being ever hopeful as each new treatment is tried). He was able to get on with his day a little better because he could get his BM over with without pacing the floor and dreading it - but he still would have one good day followed by one bad day. Our modis operandi became to survive until the surgery the next Monday.
We arrived at the ambulatory surgery center fearful that the result could be incontinence but at this point feeling that it was worth the risk because we had no life at all as it was. The surgery was a lateral sphincterotomy and it went smoothly. My husband thought he was awake the whole time but when questioned couldn't remember anything about it. We went home and he was feeling fine - pretty high! The nurse suggested taking Percocet before the pain arrived in order to manage the pain. He took one tablet when the anesthesia started to wear off and another 4 hours later. Then the pain arrived and he took another 2 hours later - whoops! He started vomiting about an hour later and his pain was terrible! He took Advil which made the pain bearable but not gone. He continued the diet, though reduced the fiber supplements to one Citrucil, one Metamucil and one tablespoon of mineral oil. The DR. told him he should not do the enemas while recovering from the surgery. He had no BM the day following surgery (we came to expect this from the self-help page) and he was deathly afraid of the one that would come the next day. He took one Percocet in the morning before his BM and managed the pain the rest of the day with Advil. He was correct in dreading that first BM - it was a monster and hurt like hell! As was his custom, he jumped right in that Sitz bath and felt immediate relief! I think the Percocet helped him relax and made him more or less jolly during the waves of pain that would follow.
His pain peaked on the fourth day following surgery - I thought I would have a nervous breakdown because he was horrible to live with that day - so negative and yelling at me and the kids and completely self-absorbed!! Luckily our next door neighbor is a nurse and she explained that this was the worst of the post-op period and it should be uphill from there! And it was - he has sudden stabbing pains which are due to the regenerating of the nerve endings, he still has pain with his BM's (this is written one week after surgery) and some burning pain (especially late at night which used to be his BEST time of day before surgery). He is even able to fart without pain and without an accident! He takes frequent Sitz baths but I think and hope we can see the light at the end of the tunnel!
My words of wisdom:
Last modified: 27 Sept 98, back to home page.