Dear Jack,I'm a 40-plus woman who has had problems with fissures on and off for 4 years, and am trying to make surgery my absolute last resort. I'm fortunate enough to have a couple of physicians in my extended family, so experiments with prescription meds have been less problematic for me than they are for some folks. I can share a few experiences:
So -- hope I can help other folks out there. This group has definitely helped me, especially in exploring alternatives to surgery. Thanks for providing this resource!
Hi, folks! I haven't written in a while, but just wanted to update the story with my recent experience.
Since I last wrote, I've had a few flareups of my anal fissure. Usually, a few weeks of oral nifedipine, nitroglycerine ointment, or both has been sufficient to heal the fissure. That is, these things were sufficient until early October of 2006, when I first experienced the Flareup From Hell.
I knew this one was worse when neither nitroglycerin nor nifedipine made a dent in the pain or spasm. It started a month after my 50th birthday, when I needed to schedule a screening colonoscopy, and when the fissure persisted for several months, my physician suggested that a colonoscopy was not only a good idea for general maintenance purposes, but might help diagnose the problem. So he referred me to a gastroenterologist, who suggested that I try a few weeks of warm baths and Calmoseptine ointment to settle things down before he subjected me to a pre-colonoscopy bowel prep.
A few weeks of warm baths and Calmoseptine most emphatically did not settle things down, so my gastroenterologist referred me to a colorectal surgeon, who noticed that the fissure had split open all the way down to the underlying muscle fibers. The surgeon and I discussed the pros and cons of surgery vs. more conservative treatment, and I opted for Botox. So, in March, I got my first Botox treatment (ouch!) It helped for a few weeks, but when it wore off the fissure was most definitely still unhealed. Also, I was starting to have bouts of bleeding that lasted a day or two. This would make the fissure feel better for a couple of days afterwards, but the pain and swelling would always come back. So, in June, I went back to the surgeon for another round of Botox. He suggested that I might have an abscess, but couldn't see it with an anoscope, so we went ahead with the injections.
When I went back for a post-Botox checkup in August, the fissure still hadn't healed, and I was still having bouts of bleeding. This time, my surgeon saw the abscess right away. It turns out the fissure had led to a small fistula, which would drain periodically on its own but was clearly not ever going to heal by itself. So, I had a minor surgical procedure done in August to drain the fistula. We discussed sphincterotomy, but since one possible complication of this surgery is "urgency" and I was soon to take off for a three-week, hotel-hopping vacation in Italy, we decided to start with fistulotomy alone. This seemed to help, but about a month after surgery, while traveling, I hoisted my backpack to my shoulders at a train station and immediately felt as though I'd really torn myself a new one. Fortunately, I had sufficient pain meds with me so that this didn't ruin the second half of my vacation. Unfortunately, it only got worse after I returned home, and a quick examination revealed that the fissure was still unhealed and the abscess was back. My surgeon's opinion was that it would have happened, backpack or no backpack, because the spasms had returned, which prevented the fissure from healing and set up another infection in the same site as before.
So, in mid-October I had my surgeon do the triple whammy. First, a colonoscopy (no other problems found), second, a repeat fistulotomy, and third, a lateral sphincterotomy. Although any anal surgery is likely to leave you sore for a while, I noticed that I wasn't quite as sore after this one as I was after fistulotomy alone in August. After three or four days of the usual thrice-daily sitz baths, going to the bathroom in the morning was much less uncomfortable and I needed much less pain medication.
Three weeks after surgery, the fissure had healed completely. The site of the fistula took a little longer, and is still prone to minor irritation three months later, but good hygiene and a little Calmoseptine keep it under control. I do have some scar tissue left from the whole experience, which my surgeon thinks is responsible for the occasional irritation, but no other problems - no urgency or incontinence, no bleeding, no spasms, and, best of all, no significant pain.
In retrospect, I'd probably have had the surgery sooner if I knew how well it would work, but I'm also glad that I found a surgeon who was willing to work with me on less invasive options first.
Best wishes to everyone for a fissure-free 2008,