Patient 13

Patient 13

Date: Mon, 21 Apr 1997

I suffered from an anal fissure for about three years. My story is pretty similar to the others on this web page. I think I did have a little different experience in my various treatments though. I went to my family doctor for this thing, and was referred to the surgery center in our HMO. At first, I thought I had a hemorrhoid protruding, but in actuality what was protruding was the skin tag of the fissure. My family doctor missed the diagnosis too. I was seen by a physician's assistant at the surgery center. He said the course of treatment would be to start with conservative measures, which consisted of high fiber diet and stool softeners. We tried this for a while, but the fissure did not heal. Next thing to try, he said, was dilation under local anesthetic. He also wanted to do a sigmoidoscopy to rule out any other problems, because I have a family history of colon cancer.

I'd like to mention a few things about the dilation experience. Apparently, the idea is to stretch the sphincter muscle, reducing hypertonicity, and allowing the fissure to heal. It's not a very common procedure in the U.S., but it is used more frequently in the UK My HMO uses it. Over the course of my fissure experience, I never found any doctors outside my HMO who used it or recommended it. I had my first dilation done in the office by the physician's assistant mentioned above. They gave me Versed through an IV, and numbed the anus with 4 injections of local anesthetic. Then he just shoved something up there, I never did see what it looked like. I took about three days off from work and felt OK after that, but my anus was still tender. The fissure did not heal, so I went back, and got scheduled for another dilation. This time he did a number on me. I remember a funny noise when he did it and looked down,( I was on my back with my feet in the stirrups), and saw he had a handful of bloody gauze. He tore the hell out of me. When I got home I was in agony. It was then I discovered a big thrombosed hemorrhoid sticking out my anus. I went back a couple days later and another P.A. fixed it by removing the clot. That help a little but the fissure was bigger than ever. I didn't really realize at the time that the guy had screwed up. They just kept telling me it would take time to heal. Three months of hell followed. Constant pain, spasms, disrupted sleep. I could have killed that guy. I just wanted the damn thing to heal up and go away.

Looking back, I was really afraid of the surgery because the PA had told it really was the last resort and there was significant risk of incontinence. I wish I had had the sense then to get a second opinion at that point. Pain was driving and distorting my thoughts. Finally the damn thing healed up for a while. I just kept thinking that if I could keep my stools soft, it would not come back.

Well it came back. This time I scheduled an appointment to see the surgeon. Can you believe it, she wanted to dilate me again. This time under general anesthetic. "Its not effective using a local", she said. When I asked about what kind of pain I could expect afterwards, I got the non-answer "there may be some discomfort". Needless to say I was not impressed. I think many in the medical community do not understand the intensity of the pain a fissure can produce. The thing at that point was "in remission" as I called it, so I just kind of forgot about it.

Fast forward to last fall. I was going to school full time and working full time. The SOB showed up again. I gritted my teeth and got through 2 quarters and could not take it anymore. I made another appointment and told them I wanted a sphincterotomy and nothing else. The P.A. and the surgeon I'd seen before were gone. The guy I saw this time was real sympathetic and seemed really confident that he could fix the problem. At this point I didn't care about the risks. I was not going to go through the pain for the rest of my life.

Surgery Day

We arrive at the day surgery center at 10:00 a.m. The surgery is scheduled for 11:30. I change in to the gown that's open in the back and put on the bathrobe they provide. Then its off to the "pre-surg" area. The nurse hands me an enema and points me toward the restroom. After I make several trips to the bathroom, the nurse sets up my IV. Before inserting that big needle, she deadened the area with some lidocaine. There was no pain when the IV needle went in. The pre-surg area is kind of a zoo. The patient next to me has his wife and her parents with him and they are having a good old time. This makes me a little uncomfortable when I get up to go to the bathroom, the gowns don't cover much.

Finally the anesthesiologist comes in and we talk about the anesthesia. We agree that it will be a general anesthetic. He did offer me a spinal, but I declined it, having no desire to be awake during the procedure. The OR nurse came and got me for the short walk to the operating room. This was the time I was most frightened. I laid on the table face up and told the anesthesiologist I was really stressing out. "No problem", he says, and a few seconds later all my problems went away, thanks to a little Versed in the IV line. Soon I was joking with him and the nurse and everything was funny. Then the lights went out. The doc performed a lateral internal sphincterotomy, and also removed the skin tag. He did not perform a fissurectomy. He told me during the consultation that he never does that procedure.

Next thing I remember was waking up in the recovery room. I wasn't in any pain at that time. The nurse said the doctor had injected the area with local anesthetic so I could comfortably make the ride home (a 40 minute trip). The nurse also gave me a shot of Demerol and a bottle of 30 Percocets.

All the way home I was thinking that as soon as the local wears off this thing is gonna hurt. We got home and I climbed into bed. I dozed a little and just basically laid there. I was pretty loaded from all the drugs. When the drugs started to wear off a little I got up and got in the tub. I'd had difficulty urinating (because of the narcotics I'm told) up till then, finally I went. Still no pain. Oh, except I could not sit. Then I ate a few crackers, brushed my teeth and crashed for the night.

Day 1 Post Surgery

Woke up and took a couple Percocets and started drinking water. The nurse at the surgery said to drink a lot of water, as the pain meds will really constipate you. So I drank about a gallon. Pain was virtually non-existent, except when sitting. Even that was getting better. Spent the day just kicking back. Had some drainage, but not real heavy.

Day 2 Post Surgery

Slight amount of pain sitting and getting up. Had the first BM in the morning. No big deal, thanks to the stool softeners and the water. I keep thinking something's not right, I thought this was supposed to hurt. Less pain than on a good fissure day. Still having some drainage.

Day 3 Post Surgery

Still no pain. Well almost none. Had a pretty firm BM and that hurt a little. Climbed in the tub for a while and felt great afterward. Now I'm beginning to feel a little guilty about taking two weeks off from work. No, I don't. I'm not going back till this thing is perfect.

Day 4 Post Surgery

Wife and I ran errands all day. Haven't been able to sit in the car that long in months. I have absolutely no problem controlling when a fart comes out. The Doc said that could be a problem. Still a little drainage.

Day 5 Post Surgery

Went grocery shopping. No problems. No pain.


Its early in the game still, but for the first time in a couple years, I have my life back. I no longer have to schedule everything around the morning bowel movements and the subsequent hours of pain.

I hope that you will see the mistakes I made and learn from them. Here's some advice:

This is the visit to this page since 23 April 97.
Last modified: 23 April 97, back to home page.