Patient 5

Patient 5

Fissure and fistula, no luck with Nitroglycerin ointment.

Date: Thu, 10 Oct 1996 12:57:50

Subject: Fissures

This is a great page for those people who have fissures. I am at home recovering from fissure surgery. I had the surgery on Monday (today is Thursday) and so far everything is going as expected. Let me give you a little history first.

About 18 months ago I had a swelling in my anal region accompanied by a dull, throbbing pain. I didn't think much of it as I thought it might be an infected hair follicle (being part ape doesn't seem to matter when it comes to fissures...). Over a period of two days, the pain kept building until finally at 3am, it was so bad I told my wife I was going to the emergency room to see what they could do. At the emergency room, I waited for about an hour as the pain kept getting worse. When I finally got into the emergency room, the two nurses happened to be mothers of kids who were on my son and daughters soccer team. Great, I thought, now I can moon two women I hardly know and will have to see them every week at soccer, oh well.... The doctor performed a digital exam and could not find anything other than some infection in a gland near the anus. He applied pressure to the area and was able to relieve the pressure by causing the infection (pus) to release itself. He then proceeded to give me a large injection of penicillin and prescribed amoxicillin to clear up the infection. After a few days of taking the medicene, and taking 3 or 4 sitz baths a day, all was fine, I thought....

About 2 or 3 weeks after the episode, I noticed pain during bowel movements and a strange lump near the anus that was tender to the touch and oozed a small amount of watery fecal material. Usually wiping several times a day seemed to keep things dry, but I still had pain during bowel movements. I thought that this was simply the opening up of the infection and felt that by use of sitz baths and keeping the area clean, things would get better. Was I wrong.

AFter trying various antibiotics (like neosporin) on the opening, things did not seem to improve. Not only that but flatulation was more difficult and seemed to result in a stereo effect and strange tingling. Jokingly I told my wife and kids that I was taking up a new profession and would bill myself as the "Incredible Stereo Fart Man". A few days later, I decided to go to my family physician, who after a quick exam told me that I had a fistula, and the only way to cure it was surgery. He then referred me to a colon/rectal surgeon, gave me more antibiotics, and prescripted more pain relievers. Since the visit to the surgeon was about 3 or 4 weeks away, he felt any infection would be gone. About 3 or 4 days after visiting him, my psiatic (sp?) nerve decided to act up, leaving me in pain so severe I could not sit, walk, stand, drive, or do anything. I called the doctor and left word with the nurse that I was having a lot of pain. He called back and prescribed a pain reliever (unfortunately he thought I was complaining about pain from the fistula, not the psiatic nerve). The pain reliever did help when defacating, but didn't help the psiatic pain. I then went into the doctor, he diagnosed the psiatica and prescribed an anti-inflamatory. Once on these drugs, I started to feel better, but the drugs I was taking for the infection and pain, caused hard stools, resulting in excruciating pain during defacation. I talked to the doctor and he advised taking sitz baths and use of Metamucil twice a day to ensure enough fiber in the diet and to drink 6-8 glasses of water a day. This seemd to help, except I now was urinating about every 2 hours. Oh well, I thought, soon I will feel better and after the visit to the surgeon, all should be fine.

The surgeon wanted to do a full rectal exam, including the psygmoscope (sp?). This would be an adventure!! I was told to take what I thought was a massive dose of Milk of Magnesia a day before my visit, and then no liquids or food after midnight of the day of my visit. Also, an hour and a half before my visit, I was to take 4 enemas. Never having an enema before, I was somewhat apprehensive of them and the effect they would have on me. Well, after the first, the rest were child's play. Of course, the pain that resulted from the bowel movements was excruciating, but to my amazement, the pain subsided quickly afterward, which was a relief. Usually a BM resulted in a dull, throbbing ache that lasted 2-8 hours, leaving me unable to sit comfortably or even stand at times.

I went to the surgeon the psygmoscope wasn't nearly as bad as I had imagined. Fortunately, the surgeon examined my butt before the psygmoscope and stated that not only did I have a fistula, but a fissure as well, and it was the fissure causing the majority of the pain. He was very gentle with the psymgmoscope exam and even decided not to perform another procedure, as it would be too painful for anyone with a fissure. This is great, someone who understands the pain I have been going through for about 6 months.... After a discussion about fistulas and fissures, we set up an appointment for outpatient surgery to repair the fistula. He advised me that this procedure could also help repair the fissure, but would not guarantee it. He said the surgery to repair the fissure was relatively minor, and could be done later if the fistula surgery did not cure it.

The fistula surgery went well, even though I had to have an IV (something I never had before) and a spinal anethesic (sp?). The spinal made everything quite comfortable and I had not problems during or after the surgery, or during recovery. In fact, the fistula went away rapidly, I had very little pain during a BM, and once again, the melodious deep bass sounds of flatulation rang forth from my butt. Unfortunately, I had to tell the wife and kids that my days as the "Great Stereo Fart Man" were doomed...

During the regular weekly, then monthly post-op visits to the surgeon, he advised all looked fine, and even the fissure was healing nicely. After the last visit (about two months after surgery), the doctor noted that the chronic fissure appears 90-95% healed, but was concerned about an acute fissure nearby. We talked about how to heal it and both agreed I would talk Metamucil twice a day and 2 or 3 sitz baths to try and heal the fissures. This would be great I thought, a few more weeks and things would be fine. And they were....for a while.

About 9 months after the fistula surgery, I started having more and more pain during a bowel movement. This pain increased steadily, accompanied by some blood during a BM. An the pain didn't stop after a BM, it continued after, causing me intense discomfort for up to 12 hours after a movement. This was starting to affect my normal life, and if I had a morning BM, I was miserable all day at work, finding it extremely uncomfortable to sit for more than a few minutes. Even standing and walking was painful, and taking a BM was a long, drawn out process, sometimes taking 45 minutes to an hour. Needless to say, this made my wife and children angry, asking me why it took so long to take a .... My only reply was that it was so painful, that I wouldn't wish the pain on anyone (except them when they give me grief).... Finally, I called the surgeon and scheduled an exam.

This time the doctor performed a simple anal exam and said "Yep..The fissure is back!". We then discussed two possible alternatives, surgery and the use of the 2% Nitroglycerine Cream. He had tried this with a couple of other patients, but had gotten no feedback from them, so he really couldn't say whether it would work or not. I told him that I would try it, and if it didn't work, we would go throught the surgery.

Along with the Nitro Cream (I lovingly call it BUTT BLASTER), he prescribed the lidocaine gel that some other people referred to. I used this religiously 3-4 times a day, once in the morning, once before bed, and after each BM. I didn't notice any change in the fissure, but everytime I used the cream, I got a massive headache. The headache was so bad, that it made the pain from a BM seem like nothing. I would take 2 Ibuprofen and the headache would go away in about a half hour. After about two weeks, I no longer got the headaches, which was great, but the pain in the butt was still there and seemed to be getting worse. After 6 weeks, with no relief in sight, and in fact the pain seeming to get worse, I called the doctor and scheduled surgery.

That gets me back to this week. Monday morning I went in for the "Lateral internal sphincterotomy". This is where the surgeon cuts the sphincter muscle and then stitched it loosely together. This will relieve the tension on the sphincter muscle, allowing the fissure to close upon itself and hopefully heal. Again, it was outpatient surgery. I elected to have a spinal anesthetic, based upon the recommendation of the anesthesist. They advised that this would be easire on myself and possibly less painful than having a series of locals. I also felt that a single needle is much preferable to several needles in the butt. This time, unlike the fistula surgery, I was awake during the surgery. There was absolutely no sensation and the recovery was uneventful. As far as I'm concerned, it was a piece of cake.

When I got home, i took the pain reliever prescribed by the surgeon nad had a small amount of pain when sitting, but placing a pillow under the butt really helped. What I was worried about was the BM......

The night of the surgery, I had a small, diarrhea like BM that burned like heck coming out, but no real pain after. As directed I took a sitz bath. The day after the surgery, no BM. OH MY GOSH...WHAT'S GOING TO HAPPEN...I'M GOING TO DIE DURING MY NEXT MOVEMENT. Well, as directed, I took a TBSP of Milk of Magnesia after 24 hours. This helped. I also take 1 TBSP of Metamucil and drink lots of fluids. This will help keep the stools soft and add bulk. In addition I am also taking 2 tablets of Docusate Sodium USP (generic COLACE at 1/10th the price) a day. The next morning (Wednesday) I had two small BM, both relatively painless. Today (Thursday) I have had an unusual number of BM (3). Each movement seems less painful. I still must push hard when having a BM, but I try extra hard to relax and it seems to help. So that's it, day 4 and so far no problems. A small amount of pain but nothing like it was, and the pain does not persist after a BM.

I'll try to keep you advised as to my progress. Right now it appears that surgery may be the only cure, but who knows, some people may be able to cure it using the Nitro Cream. I remain optimistic.

I haven't modified my diet in any way, but it is interesting to note that vegetarians or people with little meat in their diet don't seem to have this problem. I may try getting back on red meats somewhat. I'll let you know.....

(please don't use my name..thanks)

Date: Sat, 30 Nov 1996

Here is the latest update.

After 7 weeks I returned to the surgeon for a checkup. One of the two fissures is completely healed as well as the incision made during the operation. The other fissure has reduced in size from 6 mm to 1 mm. There is still some pain with a movement, but it is significantly less that before. The doctor believes that the fissure may heal itself, but has scheduled another visit in two months. At that time, he will evaluate the situation. If this second fissure does not heal, I will go in for another sphincterectomy.

This is the visit to this page since 27 Jan 97.
Last modified: 7 January 97, back to home page.