I have had this fissure (I'm assuming that's what it is) for almost two weeks. I basically haven't worked the two weeks, I've cut my food intake down to give it a break, been taking a lot of codiene, and having sitz baths twice a day. I just came from the GP and he was saying first they want to check that it is really a fissure on Tuesday then if that is what it is he can refer me to a local surgeon (not the one that did my pouch, he's 7 hours away) to do a sphincterotomy (sp).
First I want to ensure that's a good plan. But what scares me the most is having that done here. I live in a small northern town in BC, we do have two surgeons here but I would be willing to go to see my regular surgeon and have him do it. I really have a trust issue, what if they screw it up here? Am I overreacting? Any advise on what to do would be greatly appreciated.
This fissure has really been taxing on my emotional health. I want to make sure I am doing everything I can to help it heal.

Not to alarm you, but for me, surgery is last resort. There are other treatments for fissures; has anything been prescribed for you? What kind of diagnostic test is planned?
If you do a fissure search here you will find quite a bit of info.

I have proctosone suppositories that I use after each BM. And just got prescribed some litacaine (sp). I haven't wanted the GP to take a look yet because it will hurt like hell but on Tuesday I will let him. As far as I know that will just be a digital exam and he said he should be able to tell from that. I realize surgery is a last resort but I can't live like this and miss work and life etc. I am going to phone my surgeon Monday morning and see what he says. My GP said that they can do a botox treatment but of course they dont' do that here but maybe my surgeon will?

I'm just now healing from a major fissure that had me in tears daily for about one month! You have to let you Doc take a peak and see if it is really a fissure and not something else. The pain you feel is from the sphincter mucsle spasming and tearing the tissue with each BM and sometimes in between. The first line of treatment is typically to eat bland, takes sitz baths, keep the area clean, and try to reduce the numbers of BM's in a day. If these haven't worked, next is nitroglycerine ointment. I used it for about 2 weeks, and I am finally on the mend, I feel 110% better. If that doesn't work, then botox injection can be tried. This will temporarily paralyze the muscles causing the spasms and let the area heal. This can, on occassion, lead to incontinence problems. Last resort, and I mean last, is a sphincterotomy. This permanently stops the spasms, but again, can lead to incontinence problems. I would not let anyone but your J-pouch surgeon do this, but that's just me. My surgeon told me the nitro is 60% effective, the botox also 60% and the surgery 100%. It's worth a shot to try the nitro, but you have to be patient, it takes a little while to work. It can take weeks to months for a fissure to heal, it just depends on how much pain you can take! Fissure pain is horrible!!
Best of luck, I would be cautious of premature surgery.....
Cheryl

Thank you Cheryl!! I am going on Tuesday to finally let him have a look I am not looking forward to it but I do want to be sure that there is nothing else going on. I also wanted to be sure that I wasn't nuts on the not wanting anyone else to do anything unless it was my surgeon. My GP thought it was a little odd when I said that, I told him I have trust issues, plus one other time when I just had my pouch and there was a complication they wouldn't touch me and sent me back to my surgeon. So thank you for making me feel normal once again, he he. On Tuesday I will ask about the nitroglycerine ointment. I hope we both heal quickly.

Hi Sonja,

I really feel for you as I know just how much pain you must be in with this fissure. There isn't a single oral pain med that will touch the pain of a fissure which makes it even more intolerable.

I'm with Cheryl and Shelby on this one. I would definately only have surgery as a last resort and only by the surgeon who did your j-pouch. There is far to much at stake if the operation interferes with your continence.

I suffered frequent recurring fissures all throughout the 8 years with my j-pouch and the only thing that would help to heal them was a regime of Nitroglycerine ointment (3-4 times a day), Xylocaine cream, hot soaks in the bath and lots of patience.

You have to insert the nitro as far up into the anus as you can reach so that it can get to work on the right area. Also, the nitro stings like billyho when first applied so I would use the Xylocaine 10 mins before the nitro so that the area would be numb. The nitro also gave me a really severe headache but that only lasted for about 10 mins so it wasn't worth taking a pain pill for. It can take weeks or months to heal properly but you should start to feel more comfortable after a week or so.

Good luck for Tuesday. In the meantime try to get as many sitz baths or hot soaks in the tub as you can. If you have a heating pad that can be helpful for between toilet visits and sitz baths. If that doesn't help then try cooling things down to help with the external inflamation. Get a bag frozen of peas wrapped in a tea towel and hold it against your anus as this will help to get the sooth the heat out of the situation.

I really hope that you feel better soon. Let us know how your visit with the doctor goes.

Take care.

Shell

Thank you for your replies. This information is invaluable, no doctor could tell me all of this. I guess I need to bulk up on my patience which I am not that good at I must admit. I am going to use the Xylocaine before I go to the doctor on Tuesday. It will be interesting to see what my surgeon says. I feel bad now because in the spring I was supposed to go for my scope that I get done every two years and I backed out of it with my surgeon's permission of course. It really freaks me out to see this guy. He is very nice and a great doctor but if I could not see him for the rest of my life that would be great. It's been 11 years since my surgery and I still haven't gotten over that. I'll be sure to post again once I have spoken to my surgeon and gone to the GP on Tuesday. Thanks again.