Hi Dave,

I would run the question about having J Pouch surgery by your
present doctor first and see what he says. From recent experience
with seeing Dr. Varma you're going to need a physician referal
in order to make an appointment with her. Good luck with everything!

Srf1, Thanks for your response. J-puch surgery isn't on the table as of now but with eleven years of UC it remains a possibility. The colorectal surgeon I saw was thinking ahead, which I appreciate. My concern is that this needs to be handled correctly now in order to better preserve my future options. Good luck with your upcoming surgery.
Dave

Yes, the proposed treatment is the appropriate solution, and the same as anyone would prescribe. Be sure to also do hot sitz baths also, to aid in healing and pain reduction.

If the nifedipine is not effective, Botox is a reasonable choice. These injections offer essentially the same treatment as sphincterotomy, without much of the risk of potential sphincter damage that sometimes occurs with sphincterotomy. The Botox relaxes the muscle for approximately 3 months, giving time for the fissure to heal (the constant spasm that the fissure pain causes prevents healing). With the surgical sphincterotomy, there is increased risk of permanent incontinence issues.

If you think you may need a j-pouch in the future, good sphincter control is imperative and can make the difference between pouch success or failure.

Jan

Thank you Jan. It's reassuring to get confirmation that the treatment rationale is appropriate.

Jan, we don't have a bathtub. Assuming I'm taking care of the hygiene issues by showering, will sitting on a heating pad promote healing?

It might, but mostly if you also use a wet compress. You can get a sitz bath at any drug store that you fill with warm water and place in the toilet bowl. No tub necessary.

Sitz baths are the first line treatment for fissures. Showers arejust not the same.

Jan

Thanks Jan.