Anal Fissure ongoing saga. Jan?

DaveInNorCalMember

I'm a UC person currently in remission. It has been about two and an half months since I was diagnosed with an anal fissure by Dr. Amit Goyal in Sacramento and started on sitz baths and nefedipine ointment. I went back once before, at which point he said it was healing, and again today and it has not healed. He said he could actually see the muscle and it's very painful at least several hours each day. At this point he recommends either Botox injections, about which he is not too optimistic, or surgery. Surgery is potential problem in the event of subsequent j-pouch surgery.
My thought is that the Botox is low risk and I could go ahead with that but a think I must consult Dr. Varma before agreeing to surgery, if it comes to that. Your comments on the road to take are welcome. Please feel free to PM is you prefer. Thanks all.

9/14/128:34 PM

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Jan DollarModerator, RN, retired

Yes, Botox is low risk (closer to no risk), but, if there was non-healing or recurrence after the Botox wore off (3 months), then surgical sphincterotomy was the next likely choice. This probably would not alter your future possible j-pouch surgery. I do agree that consultation with Dr. Varma would be proper before proceeding with that. Botox performs essentially the same function as surgical sphincterotomy. I think the main thing you'd need to think about is how much time you want to devote to this.

Here is a good article on the topic (if you are not registered with Medscape, you will need to register, but it is free):

http://emedicine.medscape.com/...cle/196297-treatment

Jan

9/14/128:55 PM

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DaveInNorCalMember

Thanks Jan. I guess I'm just wanting to preserve my options and can cope with the pain. However, having had three abdominal surgeries, three orthopedic surgeries, and having crashed a motorcycle resulting in three broken ribs and road rash, this is the most painful thing I have ever experienced.

9/14/129:16 PM

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DaveInNorCalMember

Another question: He plans to do the injections under sedation. Is this typical? Thanks.

9/15/128:01 AM

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