Anal stricture treatment after healed fistula

Hi, have you considered having the jpouch reversed for a year and trying again. I had issues early, had the process reversed, and felt like a million dollars.

They returned the jpouch to function about a year later, and I continue to have issue after issue. I am seriously considering a permanent reversal. The spasms, night time incontinence, and overall discomfort is getting too much. I hope they can do something to help you, 

Less dramatic, try diltiazem, or nitroglycerin cream. You put it around the anus muscle, and it opens the blood vessels to allow the muscle to relax. Combine that with sitz  baths, and when sitting, use a donut. It keeps the off the pressure that can cause urgency. I use Metamucil (thickened, not like normal people use it. This makes the movements smooth, and believe me it makes a difference. You have to use it consistently, twice a day. Should have a molasses texture, maybe a bit lighter.

the diltiazem can cause a bad sting if there is broken skin, but it works. 

Keep on the cream, whichever one you choose, for eight weeks. 

Finally, adavan does relax the muscles. There is virtually nothing out there that relaxes that specific muscle, although they have antispasmofics, which never worked for me. Adavan seems to have a minor effect for me, and it helps.  Be careful driving with the Adavan. All the best!

I am seeing my surgeon tomorow for the same thing...anal stricture that I have to keep getting dilated. He wants to cut out the scar tissue also and I have been fighting the operation tooth and nail and get dilated under anesthesia every 2/3 months instead. I have never had a fistula so I cannot comment on that. I have had anal fissures often though so I know the pain level this can occur. 

I agree with the numbing cream. A presciption nifedipine may help also as it increases blood flow to the anal area. Also, metamucil is a good idea as if you have diarrhea often, this will help thicken the stools and help dilate the stricture natually. .

Yeah I do want to avoid surgery at all costs because I've had some really bad complications like the rectal fistula, and pockets of blood in my pelvis region that had to be drained by drilling a hole through my left butt cheek. I'll try what you suggested Kenny and Jean and see what happens, when I get the money for it, unless those are things my doctor can prescribe?

Hi, dr prescribes nitro/ diltiazem.

he can prescribe Metamucil for specific use, resulting from surgery.

i am Canadian, so I'm not sure of rules there 

Okay Kenny thanks for the reply. I probably won't be trying Ativan because I used to use those types of drugs years ago and got severely addicted. Hopefully my doctor could write me a prescription for the nitroglycerin cream. Another problem I have with trying to dilate is that there will be blood some of the time which scares me. I don't want to do more damage and make it worse. It does feel like I just need something to relax the muscle though. Hopefully it works. Will be seeing the doctor next week and I'll ask.

When I first had my surgery, they sent me to physio where they put a 4 inch stainless steel rod inside, attached to a tens machine, like the dr ho machine, only rectally.  I sat there for 45 minutes 2 times a week faithfully, and it hurt like nothing I'd ever experienced. It was supposed to reduce spasm. It ended up having no result. 

A couple of things I've read about very recently, are rectal diazapam. It is used for children with severe seizures, but has the ability to reduce spasm. It is applied rectally.

My relief has come from diltiazam and nitro. One thing about diltiazam is that if you have open cuts, it stings for about 90 seconds, and then goes away. 

I pray for things to get better for you, we all struggle on some level, but I am seeing people way worse off than me. God bless, and let me know. 

You may want to look up Jenny Patel, "trust your gut". Her information is online, and she has an idea for getting rid of scar tissue that causes stenosis. 

Best of luck!

Hello, Deve.

For some immediate relief, try the sitz basin. You can usually find them at drugstores or online at Amazon, approximately $15. It's a basin that fits perfectly over the toilet (seat up). Fill it with water as warm as you can comfortably tolerate, and slowly sit down. Some water will be displaced which will flow safely out of the hole in the back of basin. The warm water will bring blood circulation to that area and help internal healing. My nurse told me this after my reversal. She said for that small area the pain is so intense, but it also has the ability to heal quickly with treatment like sitz baths and fissure creams. It is very soothing to sit in the warm water. Read a book or whatever until the water cools. Refill if you need to using the tube and refillable bag that comes with it. I also had a prescription for diltiazem cream but I didn't use it a lot because the sitz bath was better for me. Also used Metamucil and it helped bulk up loose, painful BMs. I haven't needed to use the sitz since my reversal. I hope it helps you too. I am sorry about your difficulties and I hope it gets easier for you.

Thanks winterberry and Kenny. I hope everything works out for you both as well. I do have a sitz bath but I don't always have time to use it since I have two young kids (4 and 6) that I take care of every day. Diazapam is in the same drug category as Ativan. It might work but I just don't want to mess around with it. 

Fair enough. Get the Diltiazem or nitro. One of the side effects is that it opens the vessels on contact, and you will have an immediate headache. The sting lasts a bit, and then it gets better. If you are consistent with the nitro, the fisssure will heal.

when this first started for me, it was diagnosed fissure, then spastic colon, then anal stenosis resulting from the surgery and buildup of scar tissue. If your issue is scar tissue, and they are able to clear it out, that opens the anal cavity, allows the bowel to empty, and reduces spasm. The spasm occurs because the openings is too small, the anus reacts to the pain, closing up. Eventually it has to come out, triggering another episode of sitting on the toilet, something coming out, again triggering the anal response, which is to close up.

i found that metamucil binds to the waste, and allows a smooth paste to eliminate from the bowel.

You may find when you sleep, everything relaxes, and you have incontinence. 

Botox injections into the muscle apparently relax the anal muscle as well.

please let me know how it goes, I hope I'm not throwing too much at you. I have had this thirty years, and it's a struggle, I know.

take care!

I have been dealing with this stricture for about 3 years now. I'm almost afraid to see my GI doctor because he always wants to stick a camera in there. Last time he did that I was in so much pain that I didn't leave the house for 2 weeks. I'm also pretty sure the camera did more damage to my anus. It's all just such a pain in the butt literally. So many trips to the bathroom without a successful bowel movement. Sometimes I'll find myself running to the bathroom every 15 minutes because I can't get anything to come out. I'll let you know how the cream works if my doctor gives it to me.

Did he find anything with the camera? Is that how he concluded scar tissue?

Has he heard of ultrasound, its non- invasive, and can detect if it is scar tissue. 

Anyways, moving forward, use stool softeners, get orange flavoured Metamucil and stir it into water so you have a consistency that flows like soft ice cream. It stimulates the bowels and give a smooth consistency upon exit. One other distasteful thing I have done in the past: 

I will roll my fingers in toilet paper, lean to the left or right while sitting  on the toilet, and manually pull one side open to allow the feces to exit. As awful as this sounds, I found it worked well to alleviate the pressure to go again, at least for a while, and sometimes it triggers a fairly large movement.

unfortunately, nothing is sacred when you have this disease.

What part of the US are you from?

if you cannot access the cream through your doctor, I will check for online distributors. I may even be able to send you some of mine, but I have no idea why the GI would not provide this to you. It doesn't immediately solve the issue, but I am going through a bout now, and theee days in, I can function again. 

Let me know if you have any questions, I would like to help as much as I can. As I said, it can be a struggle.

Yes he had a hard time getting a pediatric scope in there, I screamed when he did it even after being drugged. I guess that's why he says it's scar tissue and with the amount of bowel movements that I reported daily. I'm from Western NY State in the Southern tier near Pennsylvania. My primary doctor will probably give me the cream if I ask, as long as it's not risky in some way. He usually doesn't have a problem prescribing much of anything. Thanks for the help.

No problem. No real side effects except headache from rapidly opening blood vessels, minor dizziness, all temporary. Please keep us posted.

all the best!