Anal fissure

[an414]

Hello everyone. I'm looking for advice for my mom, any info would be appreciated!

She had rectal cancer, with 2 ileostomies; her last ileostomy reversal was a few months ago, but she developed an anal fissure. Her stools are formed and not loose, but it is extremely painful when she uses the restroom. She is forced to go multiple times a day, and throughout the entire night. There is pain each time, she can barely manage to get any sleep at all, and also keeps losing weight due to this problem.

She has been regulating her diet by eating high fiber, taking Citrucel, she uses a sitz bath with epsom salt, and applied cream such as Dr. Wheatgrass, Desitin, aloe vera, vaseline, etc.

Has anyone gone through this experience before?
Thank you!

[SkiFletch]

Fissures SUCK, I had one through chemo that would constantly rear it's ugly ass head. I never had to deal with it along with post-stoma reversal BM's, I can only imagine how much that would suck. What kind of fiber is she eating? There are two types, soluble and insoluble. Soluble fiber includes skin-less fruit, potatoes, and rice especially, along with metamucil. Soluble fiber bulk up the stools and slows things down. Insoluble fiber like vegetable SKINs, kins of beans, fruit skins, tomatoes, pepper skins (see the trend here, skins ) speed things up and make stools more frequent and often acidy which hurts like a MOTHER with a fissure. So make sure she's on the right types of fiber. IME, pork and beef fats also really speed things up while fish and lean chicken slow things down.

Your mom won't have relief until she can get her BM's to come less frequent, and that might require immodium, or lomotil, perhaps even in large quantities too if diet alone doesn't work.

Lastly, there are two other option for fissures. Surgery can be done sometimes, although you'd need to see a colorectal specialist to see if it's an option or not. In addition, hyperbaric oxygen treatments can have success at healing fissures. So ask the docs about those, they might help.

[pog451]

Ive had issues with anal fissures since my teens and they suck even without an illeo reversal.

Im five weeks into my reversal and my butt burn comes and goes. The things that help me are using baby wipes and soap and water to get clean (stay away from even the softest toilet tissue and use a bidet if you have one or hang your butt over the edge of the bath and use the shower head) and liberal amounts of a heavy zinc oxide cream (I use Mirfulan, but thats a european brand). I also take a teaspoon of psyllium seed husks morning and evening (the active ingredient in metamucil) and that really helps firm up the stool but also makes it considerably less agressive. Im lucky in that I dont generally have to get up at night - my clusrtering occurs early evening if at all.

At the high point of my last bout of butt burn I went back to something I used after a haemorrhoid op a few years ago - A sitz bath with camomile extract. Works well.

BTW - Id stay away from petroleum-based creams such as vaseline. I have one that actually has a pain reliever in it but applying the cream burns like hell so I avoid it.

If all else fails - Take pain killers so at least you can go without too much discomfort (strong ones will also slow you down).

[an414]

Thank you very much to both of you for the information! I will let my mom know.

[emazzetti]

I had a horrible fissure develop after chemo radiation and it was the most painful Ning I have ever experienced. I was ready to give my right arm to make it better! In addition to what the others have mentioned, see if there is something her doc can prescribe. My dr gave me a nitroglycerin ointment, and it worked very well. I got almost instant relief. Hopefully she finds relief soon, I know it's not fun!

[simon031003]

My husband had a fissure also. He finally went to the doctor and they gave him a special cream. Search for fissures and you should see it pop up.

[an414]

Thanks, my mom's doctor already gave her a cream, but I don't think it is very effective. Nothing seems to be working...for months now she is barely eating or sleeping at all and I don't see how progress can be made in healing the fissure, if she spends hours going to the restroom and constantly suffers extreme pain from bowel movement.

For those of you who have had an anal fissure before, was it just a matter of waiting for it to heal by itself? How long did you have to go through this? Thank you for any advice!

[Kompressor]

I know this post is a few weeks dormant, but I don't want to give my fissure the honor of its own thread. I've been battling constipation since first chemo injection and in the process seemed to have developed an anal fissure. Pain has a whole new definition for me. I have sympathy for everyone who has dealt with this. I know there is no quick fix, I just pray that the pain I'm feeling now is as bad as it gets.
To the OP, I hope your mom has found some relief. I'm scheduled for chemo on Wednesday but it's just been postponed so I can see the GI on Thursday. Botox has been mentioned, I do suffer from some severe spasms whole having a BM. I won't resist surgery if they think it would help. They've given me some suppositories and ointments but my anus is so irritated, I can't get anything in there.
I finally made some progress on the constipation and now this fissure has made it do that I dread every BM and I find myself unconsciously holding back on going. Not the best technique for fighting constipation.

John

[an414]

Hi John,

I'm sorry that you have to go through this as well...my mom's fissure actually hasn't gotten any better. She also tried holding back on the BM by not eating as much so she wouldn't have go to as often and irritate the fissure, but combining this with the extreme lack of sleep from having to use the restroom throughout the whole night, has made her a lot weaker.

However, she said the Dr. Wheatgrass cream has been helping. And if you haven't done so already, soaking in a sitz bath with epsom salt can soothe that area as well. Goodluck!!

[Kompressor]

Sorry to hear that. I've given in, I'm sitting in the ER at MD Anderson now. The pain is now constant, can't take it anymore. I'm not sure what they will be able to do but as of now, the pain is bad enough that I can't do anything. QOL is pretty low right now. My poor wife. I'm pretty sure I'm the worst company you can imagine right now.

[an414]

Wow I can only imagine, from what my mom has described, it sounds like the pain is the most horrible thing in the world.

Please let me know what, if any, treatment you will receive. Nobody suggested anything to my mom, doctors just gave her cream to relieve the burn from the area and said to wait for the fissure to heal on its own.

[emazzetti]

I'm sorry you all are having to deal with the fissure...it's not fun! I had the same problem, and just dreaded every BM. I tried icing my butt, eating less, and nothing seemed to work. One day I was in tears from the pain, and went to the doc. My doctor prescribed me a nitroglycerin ointment that worked REALLY well! Aside from the baths, the ointment really helped the healing. It was the only thing that saved me. It has to be mixed at the pharmacy, and it's part nitroglycerin and part lidocaine, and it worked! It might be worth asking your docs about...good luck.

[Kompressor]

The nitro has been mentioned but I'm hoping for something more extreme. This has been a slow progression that has only gotten worse since first infusion. Apart from this, chemo has been a breeze. Or maybe it's just that this has been so bad, the other side effects have been mitigated by comparison. Tonight will be second night in hospital. I'm hoping they scope tomorrow. Should be a Botox injection in my future. So far, it's taken dilaudid, Valium, and oxycodone to manage the pain.

[sweeny]

Fissures are horrible. I suffered with one during my chemo, and for 3 months I was in constant pain. The pain was so bad that I would scream and would literally spend 3-5 hours a day in the bath as that was the only way I could get some relief. I tried all the creams, but they didn't work at all. My surgeon recommended the I have the surgical procedure to fix it, but I was scared because I'd read some horror stories of patients ending up with permanent incontinence after the op and after my post resection issues I was fed up of the operating room. Botox was discussed as a possible option, but my surgeon explained that in many cases it wouldn't lead to a permanent resolution and may need to be repeated every 3-6months. Anyway, when the suffering got too much for me I finally decided to have the Lateral Internal Sphincterotomy (it's a very minor procedure and you're free to go home a few hours afterwards) I was told to expect soreness for up to 8 weeks, but I have no pain at all from the moment I woke up, to thankfully now. My advice to anyone who has tried the creams without success (and 1-2 months is more than enough time to determine whether the Nitro will work) will be to find a surgeon you trust and have the snip.

Good luck.

[Kompressor]

I've been at MD Anderson since Monday. They've been able to treat the pain so far with oxycodone. Of course, I'm looking for a more permanent solution. They finally did a flex sig this afternoon and the fissure has grown since the last time they looked in April. They ended up giving me Botox injections. The doctor warned there may be some temporary fecal incontinence. Im willing to accept that if this will bring relief. The rectal spasms had reached an intolerable level of pain. Only time will tell if this has worked.