Chronic anal fissure, TTC and GTN

[gloveson]

Hi all,

According to coleorectal specialist I have developed a chronic anal fissure that has an associated sentinel pile. Got it from bad constipation at end of last year when pregnant. I went on to MC at 8 weeks on New Year's Day and now have this issue. What a start to 2021.

I'm being prescribed GTN for 8 weeks which obviously puts TTC on hold which at 36 yo I am devastated about.

Pain going to loo is pretty bad but can be up and down. Not as bad as some of the descriptions in here but now have this horrible sentinel pile. I actually think I've suffered on and off from this in past but misdiagnosed with regular piles.

Please someone tell me it gets better? I want to get back to TTC but at same time I need to be better!

I had a fissure for a number of years. There are a variety of treatments. I had glue inserted to block it 3 times, but they failed after a bit. Finally got a surgery that used a bit of anal skin as a flap to cover the fistula opening and that is still working years later... it’s not as painful as it sounds. Don’t be afraid to push for other options with your surgeon. At the very least they’ll explain their reasoning,,. Nasty miserable things... xxx

Thanks @MadFerretWoman. I'm REALLY hoping I don't need to go down the surgery route. 2 months out the TTC game is really bothering me.

I have read mixed reports about the success of GTN ointment esp when a sentinel pile has established so really looking for some positives from anyone that has had success with this with a chronic AF??

Anybody??

Hi Gloveson,
How are you getting on? Just wondering if you've any update? I'm in the same situation as you- chronic anal fissure with sentinel pile and have read similar things about surgery being needed in these cases so am really terrified. I only realised a few weeks ago after having DC2 that this is what it is as like you, it was previously put down to piles in the past. I first suffered with it after DC1 was born and was told it was piles and it settled down after a few weeks. Looking back, I've since had a bit of pain and blood if my poo ever gets a bit hard but apart from that it's been totally manageable and I didn't think anything of it until it flared up again a few weeks ago and is now painful for hours after a bowel movement. Since I now know it's chronic I'm worried there's not much that can be done although I'm hoping that as we both have had this in the past without really realising then maybe there's hope that we'll get back to that stage? Any update on how you're doing or if you've found anything that works?

My son has suffered from an anal fissure for about a year now. I am not sure what GTN ointment is but possibly what he has been given. He has to take painkillers before using the ointment as it gives him awful headaches. His GP has confirmed he does have a fissure and that the ointment does not seem to have made any difference but seems reluctant to refer him to a consultant for further assessment. Not sure if this is because of Covid restrictions or finance. At one time son was not allowed a prescription for this ointment as you are not supposed to be using it for long term, but in the end he had to beg for it as he was in such pain. So we told him to look into a private consultation and we would pay. Within a short time he has managed to get an appointment for tomorrow. The consultant does private and NHS surgery so we are hoping that perhaps, after an initial consultation, he may be able to get treatment or surgery on the NHS. Not sure, but I think the initial consultation will be around £350 and then the consultant will contact GP to discuss treatment. It’s just gone on too long and if we end up having to pay, we will. OP I hope you manage to get some help too.

Just an update in case it helps someone else. Son had his consultation today. Cost £300. He does have a chronic fissure. The ointment apparently costs £100 a tube and he gets three tubes a month I think. This, along with suppositories has eased the pain. Consultant is sending son a summary which son will forward to his GP, but advised that as he is now coping with the pain, not to part with hard earned cash and go for a private op which would cost in the region of three and a half k. So we are hoping that this consultation will now mean son will be put on an NHS waiting list for an op, having already had an expert opinion, not having to wait for an NHS referral first. It’s all a waiting game.

Gingergiraffe, you shouldn't have had to pay, honestly it's so frustrating your son's gp wouldn't refer him. My dh has this and has been referred to the hospital, examined twice and had one video consultation with a consultant. He's been offered an operation for the fissure as it's not healing.

He hasn't paid a bean.

@Tanfastic, I agree. However I feel it is really affecting him mentally so wanted to do something to help. GPS vary so much in how they deal with referrals and how seriously they take your concerns. I can’t help but feel that maybe it is a finance issue. So glad at least your dh is getting it sorted.

@Choccie12 hello there.
What ended up working for you?
I’m in the Same boat! My baby is 9 weeks old and have had a fissure for 7weeks. More like realised I had it after 2 weeks pp when pain got worse. I was pooping glass while screaming and crying in the bathroom. And the after pain was just horrid.
Just the last 2 weeks after using laxatives,ointments , numerous baths and sudocrem I found some relief. I did start earlier on these but took a while to kick in.
I did see a surgeon and he suggested botox as the best solution to help with healing. Didn’t even mention surgery and wasn’t encouraging of it.
So I had botox today even though I felt it was healing but so slow and my muscle is so tight down there. Has disrupted motherhood for me.
I hope it heals me completely and never get a retear. Can keep you posted in my journey. All the best x

Hello OP

I’m sorry to hear of your struggles with a fissure. You should try and see a colorectal surgeon to give you a dose of Botox to help you heal. Apparently once you have a cut, the sphincter goes into spasm which then makes the fissure continuously open and cause more pain (in the case of chronic fissures which last longer than 6 weeks). The Botox stops the muscle from spasms and allows you to go to the loo without subconsciously tightening up or spasm. It’s a bit of a procedure with sedation etc but it should help. If you are able to be referred to a colorectal surgeon then they may be able to do it for you. Try to avoid a sphincterotomy if you can at first as it can cause incontinence.

As for creams they help but honestly only temporarily in some cases.

As for diet, movicol seems to be the only one that actually moistens the BM enough to cause the opening of the bowel to be less painful. Try and drink lots of hydrating liquids and maybe magnesium powder in some of your water to help with BM. Lots of fiber, add seeds to salads, eat ground linseed wherever you can. Soups are also excellent, maybe broth if you have some.

Best of luck.

I should mention that I have tried both glycerin trinitrate (GTN) and diltiazem creams and they have offered some relief but not a permanent solution for me. I am waiting for my Botox for 2 fissures... it’s been a challenge and the things I mentioned above for diet and liquids are in my daily routine to make it less painful. I also use a squatty potty to help with the movement although it’s not everyone’s cup of tea.. husband doesn’t like it... I do...
Also I’m not sure this helps but I put relaxing music on and scented oil to help me relax beforehand to make it a less stressful experience.

@Notadoctor21
Hi there. Thank you for your message.
I did have botox 2 weeks ago and I felt instantly normal the same night after my first BM and everyday after till today. I forgot what it feels like to not worry everytime I go to the bathroom and to have a painless BM. It feels amazing! It’s crazy what a little tear can do.
The surgeon said I have 2 fissures. My sphincter muscles were so tight that I could not see them. Just a couple of days ago and after feeling fully relaxed there I was able to see them and they are healing.
I am praying for full healing before the botox wears off.
I highly recommend botox to start with.
My stress and anxiety levels before using the bathroom have disappeared .
I’m only 2 weeks in and have a follow up with the surgeon in 3 weeks. Hoping for some good news.
I still do take movicol but have stopped the laxatives and all ointments as per instructions. Diet has always been high in fibre and drinking around 6l of water a day. My stool has remained soft and avoiding straining.
Get is done for relief. Hopefully it works the same for you x

Thanks for your message @Cremebroule. Can I ask if you had sedation or general or just local? I am trying to avoid it but the doctor said it will be easier with it. I’m trying to push for just local as I’ve had bad side effects from sedation. They always seem to go overboard with the sedation leaving me with low pulse and BP. Thanks in advance

I was under general sedation. Didn’t feel a thing. Ask for local is possible.

I had 2 lots of botox, both under general anaesthetic - mainly I think because the surgeon wanted to do an examination while I was completely knocked out, to assess how bad/how many fissures there were.

Thank you both. I’m glad it’s worked for both of you. I will have a chat with the anaesthetist on the day and see if I have the courage for maybe sedation.

Thanks again

All the best. X

@Choccie12 sorry I've just seen this thread and see there were posts.

So I managed to heal at the start of the year and things were going well. I then suffered a second miscarriage and was right back to square one. I had a medical management due to MMC and think that caused a bout of constipation causing it to open again. I managed to get that under control but the past two weeks have been bad again. I'm back on the GTN and hoping for the best. I figured I healed before so I can do it again but the longer it goes on the more I think I will need to go back to the specialist for the next option (Botox).

It's all very bad timing with TTC again and I'm feeling pretty down about it all. Has anyone got any more positive updates to help in my PMA and general healing??

@Notadoctor21 thanks for all the advice and suggestions above. I'm pretty much doing all of the above though using dulcoease at the moment as a switch from laxido as it works quite well for me and comes in tablet form. Drinking 3-4l water a day and about to go gluten free again as I think that helped me last time.

Have you had your Botox yet? How you getting on?

@Cremebroule I'm so pleased to hear the Botox has worked for you. Did you have any pin at all after it or has it just settled down immediately? I've read some things about the Botox causing pain to begin with and whilst my fissure is sore I'm not ever screaming out in pain so this worries me a bit. I really hope your recovery is continuing to go well!

@gloveson
Sorry to hear about your miscarriage and that is caused fissure pain again. Was that due to constipation ? Or other reasons?

I had my 5 week check up 2 weeks ago following botox. Surgeon said my 2 fissures have fully healed and now I just need to not ever strain and keep it healed. I am so scared it will come back. Especially if I fall pregnant again and deliver normally. Has anyone had a reoccurrence after a second pregnancy?

As for pain, I didn’t have any afterwards. Just the normal needle pain you get if you had a blood test. It is a bit different because it’s a very sensitive area. But after a week that discomfort went away.
My muscles were so tight that I was never able to see the fissures. But after botox, I felt like I had a new relaxed butt and could see them.

The pain immediately went away and i haven’t had any fissure pain for almost 2 months now.
I still take movicol. 1 in the morning and 1 at night to make sure I always have a soft stool. Also still eating healthy fibrous food (my diet was never an issue) . Not sure how long it takes for it to be 120% healed (I read around 2 years) but I will do whatever it takes to never feel that unbearable pain again!

I would recommend botox if you have to. It worked for me and hopefully it will for u :)

@Cremebroule
Thank you for that detail. I'm beginning to think this might be the next option as I am sure last time I had a bad problem with this I was able to get on top of it quicker than this with the GTN cream. My worry is that I am going to TTC again in August once I've had my blood tests back re: the recurrent MC and worried that with Botox in my system I won't be able to do this. It's been this terrible cycle of MC and fissure since the start of the year and I'm becoming so so low about it.

I'm not sure if it was the constipation caused by the medical management of the MC that caused the flare up or the upset and distress of it all. A friend pointed out that like jaw tensing, anal tensing is a thing that happens when stressed so I think it's likely a combination. I've also read that a lot of anal fissure patients have had periods of stress and trauma so it's not just constipation that causes it.

Like you I'm also so worried about when/if I do have a baby what it's going to do to me!

@gloveson
Can you consult with the doctor if botox will affect TTC? I am breastfeeding and my surgeon said there are no studies proven to show it will affect baby so it was so safe to go ahead. I did pump and get rid of the first batch. My baby is fine.

I understand how frustrating it can be. It’s so life disrupting. It made me depressed for a while and the fear of having it again causes anxiety. I try and mange my stress and not think about it as much now. I don’t wish fissures upon anyone.

If managed properly I am sure you will be ok.
I wish you all the best. Also, I had my baby at 36:)

Hi! Would love to hear updates from you all a few months down the line. I suffered with an on and off fissure for 2 or 3 years before the birth of my little one, never sought help as each time I worked up the courage to go to the drs it would wear off and be ok for a couple of months. Shortly after giving birth I developed two more which left me in debilitating pain for months. That was peak lockdown so it was hard to get help. I mentioned it at my 6-8 week check but was just given a numbing cream which did absolutely nothing as it was that scream out loud kind of pain with every BM, I remember saying to my partner that I would rather give birth on a daily basis than poo! I got to the point where it was manageable for about 6 months, still painful but it didn't last all day and stop me from doing things. Then it got bad again with flare ups every other month so I plucked up the courage to go to the drs again specifically asking for the GTN ointment which I had wished I had just asked for from the very first instance as it did seem to help. Been using the GTN on and off for the last 4/5 months but am currently in a super bad flare as bad as it was 17 months ago after I gave birth. The trouble is we are also desperate to conceive baby 2 but I just can't fathom the thought of getting pregnant on top of this pain and doing it all again. I thought the next step was surgery so figured I should finish having babies before resorting to that due to the incontinence risk but I didn't know about Botox. I feel like even if they healed they would just open up again with birth. I basically don't know what to do right now because part of me just wants to get pregnant and then deal with it all after, but part of me is terrified of the further damage it could do. Has anyone been in this position? Finally if anybody is reading this whilst experiencing their first fissure GO AND GET TREATED. I've spent years ignoring mine waiting for them to go away but they are here to stay and just seem to get worse (and I have a very sad ugly bum).

Hi @Bessiebum
Sorry to hear about your pain. I told my husband the exact same thing. I would rather give birth again than go through this pain.
I wrote about my experience here before with betox.
In summary, I had my procedure around 5 months ago and have never had that pain since: I have maintained soft bowels since as well just incase.
I also want to have more kids but the thought of ripping again after birth scares me.
When I asked my surgeon what are the chances of it, he said 50,50. And if it does happen to immediately book a botox procedure again.
I won’t be trying for another yet till my baby is around a year. Currently 6.5 months.

I would say get urself healed first before falling pregnant just to have pain free days and no mental stress :) Botox saved me.
All the best.