Pain from Fissure, in/ext hem's...desperate for help

It has been quite awhile since I posted to this site- I'm really hoping someone can help shed some light on some issues I have been fighting for quite awhile. Sorry for the long post.

To preface things- almost 4 years out and mostly uneventful- until pain issues surfaced at 2.5 yr mark.  Pain was minor but started noticing some long term (sometimes hours) pain after some bm's.  Scared I had a fissure I immediately sought help from colorectal surgeon.  She noted "small tears" -no mention of "fissure".  Was told to find the right mix of things to help- i.e. using fiber, potassium, softeners, etc to improve bowels.  I probably failed to emphasize at that time that since the DS my bm's have been daily and a quick evac- when urge hits I need to go in about 20 mins or less.  Bowels have been soft/pudding like.

Used warm/hot compress with washcloth at times and applied a nitro/lidocaine compound prescribed.  It never seemed to help.  At the time I did not do this daily because I was left w/ impression from doc that it was as needed.  Basically did not get the understanding this actually was a fissure so I didn't worry.  Things seemed to improve some and I got pregnant.

During pregnancy I struggled with diet due to nausea and keeping hydrated.  I do not recall many issues with bm pain except on and off.  Once again- it was quick evac and much, much looser- just short of diarrhea - likely because I had problems firming things up.  I delivered naturally and I'm certain this aggravated things.  Pain returned and I sought colorectal surg again. 

She saw large internal hem and again only "small tears" and was given same instructions from past visit.  This time a more specialized compound was ordered (and expensive!) It did nothing to help pain.  Colonoscopy showed no problems.  I finally got sitz bath and really only helped a small bit with pain.  I stopped trying to firm up bowels- the looser bowels were less painful but I believe also started to aggravate things again. 

In the past month I started really working on healing this problem.  The pain is like sitting on shards of burning glass.  I think the internal hem has grown larger and possibly prolapsed so, with each bm, comes out and goes back in.  Add to this the tears, now bleeding with each bm, and this past week noticed external issues which today appear to be ext hem's.  I am in pain everyday now and usually for hours. 

I've tried adding more protein in the form of meats, cheese, eggs, etc- more fiber foods.  Increased potassium, calcium...this has created firmer bowels but more painful bm's.  I tried adding fiber supplement- upped water- w/softener- it results in the softer bm's that I start with and does nothing to help.  The topical ointments have proved useless (OTC or script).  The sitz bath no longer gives much comfort- even ibuprofen/tylenol does little to help. 

Doc's office is not aware of the bleeding/ext hem issue- concerned they will just turn me away and say I need to up fiber, etc.  I'm mentally exhausted from daily pain- it's constantly on my mind and just breaking down in tears that this will be my life.  Having buyers remorse with the DS at this point.  I feel the quick evac bm issue won't go away and will be an ongoing issue with fissure/hem's..

I speculate what has happened is that the internal hem might be so large now that it may be affecting my prob with quick evac on bm's and increasing pressure to create fissure problems.  I'm so lost- going to call colorectal again but - do I just get second opinion- I'm ready to just say give me surgery or put me out of my misery. 

Has anyone had this?  I am desperate for help and slowly going mad from the pain each day- it is debilitating.  I have a 1 yr old that needs attending, work, family and it has caused problems just functioning as my world has started to revolve around the pain, avoiding bm's...  If you got through this and/or can offer some comprehensive support- it is much appreciated.

I think another CRS is a good idea. I had a fistula not a fissure so it wasn't as painful as what you have. I was seeing a  general surgeon and the best thing I did was to find a good CRS. 

Do things like Tuc's pads (witch hazel) do anything for you? I'm not sure they would do anything
for a fissure but should help the Hem. They worked better for me than Prep H stuff. I understand it can become all consuming - stress that with a new CRS and the lack of a good treatment option so far.

I hope someone has some good suggestions - you seem to have already hit the things that helped me.  I hope this resolves for you soon.

Pete

See the surgeon. If you have lost confidence in the surgeon you have already seen, see a different one and get a second  opinion.

Sometimes fissures will heal with medical treatment, esp if it's a fresh fissure. But it sounds like you have had this problem for a long time now, which means it's less likely to heel without surgery. Surgery for a fissure is not fun but you clearly are suffering  living with it. Only you can decide whether or not going through surgery and recovery is worth it. The hemms could be addressed at the same time, either excised or banded or whatever.

If you do have surgery, make sure you get specific instructions about how to care for yourself during the recovery and then follow them every day. Good luck!

Larra

Thanks Larra! Yeah i guess it's not so fresh and has taught me to ask more about things- when typically I do.  I am also emailing the DS clinic for suggested colorectal surgeon if it can help. 

I found little info about surgical recovery w/exception it may be long recovery? I'm also concerned what this quick evac with bm's is all about and if there are ways to improve it?  Otherwise I fear issues will always exist.

My mom suffered fissures and literally told me one day that she would rather die than suffer through those ever again.  The hems are usually external, but the fissures are usually inside, so nothing external will help them.  She had the cream she inserted in her rectum and it helped short-term.  Surgery was her solution and she hasn't had a problem since.

SITZ BATH WITH EPSOM SALTS AS OFTEN AS YOU CAN - WARM WATER, EPSOM SALTS - IN A BOWL SIT ATOP OF IT AND LET YOUR REAR REST IN THE WATER 20 MINUTES! IT WILL DO THE TRICK FOR FISSURES, HEMORRHOIDS, OR ANY OTHER DISRUPTION.  GOOD LUCK

Thanks for the epsom idea.  I have only ever read to use nothing in the water-esp soap.  I will see if it changes things up.  Thanks to all the replies! It gives me some confidence in looking at options when it has felt hopeless.  Today was a much less painful day and dont know what is different but hoping for some break throughs!

You want more formed stools and less stool. it needs to heal. Healing needs a break. I fixed mine by eating 3 small meals all protein and fat 50 carbs daily STRICT !  I took all my vitamins. When your rectum gets some much needed "time off"---  it has a chance to heal. Yes I lost weight doing this down to 145 totally within normal limits. 

This fixed it for me.