Anal / rectal stenosis?
I have not yet recovered from the pain of the last scoping. As a matter of fact, the pain is getting worse. It's not just that fissure site that hurts, but my whole anal vault is painful and throbbing after passing stools. They are more formed these days, though far from firm, and each go-time is dreaded. I pass blood and mucous each time. It seems like the inner sphincter is also inflammed and hurts.
Has anyone had stenosis? How did it feel and what symptoms did you notice? I apparently have hyperkeratosis per the last biopsy and mild chronic inflammation. Perhaps that explains the pain? My oncologist has wanted me to use Annusol Ointment 5 x day, the colo-rectal surgeon wants me to use Nifedepine 3 x day. Anal applications also hurt, so I am reluctant. The radiation oncologist wants me to continue with sitz baths and wait at least 6 months before the next follow-up bevause of the damaged cells. He sees fibrotic tissue at my anus, but didn't do a manual exam because of the discomfort.
Yuck!
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Ouch
I have not used either of those ointments recommended by your doctors. I can relate to your pain though, as I have experienced that, especially with well-formed stools. I'm sure I have experienced stenosis. However, my stools are rarely that firm anymore, so exiting is not painful. I'm sorry you are dealing with this. Unfortunately, I think it's a common post-treatment issue.
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Stenosis - yes
I've been told I have stenosis too, I think we all probably do from the radiation. Painful BM's and bleeding are symptoms.
My biopsy in Jan. also indicated inflamation.
Have you tried Advil for the pain, it's also an anti-inflamatory. You may also want to try a stool softner. (My radiology oncologist recomments Colace.)
Hope you get some relief soon!
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Thanks, sephie.sephie said:ouch
sorry you are having pain..... anusol cr. is used for hemmorrhoids so antiinflamatory....nefidipine sort of freezes the anal spincter, i think....so that it will not move as much during bm..... hope you find relief..... sephie
Nifedepine helps keep muscle spasms at bay, and therefore the fissure pain, in between poos, but doesn't prevent the pain when I go. During the whole radiation treatment and beyond, I used constant Annusol suppositories. The wax was soothing all by itself when it melted, but I never got that inflammatory relief that the docs said they'd give. The ointment doesn't seem to give inflammatory relief, either, is painful to shove up there, stings unless I mix it in with the Nifedepine, and lacks that soothing melting wax quality. Maybe I should go back to the suppositories if there's no good reason not to.
Once pain starts, everything aggravates it - standing then each step I take, bending, stooping, lifting, driving. Sometimes I cry a bit.
I take Percoset 5/325 once or twice a week when the pain gets so bad that I start having a vaso-vagal episode. But I don't like it - it makes me so queasy that I have to take Zofran with it and it makes me groggy for a good 18-24 hours. When I had to start on B/P meds during cancer treatment, I had to stop taking ibuprofens. Also, I had to stop taking asprin during cancer treatment and again afterwards when my platelets fell. I'm hoping that I can start them again soon because of atrial fibrilltion.
I was hopeful that the radiation effects would fade out as time goes by, not get worse. Maybe it's true what they said on the show, Community: "Hope is faith's richer, b----ier sister." B^)
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I am hardly an expert here as
I am hardly an expert here as my diagnosis/treatment is brand spanking new, but my doctors are suggesting this "low-residue" diet. It cuts the amount of nondigested food, thereby creating less bodily waste. Have y'all tried this? I'd love your input as I'll be starting the radiation very soon.
Feel better!
Kelle
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KelleKelleb said:I am hardly an expert here as
I am hardly an expert here as my diagnosis/treatment is brand spanking new, but my doctors are suggesting this "low-residue" diet. It cuts the amount of nondigested food, thereby creating less bodily waste. Have y'all tried this? I'd love your input as I'll be starting the radiation very soon.
Feel better!
Kelle
I was not advised by any of my doctors to follow a low-residue diet while undergoing treatment. However, I wish I had, as it probably would have cut down on my overactive bowel issues, which were horrible. I probably had 20 BM's per day and uncontrollable diarrhea.
My experience with low-residue came in January 2013, when I was hospitalized for a partial small bowel obstruction, thought to be as a result of the radiation I received in 2008 as part of my treatment for the anal cancer. Adhesions can form after radiation and sometimes cause blockages. At the time of my discharge from the hospital, I was advised to follow a low-residue diet for at least 2 weeks, which I did. This allows the bowels to "rest." It really does cut down on the amount of stool output, which would be a definite plus while getting radiation, IMO.
You sound like a very health-conscious individual, which is great. I am too (most of the time!). However, when I went through treatment, I lost significant weight and got down to 92 pounds. A lot of foods did not taste good to me and the result was weight loss. All of the diarrhea didn't help either. My oncologist threatened to put me in the hospital for nutrition if I didn't maintain my weight. His advice to me at that time was to eat whatever tasted good, whether it was healthy or not. That was hard for me to hear, but I had to start doing that and found towards the end of my treatment about the only thing that tasted good to me was Ramen noodles or canned soup, which is something I would NEVER eat under normal circumstances. However, I was able to maintain my weight and keep myself out of the hospital.
If your appetite tanks like mine did and that of so many others who go through this treatment, I would give you the same advice if weight loss is a serious issue. In my case, I was a lightweight to begin with and could not afford to lose anymore weight because of the treatment. You may find that foods that you love will not taste good during treatment. Fruits and veggies might go through you like a bullet train, which was the case for me. Supplement drinks, such as Boost and Ensure, can be helpful in getting your body some of the nutrition it needs during this time if foods are not providing enough. Protein is key for healing, and these drinks provide a good source of that.
Once you have treatment behind you, then you can get back to healthy eating if you are not able to maintain that type of diet during treatment. This is only for a short time. Just do what you have to do to get through it.
Martha
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I went through exactly the problem that you are currently experiencing.
After a year of following the ointment/spritz path with absolutely no relief, I finally found a doctor who recommended and with my concurrence, carried out manual dilation of the stenosis under propofol sedation.
The first year, I required dilation every 2-3 months or so.
The next year, I had only 3 dilations.
And in the following year, only one.
This has been for me an absolute god-send.
I hope that this is of some assistance, and assurance that the right doctor using the right treatment can and will make life so much easier.
Best wishes;
Victor.
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Hello, Victor.victor said:I went through exactly the problem that you are currently experiencing.
After a year of following the ointment/spritz path with absolutely no relief, I finally found a doctor who recommended and with my concurrence, carried out manual dilation of the stenosis under propofol sedation.
The first year, I required dilation every 2-3 months or so.
The next year, I had only 3 dilations.
And in the following year, only one.
This has been for me an absolute god-send.
I hope that this is of some assistance, and assurance that the right doctor using the right treatment can and will make life so much easier.
Best wishes;
Victor.
Thank you so much for your post.
I have read about manual dilation regarding therapy for anal fissures (I developed that during radiation treatments and each subsequent follow-up scoping re-tears it), but not regarding stenosis. There's not all that much about stenosis to begin with on the 'Net and nothing I could find about its being caused by radiation damage. I'm glad to see that manual dilation worked you and that you did not suffer from incontinence because of it (it has a reputation).
From my symptoms, the oncologist thinks I may have stenosis and wants me to go back to looser stools. The loose stuff can really harm the fissure when it's broken open, though. The radiation oncologist says I have fibrotic tissue on my anus (inflexible scar tissue), but didn't do a digital exam because of the fissure pain. The fissure is no longer healing like it eventually would in the past.
I'm just so sick of being anus-centered and living life tethered to a bathroom because of increasing incontinence. And the chronic pain standing, walking, lifting, bending, squatting, etc, is getting to me. Percoset controls the pain beautifully, but makes me so queasy that I have to take it along with Zofran. Then I'm really groggy the next day. As Charlie Brown would say in the "Peanuts" cartoon strip when he was really frustrated, "ARRGGHHHHH!"
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Pain reliefOuch_Ouch_Ouch said:Thanks, sephie.
Nifedepine helps keep muscle spasms at bay, and therefore the fissure pain, in between poos, but doesn't prevent the pain when I go. During the whole radiation treatment and beyond, I used constant Annusol suppositories. The wax was soothing all by itself when it melted, but I never got that inflammatory relief that the docs said they'd give. The ointment doesn't seem to give inflammatory relief, either, is painful to shove up there, stings unless I mix it in with the Nifedepine, and lacks that soothing melting wax quality. Maybe I should go back to the suppositories if there's no good reason not to.
Once pain starts, everything aggravates it - standing then each step I take, bending, stooping, lifting, driving. Sometimes I cry a bit.
I take Percoset 5/325 once or twice a week when the pain gets so bad that I start having a vaso-vagal episode. But I don't like it - it makes me so queasy that I have to take Zofran with it and it makes me groggy for a good 18-24 hours. When I had to start on B/P meds during cancer treatment, I had to stop taking ibuprofens. Also, I had to stop taking asprin during cancer treatment and again afterwards when my platelets fell. I'm hoping that I can start them again soon because of atrial fibrilltion.
I was hopeful that the radiation effects would fade out as time goes by, not get worse. Maybe it's true what they said on the show, Community: "Hope is faith's richer, b----ier sister." B^)
How about a pain patch I'm on Fentanyl 50 mg.
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Update.Ouch_Ouch_Ouch said:Hello, Victor.
Thank you so much for your post.
I have read about manual dilation regarding therapy for anal fissures (I developed that during radiation treatments and each subsequent follow-up scoping re-tears it), but not regarding stenosis. There's not all that much about stenosis to begin with on the 'Net and nothing I could find about its being caused by radiation damage. I'm glad to see that manual dilation worked you and that you did not suffer from incontinence because of it (it has a reputation).
From my symptoms, the oncologist thinks I may have stenosis and wants me to go back to looser stools. The loose stuff can really harm the fissure when it's broken open, though. The radiation oncologist says I have fibrotic tissue on my anus (inflexible scar tissue), but didn't do a digital exam because of the fissure pain. The fissure is no longer healing like it eventually would in the past.
I'm just so sick of being anus-centered and living life tethered to a bathroom because of increasing incontinence. And the chronic pain standing, walking, lifting, bending, squatting, etc, is getting to me. Percoset controls the pain beautifully, but makes me so queasy that I have to take it along with Zofran. Then I'm really groggy the next day. As Charlie Brown would say in the "Peanuts" cartoon strip when he was really frustrated, "ARRGGHHHHH!"
Thanks for your concern, dpatter03, but after I finished the cancer treatment last year, I began to wean off of Fentanyl patches when I started to have severe night time sweating (absolutley wringing wet 2-3 x night) and extremely large, bulky stools ~2-1/4 - 2-1/2"" in diameter causing vaso-vagal episodes. When I found out that Fentanyl causes those side effects, I ripped off the patch, weaning be darned. The side effects went away immediately. Anyway, I have pain intermittently so take Percoset and Zofran intermittently.
Earlier this month, I drove to and from Cape Cod, a 6 hour drive each way. Due to my fears of incontince while on the road, I blushing wore an actual adult diaper and took several full doses of Immodium before setting out. I took a bag with lots of supplies including washcloths and a change of jeans. Thankfully, I had no trouble at all.
The fissure seems to have healed closed in the meantime - finally. I saw the colo-rectal surgeon. He says that since I have fissuring after each scoping and since I've had 2 clear three month scopings with biopsy, he's willing to go to yearly scopings. As for increasing incontinence of poo and pee, he sees scar tissue in my anal canal and the inner and outer sphincters as well as some inner sphincter weakness. If this persists, he wants me to consider getting a Medtronic implant.
Ironically now, I've just had 3 days of constipated stool. My inner sphincter is extremely sore from having to get it to stretch enough to pass the poo. It felt gigantic, but is only 1 - 1-1/4" in diameter. I guess the scar tissue isn't dilating as much as it should.
I stopped the low-residue diet and am now back to veggies and some fruit. I took Senecot (didn't help much) and tried psyllium husks again 3 hours ago. So far, no watery stools have resulted like my first experiment with it.
Again, my life is STILL anally-centered! It is, to excuse a pun, a real bummer!!!
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Improvement-ish.Paris75 said:I had this problem and now
I had this problem and now take Miralax, a stool softener, every day. Also I take a strong pain med before doctor visits, as they always want to stick their finger up there....ouch!!!!
Hello. It feels like my anal fissure has reduced in size so when it breaks open, it hurts, but not enough to take oxycodone anymore. The scarring has progessed, though, and I have to sprint to the bathroom in Olympic time or I am incontinent. I seem to have no more inner sphincter tone and less out sphinctor tone. My stools are generally extremely loose to watery, so that doesn't help at all. Some days, I fear leaving the house at all.
Your suggestion to take meds before the MD visit is a good one. The colo-rectal guy gave me Ativan, but that did nothing to relax me. A full oxy tab is probably how I should go next time. I still have about 60 left from 2014 because I got so queasy with them that I only took oxy if in severe pain.
I have been having a lot of depression over this whole "wounded anal canal" thing.
I wish I had been warned of this complication before I signed the consent for treatment way back in 2014.
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Proctitis and Stenosis
Went through 6-weeks radiation for anal cancer ending early 2013 (two weeks chemo) and so far clear of cancer; however, major issues with recurring proctitis (swelling, mucous) even more so now in 2017. I also believe Stenosis is a major issue as stools have always been thin since radiation but now are very difficult to pass and only slightly larger than a pencil in diameter. Fiber is always taken/used never completely firm stools for years so that's not the issue.
Can't figure out how to completely get rid of proctitis (Canasa and Proctofoam used to help but not consistently). I believe the cause of proctitis so often is stenosis and issues passing BMs. Becoming housebound having to go every 15 minutes (and really often nothing more than cramps/mucous) and eventually stools throughout the day. Never feeling complete.
I'll be switching colo-rectal surgeons since mine seems to have no solutions (nor concerns) about my issues simply that's what happens! Dialation seems like something I need to look into but but thought I'd ask (this is my first blog/forum regarding this ever). Thanks for your help.
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DLH
Welcome to the forum, but sorry you are having problems. I definately think you should get an opinion from another doctor. I think most of us have run in to doctors that either don't know how to help or just aren't concerned with quality of life issues like being housebound from frequecy or in chronic pain from radiation proctitis. One thing that seemed to help me was to cut out lactose, that cut frequency of stools. For me having frequent stools means more rectal pain. Weirdly if I have a lot of diarrhea I get recital spasms and muscle relaxers help. Dilation has helped some people but tissue that's been irradiated doesn't heal well so that canbe a problem too. If you decide to go lactose free you can get lactaide milk, give it a few weeks.
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I finished anal/rectal treatment one year ago and was surprised to find out that getting rid of the cancer is only the beginning. I'm writing because I came across Dr. Sylvie Delanian on another site. She is in Paris, but she prescribes antifibrotics and thinks that the fibrosis is reversible. The medications she uses have few side effects and you might be able to convince a physician here to prescibe them. While the rectal part is truly awful, fibrotic changes are progressive.
Best luck to everyone
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