Fissue issue >_<

Ouch_Ouch_Ouch
Ouch_Ouch_Ouch Member Posts: 508 Member
edited November 2014 in Anal Cancer #1

I apologize for being a pest, but this is currently, by far, my most troublesome problem; after today, I'm not sure I can stand it much longer.

No proctitis, but I have, on biopsy, "mild chronic inflammation", "focal mild squamous dysplasia (AIN-1)", and "parakeratosis". The latter causes very dry skin to the point of fissuring. No wonder it feels like paper cuts in there! Since my 3 month siqmoidoscopy in October, it has been very painful most of the time; well traumatized, I guess.

Treatment: Annusol Cream 4 x day, Nefedepine Gel 3 x day, moisturizers (using coconut oil), daily psyllium, daily probiotic, and sitz baths 2 x day. Putting all that ointment in there every day is painful no matter how careful I try to be. I cannot do the sitz baths consistently as The Uncle is literally in the bathroom a good 20+ x day and expects us to get out immediately whenever he bangs on the door. My husband is going to squeak a toilet into the laundry room in the next week, which should help.

Although I have been trying to keep my fiber intake down, I pass so much waste - it seems like far more comes out than goes in! I have gone 4 x today, all told, easily 4-1/2 or so linear feet of the stuff = anal pain while toileting, sitting, standing, walking, bending, and lifting. Then once or twice a week, the pain reaches right up into my core, making me shake and breathe through pursed lips. Those are the times when I cannot avoid taking Percoset.

The colo-rectal surgeon said that with my next sigmoid in January, he will examine the particularly painful spots thoroughly if they are still there. If I let him know about the extent of the pain now, I'm sure that he would go in sooner, but then I would be exchanging one painful procedure for two.

What can I do to hang on until January? Has anyone else had painful persistent fissures? How were you treated? How do you keep fissures from reopening? All tips and suggestions will be gratefully accepted.

Thank you so much for your time, dear ones.

Comments

  • mp327
    mp327 Member Posts: 4,440 Member
    #2
    Ouch

    I am so sorry you are in this terrible pain!  The problem with fissures, of course, is that if they begin to heal, it can be only a matter of time before they open up again, due to a bout with constipation or a large BM.  I don't know that I've ever had one, but if I did, it was very minor.  I did have times in the past when I would bleed with a BM and the skin would "crack." 

    Check out this website (perhaps you already have).  http://emedicine.medscape.com/article/196297-treatment

    Botox injections seem to be mentioned often in information on treatment of anal fissures.  Have you asked your doctor about these? 

    Obviously, the amount of stool you are passing seems unreasonable, given your diet.  I experienced that for awhile after treatment myself.  I wasn't eating much, but still having 10+ BM's a day.  I couldn't figure out where all of it was coming from.  Like you, I finally decided that fiber was not my friend.  Once I cut back, things eased up a bit.  I will say, though, that even at over 6 years out, I go more frequently than I'd like, but have just learned to accept that fact.

    I don't blame you for not wanting to have another procedure that will most likely just irritate things even more.  I know you are not that far out from treatment and the 2 year mark seems a long way off, but my personal experience was that once I reached 2 years post-treatment, things were SO much better.  Keep looking for relief and have hope that as time goes on, things will get better.  Hang in there!

    Martha

  • Cjeepgirl
    Cjeepgirl Member Posts: 6
    #3
    so sorry

    Martha is so support, she has so been there for me.

    I am 2 yrs post treatment and having a lot of pain when having a BM.  Yesterday was such a good mostly because I did not have any BM and therefore no pain and felt normal. Today, constipated which means it is all cracked open and I was just woke out of a sound sleep by the pain which then terrifies me and makes me think its a relapse.  Ugh.  I am do for an anuscope Dec 10th and will be refusing it from now on unless they put me out, I cannot take the pain anymore nor do I think I should have to. My family doctor is trying to manage all my various body parts that are causing pain, and I just got a 12mcg fentanyl patch for now.  But when things aren't so bad...and the pain is mild to moderate, I use dibucaine. it has lidocaine in it and works pretty well. I have to request the pharmacy at costco to order it for me because most stores do not stock it, but I have a ready supply always handy.

  • Ouch_Ouch_Ouch
    Ouch_Ouch_Ouch Member Posts: 508 Member
    #4
    Cjeepgirl said:

    so sorry

    Martha is so support, she has so been there for me.

    I am 2 yrs post treatment and having a lot of pain when having a BM.  Yesterday was such a good mostly because I did not have any BM and therefore no pain and felt normal. Today, constipated which means it is all cracked open and I was just woke out of a sound sleep by the pain which then terrifies me and makes me think its a relapse.  Ugh.  I am do for an anuscope Dec 10th and will be refusing it from now on unless they put me out, I cannot take the pain anymore nor do I think I should have to. My family doctor is trying to manage all my various body parts that are causing pain, and I just got a 12mcg fentanyl patch for now.  But when things aren't so bad...and the pain is mild to moderate, I use dibucaine. it has lidocaine in it and works pretty well. I have to request the pharmacy at costco to order it for me because most stores do not stock it, but I have a ready supply always handy.

    Thank you both.

    Cjeepgirl - I am very sorry to hear of your continued episodes of pain after so long. Are the problems related to radiation damage? I cannot, at this time, anyhow, contemplate a sigmoidoscopy without sedation and IV atropine. I am only about 4-1/2 months post treatment and I am totally gunshy about painful procedures! Do tell the doctor that you need sedation from an anesthesiologist. POSSIBLY, there may still be exquiste pain following the procedure for a time, but you will at least get through the scoping itself.

    mp327 - As a matter of fact, I tried to access emedicine.medscape some days ago, but even with logging in, I couldn't do much - links wouldn't work for me, the search result links did seem to work, but the pages popped up blank. I filed a work ticket and tonight, I was able to access the site. (I loved emedicine and used it continuously before it folded into Medscape, but now, it's a pale shadow of it's former self. >_<) I read the article you found, thank you.

    I found the Anal Fissure Support Forum at http://www.anal-fissure.org/. There's a lot of info there and empathetic support, but there's dreck as well, not substantiated information like is found in this forum (and one of the things I really love about it).

    For the information of other persons with fissures who are unsure how to properly apply the ointments, as I was until just tonight, this page is also on Medscape: "Hemorrhoids Can Be a Real Pain" - look at the segment (video and/or text) called "Management of Fissures". http://www.medscape.com/viewarticle/829350

    The fissure is in the same spot where the cancer tumor erupted through my skin. I'm a big baby, I know, but it gives me..........pause.

  • Ouch_Ouch_Ouch
    Ouch_Ouch_Ouch Member Posts: 508 Member
    #5
    Cjeepgirl said:

    so sorry

    Martha is so support, she has so been there for me.

    I am 2 yrs post treatment and having a lot of pain when having a BM.  Yesterday was such a good mostly because I did not have any BM and therefore no pain and felt normal. Today, constipated which means it is all cracked open and I was just woke out of a sound sleep by the pain which then terrifies me and makes me think its a relapse.  Ugh.  I am do for an anuscope Dec 10th and will be refusing it from now on unless they put me out, I cannot take the pain anymore nor do I think I should have to. My family doctor is trying to manage all my various body parts that are causing pain, and I just got a 12mcg fentanyl patch for now.  But when things aren't so bad...and the pain is mild to moderate, I use dibucaine. it has lidocaine in it and works pretty well. I have to request the pharmacy at costco to order it for me because most stores do not stock it, but I have a ready supply always handy.

    Tears (ouch!) and tears (sniffle).

    I had pain big time throughout the radiation therapy and was told by the radiation oncologist that he saw the occasional fissure, but I was so overall miserable that I didn't pay it much attention. I also had months of radiation enteritis where I passed industrial drums full of neon yellow water. The looser the stool, the more painful it was.

    Then when the enteritis stopped, I was still on 75mcg of Fentanyl via patch and suddenly, for about 2 weeks or so, I had non-stop Niagra Falls hot flashes all night long and passed huge large diameter bulky stools that clogged the toilet and caused vaso-vagal episodes and severe anal pain - tears (ouch!) and tears (sniffle). Since I couldn't get control of those alarming stools, I ripped that patch off in frustration and haven't had the hot flashes or Gigantor stools again (just really really LONG ones). [Then the follow-up sigmoidoscoscopy really traumatized the fissures, blah, blah, blah.]

    As useful as it is, Fentanyl can have side effects. Be aware that it could exacerbate your constipation, so drink mucho fluids and stay right on top of it.

    Virtual tea and sympathy!

  • AZANNIE
    AZANNIE Member Posts: 445 Member
    #6
    Ouch

    So sorry you're dealing with fissures. Is there something that can be sprayed on to relieve the discomfort? Have you tried Aquafor? I don't have fissures that I know of, but sometimes deal with irritation if I eat something spicy and then my rear end burns so I smear on Aveeno diaper rash cream. I also remember doing a lot of pooping, but think it was due to all the IV antibiotics when I was in the hospital. Thank goodness for lomotil. Are you using unscented baby wipes. I was using Sam's Club brand until they were recalled. Now I'm using Pampers sensitive.  Hope you feel better soon! 

     

    Ann

     

  • Ouch_Ouch_Ouch
    Ouch_Ouch_Ouch Member Posts: 508 Member
    #7
    AZANNIE said:

    Ouch

    So sorry you're dealing with fissures. Is there something that can be sprayed on to relieve the discomfort? Have you tried Aquafor? I don't have fissures that I know of, but sometimes deal with irritation if I eat something spicy and then my rear end burns so I smear on Aveeno diaper rash cream. I also remember doing a lot of pooping, but think it was due to all the IV antibiotics when I was in the hospital. Thank goodness for lomotil. Are you using unscented baby wipes. I was using Sam's Club brand until they were recalled. Now I'm using Pampers sensitive.  Hope you feel better soon! 

     

    Ann

     

    Thank you!

    Thanks for the suggestions, AZANNIE.

    I have Albolene to use because Aquaphor has lanolin in it. I find it irritating to my skin and I also try to be as meat-free as possible. The oncologist has prescribed Annusol Cream (hydrocortisone), but I don't think that really helps. I've been on Annusol suppositories all spring, summer, and early autumn long without a dent in the pain of radiation burns.

    The colo-rectal surgeon prescribed Nefedepine Gel, made at a compunding pharmacy, from the same active ingredient as the calcium channel blocker B/P med, Norvasc. It's meant to relax the inner sphincter in order for more blood to flow into the anus and help heal the fissures. I recently found out that I wasn't applying it correctly, so now I'm following the instructions in that video I provided the link to in an above post. (This is an area where the circulation is extremely poor to begin with. Then the involuntary inner sphincter makes it worse when it clamps down in spasms when irritated, thereby causing an outright ischemia situation and impedes healing.)

    I am using Comfort Shield Barrier Cream Cloths by Sage Products after a nurse gave them to me to use in the hospital. Expensive, but necessary for me at this time. They are like rectangular clouds! Each 8-1/2 x 8-1/2 wipe can be cut into 4 toilet-paper-sized pieces that I leave in the bathroom and in my pocketbook. (Available through Amazon from several vendors, icluding Sage Products.)

    I am having difficulty following the colo-rectal's other instructions, though. Doing sitz baths 2 x day is nearly impossible as the elderly Uncle monopolizes the bathroom all day and expects us to Get! Out! as soon as he bangs on the door or he goes outdoors and pees on the lawn in view of the neighbors (he has a dementia going). Also, water can dry my skin, especially in cold seasons. So, now I am sitting on a heating pad like a nesting chicken all day. Ahhhhh! The colo-rectal also wants me to use psyllium daily. I tried a small experimental 1tsp dose - that gave me diarrhea within a few hours and the looser a stool, the more painful it is for me.

    I am trying to keep my fiber intake down to reduce the amount of stool that pushes its way out. I wait until I really have to go, then try to relax as much as possible while allowing parastalsis to take over. This helps. I try to instill some Albolene prior to going in order to grease the skids and coat the fissures from the poo, but I usually don't have enough warning.

    So, the last few days have been better. I am sore, especially with pottying, but that deep pain is more controlled. If a fissure is going to heal, it can take many weeks. Hurry up, body!!!!

    [I was hospitalized three times during the cancer treatment for neutropenic fevers, so I, too, received tons of IV antibiotics, rotating between at least three brands each time.]

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