Anal fissure and antibiotics, what are your thoughts?

[R_1893]

Been suffering with an anal fissure for about 1 year now. Got a LIS+Fissurectomy last July which did not cure me, as the LIS cut was too conservative, and the pressure in my internal sphincter is still too high to allow proper blood flow, hence healing. I stumbled upon some researches showing how antibiotics (oral and topical) would actually help greatly with fissure healing and symptoms. In this study they talk about topical Metronidazole specifically, which would work by killing anti-gram bacterias who colonised the wound, making it chronic. Did you guys ever tried this approach? Any useful experience that you would like to share? I would love to give this therapy a try, since I got nothing to lose at this point.

Link to the study can be found here:

ncbi.nlm.nih.gov/pubmed/259...

[kalecolbe12]

Wow why did they do the LAS too conservative??yes I would do the antibiotic treatment but take probiotics with it to prevent yeast or take a diflucan or two

[R_1893 in reply to kalecolbe12]

My surgeon told me that under anesthesia my sphincter wasn't that much tight, so he thought a very "light" cut would have been enough...too bad it wasn't. Regarding the antibiotic, I was thinking about the topical ointment to apply directly to the sphincter. Oral antibiotics usually mess me up pretty bad, so I'm not taking any chances!

[kalecolbe12 in reply to R_1893]

I wonder if you have pelvic floor dysfunction and maybe need to see a pelvic floor specialist...mine all lead to fissure but it ended up being more like IBS and pelvic floor dysfunction

[Karen1954]

Hi!!!!! Oh my god!!! I have the same problem!!! Had LIS sx in September but feel the fissure is still there!!! It’s excruciating after I have a bowel movement and then all the time!!!! I have tried EVERYTHING!!!!!!! I’m going to ask my doctor about the metronidazole!!!! I can’t do ANYTHING!!!! I’ve had to stop working out and pretty much living!!!! My ass burns like there’s a fire there!!!!! I can’t live my life like this!!! I have grandchildren I want to play with without having pain!!!!! Mine started when I took the ibs formula pills. I had SO many bowel movements it basically tore my rectum up!!!!! After trying topicals and sits baths my doctor said to do the sx!!! I also have hypersensitivity in my rectum as I feel everything!!!!! I’m sorry u r going through this!!! It really sucks!!! I’ve been dealing with rectal pain for five years and this fissure for seven months!!! I’m done!!! Let me know if this tx works for u!! I’ll let u know what my doctor says!!! Please keep in touch!!! It’s also very isolating!!!!!! Best wishes and take care!!!!!

[kalecolbe12 in reply to Karen1954]

Hi same thing here...can you guys keep me in the loop?I started my own chronic pain group locally but I need people with same condition to talk to.. thanks!!

[Karen1954 in reply to kalecolbe12]

Of course!!!! We have talked before!!! How did u start your group? That’s great!!!! If u hear of anything new please let me know!!!! The ibs just plays havoc with the rectum!!!!!!

[kalecolbe12 in reply to Karen1954]

I only work 2 days a week now thank God...but i started my pain group on next door.com....fyi...i find cyclobenzaprine helps a lot....I am at a Christmas party so I'll message you tomorrow I've got more info

[Karen1954 in reply to kalecolbe12]

Sounds great! Looking forward to it!!! Have fun at the party!!! I barely do shit!!!!

[kalecolbe12 in reply to Karen1954]

Hi Karen...well as promised I wanted to discuss this horrible condition we have....so do you think you have pelvic floor dysfunction?i recently went to a new gastro and he said this all can be caused by IBS only confined to the rectal area...you can also have anorectal chrons disease which I am gonna ask him about.he is doing a celiac panel blood test to see if that is something I may have since my ancestry DNA said that is in my family... It's all so hit and miss...can you tell me what doctors you have been to and if you did pelvic floor therapy and what meds you have tried?also did you try Botox?some people are getting a spinncterotomy to lower anal pressure....I don't know how to do a private message on here so I'll just give you my email [e-mail]

[kalecolbe12 in reply to Karen1954]

Oh forgot to say my name is Audrey

[Karen1954 in reply to Karen1954]

Hi!!! Just sent a LONG message to your gmai and it said failure!!! Trying to find a way to resend it

[Karen1954 in reply to Karen1954]

Hi Audrey!! Oh! Also tried Botox with no improvement with the levator problem. Also saw pain management for two years with numerous injections!!!! No help!!!

[Andilynn in reply to Karen1954]

Hi Karen, We have talked before, but it’s been awhile. I am sorry you’re still struggling with this awful condition. Mine started a year ago after a c diff infection. I’ve seen many doctors, had colonoscopy, CT scans and MRI. Nothing shows up. My neurologist suggested that it’s inflammation of the inferior rectal nerve. After reading as much as I could about that, I completely agree. I also feel that I hold tension in my pelvis which didn’t help. So, how to deal with all this...painful bowel movements, rectal and anal pain all the time, sometimes numbness up the rectum almost to the tailbone. This is a depressing and isolating condition. Here’s how I helped myself and I am 90 % improved. I read the three books others here recommended - Ending Female Pain (2nd edition) by Isa Herrera, A Headache in the Pelvis by David Wise and Rodney Anderson and the book that helped the most is Pelvic Pain Explained by Stephanie Prendergast and Elizabeth Akincilar. All the books state that pelvic physical therapy is the best treatment. The last book said there are many types of pelvic pain issues, but that there is one yoga pose that will benefit all of them. I’ve had no physical therapy. In October I started doing the yoga pose twice a day and it totally worked for me. I also watch my diet. I find that the prunes, dates and rice bars that I was eating daily, went in okay, but caused issues coming out. Oats do it too. For some reason they irritate the anus, so I quit eating them. The yoga pose is the following and it has been life changing for the better. Lay on back on yoga mat (or floor), put soles of feet together (no shoes), put yoga blocks (or pillows) along sides of knees for support), rest hands on belly or thighs. Breathe in through nose, breathe out through mouth maybe four or five times. Consciously relax entire body, even the face. You will feel the vaginal and rectal area being affected in a positive way. ..stretching and relaxing. I only keep the pose a minute or two. Longer hurts my hips.

Occasionally after a BM I’ll feel some irritation. I spray a little cool water on and pat dry which seems to help. I’ve used Balneol (Amazon) too, if water wasn’t enough. I take Lyrica and baclofen and Tylenol for Arthritis for peripheral neuropathy which never seemed to help the rectal pain. Those are the only prescriptions I use.

It’s been exactly a year since this started with me. I’m finally having some very good days. Keep at it, hang in there. Wishing the best for you.

~ Andi

[Karen1954 in reply to Andilynn]

Hi andilynn!!! I will definitely try that yoga pose!!! I just don’t know what to do. I think my fissure is still there. I’ve used baclofen and so many other meds it’s ridiculous. I have a hypersensitive rectum where I feel everything in there. I’ve had the sphincterotomy and hysterectomy which helped with my prolapses but still have the rectal pain!!! I can’t do anything!!! I took an ibs pill in may and that tore me up literally!!!!! I’ve tried numerous things for the fissure and spent SO much money!!!! I went to pain management for two years but that didn’t work!!! I’ve read a Lot of books on this and have seen two women pelvic floor therapists which didn’t do much!!!! I just want to poo and be done with no pain. It is SO isolating!!!!!! I can’t do anything!!!! I’m going back to my colo to see if the fissure is still there!!! Thank u SO much for writing!!!! What were your symptoms and what else have u tried? Maybe someday we will be better!! Do take care and I will talk to u soon!!!!

[Andilynn in reply to Karen1954]

Dear Karen,

I think I had a fissure after the c diff problem, but no doctor checked for that until later when I went to a GI doc and he didn’t see anything. Nerves heal very very slowly, so if there is any kind of irritation in the rectum, it will not be a quick heal. I never had any procedures done except the imaging tests I mentioned. I kept thinking I wasn’t getting better because of something I was eating, so I barely ate anything and lost too much weight. The GI doc referred me to a dietician who assured me after a few visits that my diet was not responsible for the rectal pain I was having. I don’t totally agree with her because it’s worse after certain foods, but she gave me some good ideas. Especially to include some kind of protein in every meal...so I do. My symptoms were pain, irritation and sometimes numbness in the anal and rectal areas. Nothing was visible though because it was all nerve related...no redness, swelling or anything like that was visible. At the end of July I decided whether I felt good or not, that I was going to walk a little twice every day. I started feeling better about myself because of it. Between my 30 minutes of daily walks, the yoga pose (once a day now) and avoiding certain foods, I feel good most days. I’m hoping the worst of it is behind me (a little rectal humor there!)

Good luck with the Reclining Angle Bound Yoga Pose). Do it slowly and be gentle with yourself, don’t rush into the pose. I started with twice a day every day for a couple months, now once daily.

Keep us posted.

Best,

Andi

[Karen1954 in reply to Andilynn]

Hi andilynn!!!! I’m so glad u have found a balance and r able to get out and enjoy life!!!! My problem I think is still have the fissure in some areas. Like I said I can feel everything in my rectum and it’s so irritating!!!! If I poo and there’s some still inside I feel it and it usually burns. I know that’s normal for it to be there but I hate it!!!! I want to go back almost 8 years before this shit set it from my job that I was fired from for being sick with my ibs. The pain is always there!!! Not always pain but extreme burning and irritation!!!! Burns like hell!! Going back to colo next week to see if it’s still there. I haven’t worked out since June!!!! It is SO uncomfortable!!!! It’s just emotionally draining to not be able to live my life like I want. I’ve had this burning for 7 months everyday!!!!!!!! I know I’m better off than some people but geez!!!! People don’t understand what they don’t know!!!! I really appreciate all the information u have shared with me!!! Starting the yoga pose!!!! God bless and take care!!! Keep in touch!!!

[Andilynn in reply to Karen1954]

Karen,

I understand the hypersensitive rectum and feeling it all the time...burning, aching, irritation. Even gas in there can be felt. I’m hoping the yoga pose will make you feel better. It took a week or so of doing it twice a day to notice an improvement. Hang in there dear. I know it’s rough.

~ Andi

[Karen1954 in reply to Andilynn]

Thank u SO much for your words of encouragement!!!! Too bad they can’t sever some of the nerves!!!! Lol. It is rough and lonely!!! Can’t do much if anything!!! I’ll keep u posted on everything!!! If u come up with any new ideas please let me know!!! Best wishes to u!!!! Talk soon!!!

[Andilynn in reply to Karen1954]

Karen,

Another thought...I was eating a lot of honey every day. I eliminated that and saw improvement right away. Maybe that’s an issue for others too and it’s easy to experiment. Once I understood that food, just like any medications we take, cause reactions in our bodies, I’ve been able to help myself with various issues. I do watch my oxalate intake as I tend to be sensitive to foods that are high in them (unfortunately many of them are considered super health foods!).

I hope everyone has a better day today.

Best,

Andi

[kalecolbe12 in reply to Karen1954]

Hi Karen..Audrey here... how do I do that yoga position Andi was talking about?

[Andilynn in reply to kalecolbe12]

Karen has the pose right. You lay on your back on a yoga mat. Put the soles of your feet together and gently open your knees apart. Put pillows or preferably yoga blocks to support each knee. I don’t let things stretch open to wide or for too long...just a minute or so and breathe. Do it twice a day. I had a slight relapse and haven’t done the pose for a few weeks, I seem to get the same benefit by sleeping with a pillow between (from the knees to the heels) every night. It separates things and doesn’t stretch them open as much. I was having some vaginal pain that may have been caused by the yoga pose...not sure. I’m not having the rectal pain so much, but still have the anal discomfort following BMs. Usually gets uncomfortable when I’ve walked around for awhile. Just feels very irritated and burns sometimes. Balneol lotion (OTC) helps most of the time. I’ve noticed that things are worse if I eat chocolate, so I’ve crossed that off the list for now, at least.

Hoping we all find things that help us and that we continue to share with each other. We are not alone in this.

~ Andi

[kalecolbe12 in reply to Andilynn]

Can you tell me how to do the yoga position?

[Karen1954 in reply to kalecolbe12]

I think u lay on the floor and put your knees out with your soles together. U can put pillows under your knees to relax and then do deep breathing exercise so that the pelvis relaxes and hopefully your rectum and sphincter muscles. I did myofascial therapy on Monday and had a pretty good day yesterday but today has been hell!!! Waiting for the sigmoidoscopy in February!!! I cannot deal with this shit anymore!!! I don’t want to poop anymore!!!! I just want to live life!!!! Good luck with the yoga pose!!!

[kalecolbe12 in reply to Karen1954]

Yep I get yhe pain after pooping too. in fact starts a whole spasm episode off for hours sometimes so I'll take a muscle relaxer and I'll do this cream.....I was in the dollartree and found a hemhorroid cream with anesthetic in it for a dollar and it really works to curb the rectal pain....I bought like 5 of them...did you see my post about the pudental cryoblation?and the ptns...just Google Dr Prolongo for both

[Karen1954 in reply to kalecolbe12]

Hi!!! I didn’t see the post about cryoablation or ptns. What is ptns? I’ve been told I don’t have pudendal problems but who knows!!!! I bought some cream from Walmart called numbify!!! I use a baclofen/ lidocaine suppository at night but it’s ok. I’ve tried a lot of creams!!! I’m tired of all the pain!!! Today was awful. Had a more hard stool today but not bad and the pain is off the chart!!! If nothing doesn’t show up on the sigmoidoscopy then my colo was thinking of defacography. They aren’t fun!!! He said he could do a sx if it comes down to it but not too sure!!!! I’m SO frustrated!!!!! Yesterday was SO much better after myofascial therapy!!! WTH!!! I’m sad. My daughter and grandkids stopped by and I want to play with them with NO pain!!!!! What do we have to do? Anything else worked for u? I feel my pain is at the sphincter but after having LIS sx I shouldn’t have that!!!! Any help u can give me would be greatly appreciated!!!!! I know u r doing better which is great!!!! Thanks for keeping in touch!! Take care!!!!

[kalecolbe12 in reply to Karen1954]

Actually I am having problems after bowel movements now so I'm back on the meds since I having a pain flare right now I'm not sure it ever goes away completely... Let me think about everything and I will get back to you in the next day or so Karen

[Karen1954 in reply to kalecolbe12]

Thank u!!!!! I’m SO down!!!! I sit on a heating pad all day!!! There is a doctor here in Sacramento who treats pudendal neuralgia with cryoablation but not sure that’s what I have!!!! Talk to u soon!!

[kalecolbe12 in reply to Karen1954]

Karen can you find out the doctor's name who does the pudental cyroblation and see what his success rate is I would really appreciate it

[Karen1954 in reply to kalecolbe12]

I’ll try and find out. I can call the office. He’s had good and bad reviews for his office bedside manner. I’ll keep u posted!!! Do u have burning and pressure before bowel movement? I’m in Off the chart pain!!!!!!!

[kalecolbe12 in reply to Karen1954]

I have had pressure for 3 days and it felt like the Fall moon was stuck in there...it came out today and then I have pain for 3 hours afterwards and I took a muscle relaxer and ibuprofen and put some lidocaine in there because I was at work and I have to handle my clients

[kalecolbe12 in reply to kalecolbe12]

Sometimes I have a lot of pressure at the times I don't sometimes it burns othertimes it doesn't sometimes it just aches oh my God I'm so sick of it all

[kalecolbe12 in reply to Karen1954]

I may try the gabapentin pain doc gave me ... supposed to help with the nerve pain and I'm scared of it but I guess I have to try it at some point!!! Apart from the pain and anxiety this is getting expensive also....I have a little tiny heating pad that attaches to USB cord to wear in between two pairs of underwear and that helps sometimes... otherwise I have heating pads in my bed and on my couch at home

[Karen1954 in reply to kalecolbe12]

I’ve tried gabapentin. Didn’t do a thing!!! I have spent SO much money on all this the last five years!!!! Insane!!!! Where did u get the small heating pad? Yeah I’m going to shoot myself!!! Sometimes I feel burning in the vagina which is new!!!!

[Karen1954 in reply to kalecolbe12]

His name is Stephen Irving Mann on K street

[kalecolbe12 in reply to Andilynn]

okay SnduI have the exact same thing as you rectal pain after bowel movements that last for hours ....and it's the same with me it started last January so it's been exactly a year although I have been in six months of wheat a pelvic floor physical therapy which really helped I felt or maybe it was just more of a support system but I could not tolerate any internal so I do have inferior rectal pudendal nerve problems I think too....I've been on cyclobenzaprine muscle relaxer which really helps but I'm going to start the gabapentin to see if that helps so but sometimes I feel okay and then other times it flares ...I also have some baclofen lidocaine suppositories I can use so and I will also see a neurologist next week because I feel like I want to get an MRI of the nerves...the T3 I think it's called....I am going to do that yoga goddess pose you talked about and I'm also doing some stretches the PT gave me... I'm going to try the ointment you suggested too....I have some hemorrhoid cream with anesthetic in it which I can use if I need to that helps..... I thought I was 90% better but now it's just flared up again 😩🤪☹️

[Andilynn in reply to kalecolbe12]

I don’t know why it comes and goes, it just does. I’ve had problems with this since December, 2018 following a c diff infection. Perhaps that’s coincidental, but regardless, I have it and it’s a royal pain. I am, however, much better than I was last summer. I’m grateful for that.

[kalecolbe12 in reply to Andilynn]

I feel overall I'm better but I think we also get used to the pain and now we are less freaked out by it because we have some tools to deal with it

[Andilynn in reply to kalecolbe12]

I completely agree with you. I don’t let it get to me as much. Maybe eventually, it will go away... I try to address the burning as quickly as possible and it usually settles down within an hour. I use Balneol or just spray some water around the area and gently blot with a soft bamboo wash cloth (bought those on Amazon - they’re super soft).

[kalecolbe12 in reply to Andilynn]

Okay I will look into balneol

[Cattlewoman in reply to Karen1954]

Pease don’t give up. I am feeling suicidal as I also lost my son.. and am in a bad divorce.. away from my other grown children.

[Rxmom]

I had lis & fissure repair surg July 2017 & pain reduced a bit. But the PN was still there of course. Had neuro stim implanted w great results until a few months ago. Surg was going to reposition it - but I went to colorectal doc and a small fissure is back & now being treated w topical nifedipine to incr blood flow. Surg said fix fissure then re-eval.

The fissures, hemmeroid & ibs like symptoms seem to go along with PN. It’s like a hamster wheel.

I have 2 questions to all

Do many of you w PN also have fissures?

Does intercourse help relieve pain (it does for me) I guess it’s like PT, maybe?

what a hell of a condition....

[brycesara in reply to Rxmom]

Are you still on the forum? My husband has fissures, hemmroids and I think he has PN...if you're still on here just curious about your surgery? Thank you Sara

[Rxmom in reply to brycesara]

Hi

I addressed fissure but pain still off charts so surg (stim) is scheduled for feb 3.

[brycesara in reply to Rxmom]

Thank you for your reply. If you don't mind, what healed your fissure? Did you do botox to spchinter or pelvic floor? So sorry about your pain. What is the stim?

Thank you, Sara. We are in PA, what state are you in?

[brycesara]

Hello there, how are you doing? Any relief from your fissure? My husband has at least one fissure. Curious study you found. I found one on ISDN 1% ointment too. Check it out. If I find the exact page again I'll post it on here. He's had his fissure since early December 2019 and I think he has PN as well. Any help appreciated and I can share some things I've researched with you as well. Have you tried diltizem, nitro, Bethancol, nefedipine, ISDN? I found a study on a chemical spinterononmy and there's 5 chemicals that do this used symotanisly. 3 of them are diltizem/nefedipine Bethanechol, nitroglycerin/ISDN. Thank you, Sara

[Rxmom]

It’s “interesting” to read that others have fissures & ibs like condition along w the PN.

I can’t get it under control & it seems to start up the spasms first thing every day.

All gi docs tell me my gi tract is perfect.

I treated latest small fissure w topical dilitizem (or nitroglycerin but need to watch bp). Fissure healed in a few wks.

I agree w comment about probiotics along w flagel.

I had the retrograde stim repositioned Monday - at main line spine in king of Prussia pa. Lead had migrated so my entire right side was not getting stim benefit.

So a few wks of recovery ahead. This recovery was so easy (pain wise) compared to first one.