Has anyone had the anal flap surgery for anal fissures?

I've had a bleeding, excruciating fissure since last June. My GP referred me to a colorectal surgeon last August. I was seen by a registrar in November, she was hopeless. I told her not to examine me internally but she did without my permission and tore the fissure. My January appointment was put back until April. I've had pus coming out, so saw my GP who gave me antibiotics. It hasn't cleared. I paid to see my consultant at the Nuffield on Thursday, and he wants to operate urgently. All the straining since being hypo has been so damaging, but I think it's a motility problem because I'm not constipated, and I drink 4 litres of water a day.

[SeasideSusie Remembering]

No, Helcaster, I have no experience but I have to say that this horrified me:

"I told her not to examine me internally but she did without my permission and tore the fissure."

I'm speechless, well not really as that a very rare occurrence with me, but I can't exactly say what I'm thinking as my opinion of some doctors is pretty low as it is

[Hidden in reply to SeasideSusie]

Susie, she was an arrogant b****. Her opening line was "what makes you think you have a fissure" I wanted to hit her. I've had them five years now, but this last one has left me housebound, except for doctors appointments. I have a complicated history so I typed some concise notes. I always do this for new consultants, and they are always very grateful, read them and put them in my file. She refused to read them! My partner couldn't believe how she was. You can see the fissure from the outside and my body has grown a huge tag over my anus, she said it's not a problem, but it is! It bleeds and rubs so I can't walk. The guidelines say not to examine without anaesthesia, obviously fissures are just so painful. She shoves her finger in I felt the familiar red hot stabbing pain, but she carried on and said there's nothing stopping you getting your stool out. I told her to stop and she carried on, I asked her is there blood, she said no you're fine, but I knew what she had done. I felt sick and faint it hurt so much. She had zero compassion. I told her I had some of the worst pain I have ever had and it's affecting my mental health. Of course when I got home I was bleeding again and all the pain was so much worse especially when opening my bowels, and I had got beyond that. It's taken months to get back to where I was.

Seeing my GP with the pus, it's profuse too, on my pants, nightie, and bedsheets I have to wear a pad now. My GP said she wants me examined under general anaesthetic. The only way of seeing my consultant quickly was to pay, I told him what had happened in his clinic. I hope he has a word because my gut was telling me to file a complaint. He wants to do two ops, firstly the anal flap then a surgery for prolapsed rectum. I'm terrified to be honest. I'm having this done on the NHS because of a horrendous experience previously after surgery at the Nuffield The rectal issues have triggered a bladder flare as I have interstitial cystitis.

[Marz in reply to Hidden]

So sorry you are suffering so much ....

[SeasideSusie Remembering in reply to Hidden]

What a sorry tale Helcaster, I can't imagine what you're going through and if sympathy can help just a little bit then I send it by the bucket load.

I had an experience with a female gynaecologist who was, to say the very least, rough and I left the appointment bleeding after her doing a particular examination she didn't tell me about. She kept saying "everything is in it's place and well supported". I asked, about half a dozen times, changing the wording of the question each time but the meaning was the same, what was is then that I could see and feel and was diagnosed with 2 years earlier by my GP. Every time the answer was "everything is in it's place and well supported". I was beginning to think she had only learnt a few English phrases. The strangest thing was she was pushing me to have surgery for this thing that apparently wasn't there!!

A friend with a similar problem, seen at the same hospital, had a very similar experience and said to me "These ***** women are all brutal b*tches".

[Hidden in reply to SeasideSusie]

Thank you Susie, this site is such a support, with lovely people! I just received your bucket thank you!

I do wonder sometimes if they know what they're doing. I can't believe a female gynaecologist could be so clueless. I had a bad prolapse after forceps and 4 big babies. When you're being diagnosed lying down how can the prolapse be assessed 100 % accurately? I saw a physio more recently who examined me to see if i was doing my kegel exercises well, and she said my pelvic floor was fine, she told me to eat more pears. I have stress incontinence for goodness sake, and here we are again with rectal prolapse for the 3rd time. I only saw this physio about 5 years ago. It's a shame you can't be assessed standing up!

It seems we have similar experiences with doctors! You know if you have a problem because of the symptoms you live with day in day out. Have you tried a kegel8 device?

[SeasideSusie Remembering in reply to Hidden]

I'm doing quite well with Kegal8 Ultra 20 and their biofeedback trainer and it makes me wonder why they don't start with the most simple thing rather than push surgery straight away. I asked to be referred to a Physiotherapist (to the surprise and amazement of the Gynaecologist and my GP) and she was most interested in both devices and said would be telling her other patients!

"You know if you have a problem because of the symptoms you live with day in day out."

Very true, but why don't doctors believe us and give us credit for knowing our own bodies. I had occasion to say to my GP last week that I feel as though I had been fobbed off. Dimwit asked me what I meant by" fobbed off" so I said I felt I hadn't been taken seriously or listened to. His reply was

"We are not experts, our job is to rule out anything serious, nothing else".

So there we are, that's me told! So I can't expect any help for anything that isn't immediately life threatening and when I do go with something worrying I am denied any investigation. I now know my place!

[Hidden in reply to SeasideSusie]

If I had my time again no way would I agree to a hysterectomy and pelvic floor repair. What I have found over the years is surgery hardly ever 100% fixes the problem and often causes the need to have more surgery.

I'm so pleased you have your kegel machine! How is your progress? I have a cheaper version but just used it here and there, when I should have used it constantly. I took mine in to the physio's appointment too, why can't all women have access to these? The only help I received was which program to focus on and to eat more pears

Because I've had health problems for a long time now, I have seen many doctors, a lot of them pretend to know stuff, then you catch them out, many just make assumptions because they think they know best, and the ones I have respect for tell me I don't know but I will discuss this with colleagues. I think because of all the tick box medicine we have now doctors have lost the art of examining patients to form a diagnosis. Of course as women we are either hysterical, it's our age or we just have to live with stuff men wouldn't put up with! Sick of that attitude.

[SeasideSusie Remembering in reply to Hidden]

I've made good progress with the Kegal8. I bought the Ultra 20 as it has a programme specifically for prolapse. I have changed probes and the one I have now is much better than the original one (I bought my machine about 2 years ago, the probe now supplied with it is the better one). But what really upped the game was the biofeedback trainer. I've been using it for 40 weeks and it took about 8-10 weeks to to reach maximum 'squeeze' and I achieve it every time now. I use the Ultra 20 in the morning and the biofeedback trainer every afternoon. I can miss a day if I have to but I prefer to do it every day to keep my "strength" up.

I had to laugh at "eat more pears". Not heard that before. What do pears do?

[Hidden in reply to SeasideSusie]

That's fantastic Susie and you can map your progress too! More women need to be told about these devices, if they can cure urinary stress incontinence they must be very powerful things. If it saves having surgery it has to be a good thing. It's a shame the NHS can't loan them, it would save money long term.

I think the pears advice was to help me poo, she wasn't listening, I'm not constipated! I only had one appointment, what was that supposed to do?

[SeasideSusie Remembering in reply to Hidden]

After my "fight" to see the Physiotherapist, I asked to see one at my local community hospital rather then the main hospital 50+ miles away. She told me she wasn't a specialist gynae physio but had advice from the specialist one (based at main hospital). She was really lovely, the senior physio at that hospital and I think I was her first prolapse patient so she was interested in what I was doing to help myself. She had seen urinary incontinence patients before so showed me a probe with "indicator" that she advises them to buy, the indicator shows if you are performing the exercise properly. So even though I wasn't there for urinary incontinence, it's the same muscles so the principle was the same.

On my second appointment I took the instruction books from my Kegal8 devices so she could see what I was using. She was impressed enough to make a note and say she would be looking into it and informing any future patients.

I probably wasn't bad enough to need surgery (can't understand why it was suggested) and I didn't want a ring pessary, so I wanted to try the simplest treatment first - surely better for the patient and cheaper for the NHS. Fortunately it has helped me, I know it won't go away but it is much better than it was, and with the rather high failure rate of prolapse surgery I have probably avoided big problems in the future. I actually don't understand why so many people just agree without question to some procedures rather than do a bit of homework first, in some cases the answer can be much simpler, less invasive and save a lot of heartache and pain. I really think that sometimes doctors are too keen to get out the knife!

[Hidden in reply to SeasideSusie]

I agree with doctor's suggesting the knife, especially if you're a private patient! You don't get any counseling like you do on the NHS for a hysterectomy etc etc, just I can fit you in next week. I'm not sure these devices were around in 1998? But I would have used one, although everything had prolapsed badly. But after the pelvic floor repair element of the surgery I still had some uninary incontinence. Then I've read that hysterectomy can cause a rectocele, no one told me that. My uterus was healthy she told me which didn't help at all, I went into a deep depression for years. I'm very maternal and it has been really hard to live with and caused so many problems.

My hospital is 40 miles each way, no fast roads here, the whole thing is exhausting.

When I saw the physio ( once) I'm not 100% sure if she had seen one of the trainers? I would have thought they would at least be recommended, so many women have improved with urinary incontinence with them.

[SeasideSusie Remembering in reply to Hidden]

I don't know how long the devices have been around, just realised that 1998 is 20 years ago 😮

I did a lot of "homework" when first diagnosed and discovered the downsides of hysterectomy and the high chance of other organs prolapsing, I wonder if they're informing patients now. I have a friend awaiting surgery for what appears to be a calcified lump in that area, she told me they were "taking everything away". I asked if her womb, etc, were diseased and apparently they're not so I can't understand such radical surgery.

Then of course there is the massive problem with mesh repair. Plus the failure rate of the surgery. Also the potential problems that ring pessaries can cause. It all helped make my mind up that if I could do something to help myself and avoid all this then I would. Thankfully, although it's taken a long time, I'm in a better place with that and hope it stays that way.

It sounds as though you're in a similar situation regarding hospitals, a rural(ish) area with only country roads, no motorways or dual carriageways.

[Hidden in reply to SeasideSusie]

Hi Susie, no motorways here! I live on the Shropshire/Powys border, up a single track surrounded by sheep, it's very remote and rural, it's a farming community here.

I don't think there was much info around when I had the hysterectomy, I felt backed into a corner. Now I research everything, a big advantage having the internet. There are far too many hysterectomies, when more conservative treatment would be better in the long run for most patients. I have friends who were offered them for heavy periods, when there are alternatives.

Keep up the good work, great you're making such progress. I'll be doing the same as soon as I am able!!

[shaws Administrator]

I am really sorry you are suffering. I do hope everything is resolved soon and I don't know why doctors don't pay more attention to the patient who is already suffering but makes it worse.

I wish you a speedy recovery.

[Hidden in reply to shaws]

Thanks so much Shaw's, it should have been done with anaesthesia. I'm still thinking of complaining to be honest. I just hope I see her on the ward, I won't be able to hold back!

[whispers in reply to Hidden]

I truly feel for you lovely and I don't want to make you feel any worse but you should seriously think about putting in a complaint.

If you catagorically told her no then what she did was abuse by penetration. It doesn't have to be sexually motivated, when you say no they have to stop

[Hidden in reply to whispers]

Thanks whispers for your support. It did leave me traumatised, my GP was livid when I told her. Yes I started my consultation by telling her not to examine me internally. The same with my GP's and they have never attempted this because it's too painful.

When I've had the surgery I will complain.

[whispers in reply to Hidden]

I can tell how you write how deeply it has affected you and that is wrong on so many levels. its not just a complaint to the medical council that is needed its a police matter, was your partner in the room with you at the time?

I hope your health begins to pick up and you can start to put this behind you x

[Hidden in reply to whispers]

Hi Whispers, yes he was with me. He noted her attitude and that I told her not to examine me internally, and me crying out in pain but she carried on, he also heard me ask is there blood? I absolutely broke down when I got home, I had had 5 months of pain that was off the scale and I had no control over. I said to him I just can't go back to that pain. I even tried playing music in the loo to try and distract me, it's like pooing red hot broken glass. I had gotten beyond that at this appointment, I was even thinking I could start driving again, but she put me back many months.

[whispers in reply to Hidden]

you're partner needs to write down his version of events to keep to put with your complaint,

make sure your gp and everyone else you have informed already have made notes so you can call back on them too if its needed, I certainly would be taking this further once I had the strength.

[Marz]

Could it be that the problem is further into the bowel - maybe Crohns - IBS or Colitis ? The end result - pardon the pun - could be caused by gut/bowel inflammation.

[Hidden in reply to Marz]

Marz, yes I have really inflamed skin there and I know fissures can be a result of bowel disease. I have had 20 years of diarrhoea after a hospital infection but that has eased considerable in the last 2 years. My consultant is now going to do a colonoscopy while I'm under. Last time I had one I had to admitted as an emergency with heavy bleeding, I've told my consultant about this. He told me you don't usually get any kind of discharge from a fissure and he thinks there's an ulcer in there too.

[Marz in reply to Hidden]

I am inclined to agree with your Consultant ... I was diagnosed with Crohns almost 45 years ago after Gut TB. Are you gluten free ?

[Hidden in reply to Marz]

Yes Marz, 100 % gluten free since September. I had read some people have healed their fissures by doing this. There's something going on in there because it bleeds so readily. Last time I took antidepressants, years before I was diagnosed with Hashimotos, my rectum cracked and bled and it was just awful. I saw my GP for an emergency appointment and she said to never take them again because of this.

How do you cope with Crohn's? It must be awful for you.

[Marz in reply to Hidden]

Am fine and do not take any drugs. Have had several op's with complications but managed to keep up ! Guess now I am 71 everything slows down including the bad bits 😊

Have recently gone dairy free too ! How are your T3 levels ?

Hope things soon improve for you.

[Hidden in reply to Marz]

Gosh I can't believe you manage without drugs. Sorry you had complications from surgery too. Is being dairy free helping you?I confess I love dairy, I drink far too much milk.

I haven't had a thyroid blood panel for years and to be honest that's how I like it. My GP knows I'm self medicating and she's leaving me to it. I take NDT and liothyronine, so hopefully my levels are good.

[Marz in reply to Hidden]

Am sure you are right - your T3 levels should be good 😊 I miss my cheese and yogurt - am not a milk drinker - but have read it is an inflammatory food so seeing how it goes. Drugs for Crohns made me more ill back in the early days so .... check out milk and see what you think .... I grew up on a Dairy Farm too and have never been able to drink milk ! Hope you soon find some comfort ....

[Hidden in reply to Marz]

Maybe I should cut out dairy then Marz? I drink 1 1/2 pints a day, plus I occasionally have cottage cheese or brie, I love butter too, and Greek yogurt

I hear what you say about drugs, they can only do so much, you have to change your lifestyle accordingly too. If yours made you worse then there was no point taking them.

I live in a farming community, mostly sheep though as we're in the Shropshire Hills. A little dairy on the valley floor, what a wonderful childhood you must have had!

[Marz in reply to Hidden]

drhyman.com/blog/2017/07/27...

I follow this website - both Dr Hyman and Yeotown Perhaps there is something useful there for you

[Hidden in reply to Marz]

Thank you so much Marz, I will definitely read this!

[Marz in reply to Hidden]

The article title is - Are you still consuming dairy ?

[Hidden in reply to Marz]

I've read it thanks Marz, I will cut down on dairy, but I'm not cutting it out. It's difficult when you know farmers who have gone to the wall because they aren't getting a good price for their milk, and milk consumption is down. At least here the cows feed on meadow pasture, and they keep their calves with them, so it's not all bad.

[Marz in reply to Hidden]

Hope all goes well ...

🌹

[Hidden in reply to Marz]

Thanks so much Marz, you've been really helpful. X

[Hillwoman]

Hi Helcaster, I'm so sorry to hear of your latest health problems. All I can offer is another bucket of sympathy to add to SeasideSusie's, and some encouragement to you to make a formal complaint. I read your account of the examination with my jaw on the floor. Try complaining to the hospital Chief Exec first, rather than the usual complaint route - husband tried the CE twice and immediately got more attention on the problem.

[Hidden in reply to Hillwoman]

Thanks for your advice Hillwoman. I'm glad I told the consultant how his registrar behaved. After my surgery I'll take it further, I don't want to add to my stress for the moment. Thanks for suggesting the Chief Executive to complain to, i know PALS are a total waste of time!

[nightingale-56]

So sorry to hear that a thoughtless and careless doctor has made your problems worse. I often give you a thought as I know you have interstitial cystitis. I have recently twigged that it is gluten(or wheat) that causes me cystitis-like pain in bladder when I eat it. I have been gluten-free for about 20 years now, but fall off the wagon now and again. Really checked it out over the past few weeks and now I am sure. Hope being gluten free helps you feel better. Wish you well.

[Hidden in reply to nightingale-56]

Hi j_bee, I'm really pleased you've found a trigger for your bladder pain in gluten, and it's easy to irradiate, it must be such a comfort to you. Anything acidic sets mine off so I eat a very bland diet and the only fruit I eat are apples and pears. Drinking gallons of movicol since September isn't helping my bladder at all, although I have the one that isn't flavoured. If I don't just drink water or milk then I quickly get pain.

One positive at least I'm losing weight lol!

[nightingale-56 in reply to Hidden]

Unfortunately I haven't got an answer for the constipation problem, but that is not too bad at the moment so long as I have some sort of salad for lunch and vegetables of an evening. I do find that walnuts and dried apricots help though, and always have Movicol to hand as my insurance. Hope you soon improve.

[Hidden in reply to nightingale-56]

I'm not constipated j_bee, it just doesn't move! It's like trying to poo through the eye of a needle, everything is just so tight. I made stewed pears yesterday, so that was 5 pears I ate in two sittings. I also had lentil soup for lunch and had 4 veggies for dinner, I don't even eat potatoes, or anything with a cornflour sauce, or grains, because they firm things up. I drink 4 litres of water a day to keep my bladder happy. I'm taking 3 movicol, and 3 dulcoease a day to keep things runny or I wouldn't get anything out

[SeaVee79]

Hi helcaster.

So sorry to hear your pain. I have suffered on and off with fissures for about 20 years. When I was in my early 20's I had a sphinterectomy which I immedietly regretted as it didn't heal and then instead of 1 fissure I now had 2. It took me a few years and a bit of deep soul searching (I wanted to look at whether anything emotional might be hindering my healing) but I finally managed to get it to heal up for a while. Physically a natural 'laxative' called Ortisan did the trick... I found the only way to get it to close up was to keep my stools as soft as possible. Ortisan allowed me to do this with no other side effects (like the ones I got from long term lactulose use).

After I had a baby 4 years ago it opened again and it took a while but i managed to heal it in the same way then just after chrimbo it opened up again due to me becomming hypo and prob also eating too much rich food and I've just managed to get on top of it now.

However.. if you have had long term diarrhoea then I guess hard stools isn't what is causing your problem to persist. It sounds awful and I know just how horrendously painful a fissure can be and how much it can affect your mental health. I hope you can find something that works. Sending strength.

Chloe

[Hidden in reply to SeaVee79]

What an awful experience you've had. I'm so sorry because I understand what you've gone through.

The colorectal surgeon doesn't want to cut into my anal sphincter because my pelvic floor is so bad, I would definitely have incontinence. The surgery is taking a flap of healthy anal tissue, to use it as a patch over the scarred tissue and fissure. The only complication is if the patch doesn't take and dies.

I've been trying to heal this for 5 years, I make sure everything is very soft, but this time according to the surgeon everything is very swollen inside, my poo is like spaghetti, if things weren't almost runny I wouldn't get anything out. I'm never constipated just motility issues, and my rectum had prolapsed again, so I have to strain like crazy to move anything. Believe me I have tried everything to heal it, I've completely changed my diet, I no longer have gluten free porridge for breakfast, I have an avocado on one slice of seeded gluten free toast, followed by a pear, lunch is a high fibre soup with lots of pulses, and dinner is fish or meat with 4 veggies, then I'll eat an apple.

The pain is truly awful, mine is constant, passing a stool makes me feel faint and nauseous. I have had no control of the pain, that's the worst part. I couldn't stand for the 2 minutes it takes to brush my teeth, that has improved, and I can stand in the shower again, thank goodness.

I had a high forceps delivery, after an induction and the oxytocin drip was on full blast the whole time, I had my first baby in 6 hours. I then went on to have 4 babies in total, 2 over 8 lbs plus one 9lbs 4 0z. With my second child the episiotomy wasn't pulled together properly and stitched. I remember the junior doctor saying you're my first one to stitch she left a big flap hanging out that the gynaecologist said was as big as a turkey's parsons nose. I had surgery to deal with that 2 years later.

Yes it does affect your mental health, there's no quality of life. It has really affected my interstitial cystitis too, the pain seem to transfer to my bladder, there are times I couldn't pee, or it was excruciating to get a trickle out. Thank goodness for my bidet, what a godsend at a time like this.

Did you every get a discharge or sentinel pile with your fissures?

[Marz in reply to Hidden]

You were possibly Hypo when you had your children - me too ! But not diagnosed for another 39 years Dr Barry Durrant-Peatfield mentions in his book - that big babies over 8.7 lbs indicates the Mother is Hypo ... I know too late but .....

[Hidden in reply to Marz]

Dr Skinner thought that the trauma from the first birth had triggered Hashimotos, or it could have been glandular fever when I was 19. I had had it at least 20 years when he saw me. I remember going to my GP with exhaustion and weight gain in the early 90's, she didn't test my thyroid, but said my white blood cells were elevated and it should be followed up, it never was.

3 of my babies were well over 8.7 lbs.