Some Advice

[david65]

Hi,


I am having a terrible time trying to heal my anal fissure. I basically have two options if this does not heal.

First there is the colostomy idea. Irrigating may work or not. Probably will but is tricky.

Secondly, I could have the sphincter muscle cut. They say that 95% of patients heal this way that have it done. Unfotunately, chanches are none of them were SCI. Does cutting the sphincter muscle keep SCI's from having a bowel movement?

[crags]

have you had a surgical consult. with surgical intervention and cauterization it should heal.

i had a fistula, worse than a fissure that was taken care of in day surgery that healed fine.

[david65]

Crags,



Thanks. I read where one other person (non SCI) got healed by cauterization. I guess the location of the sore matters too. Mine is external but it still gets irritated some times. I don't even sit up, so that it may heal? I have been to three doctors that wanted to cut the sphincter muscle. Is this procedure the one you are saying when you say "surgical". I have had the colostomy in 2001 but didn't irrigate. Then an ileostomy in 2002, but I didn't get the full healing from my food. I am very leary about cutting the sphincter but if it works - it would be easier.

[SCI-Nurse]

David --As crags asked, are you being seen by a surgeon to discuss further options? PLG

[david65]

Yes,


I have a colo-rectal doctor in Mankato, two hours away. He has given me the option of getting rid of the ileostomy and get a colostomy. I chose to try bowels with a suppository because of what happened when I had the first colostomy. (didn't irrigate)

After I had my ileostomy reversed in late August this year, I had two bad days of diahhrea that may have compromised my full recovery. The constipation was no help soon afterwards.

I don't know if the doctor is still willing to do the colostomy and if so when? It has only been 5 weeks today since I had the ileo reversed.

Is there another way?


David

[Curt Leatherbee]

Wish I had some ideas David, but not really sure. Cutting the Sphincter though sounds kinda radical, I Cant believe they are recommending this, theres gotta be a better way.

"Life is about how you
respond to not only the
challenges you're dealt but
the challenges you seek...If
you have no goals, no
mountains to climb, your
soul dies".~Liz Fordred

[betheny]

Hi, David, it's your rectal problems pal here. I've been contemplating re-visiting my colo-rectal specialist again for this stubborn and painful fissure.But I found an excellent website-http://www.boardsailor.com/jack/af/patient
There are a whole lot of stories and suggestions re anal fissures here, both surgical and non-surgical.
How did the nitroglycerine ointment work out? 0.2% mg 3X dly and after BP is said to heal around 80% of fissures w/in 12 weeks. Unfortunately, it cratered my blood pressure too far. I suspect that none of them have this spastic rectum, sci-related, which I think you and I both do.
As always, fiber, water, motion, warm soaks, less red meat...This seems to be lifestyle related. I don't want the surgery. I'm afraid of even more incontinence. I do pretty well, but any accidents are too many. Please chech out this website, let me know what you decide.Good luck..Betheny

[david65]

Betheny,


The doctor gave me a substitute (called - Diltiazem) on the nitro. It is suppose to be like nitro but without the side effects. I did not use it yet because moisture has been one of my worst enemies from the very beginning.

In December of 2000 I was in the hospital after Christmas with my new colostomy. Everything was going great the first two days. Basically my fissure was not much bigger than a match head; if that even! OK, day three and I am having chills (natural for me), didn't sleep much in 3 days so I crank the heat up, put on 4 covers and asked the nurse for a pain med to help with my chills. She gets this stuff to going into my IV too fast and I am trying to open my eyes and I just can't do it. I guess I feel asleep briefly... and that is when things started turning out bad. Another nurse came and stuck a gauze pad with zinc on it while I was a sleep.

Zinc is suppose to be used with little pressure and no heat. Just read neosporin. I had already had a burn from this in May earlier that year. Well, anyways - My anus felt like it was on fire all night until noon the next day. I asked my mom to look at me and that is when we found the gauze. We thought the worst than just a burn. A yeast infection would be terrible so we thougt that. I have had yeast in my groin, so there we go.

The general surgeon soon comes in, looks at it, gets a strange look, and says, "that was not there yesterday. He never said it wasn't yeast so for 5 weeks - I am putting lotrimin on my tail. It (the moisture) just made me hurt, then I started to get up and that is mainly why the first colostomy did not help me.

I don't even know if my colon can relax now. I am in a state of colon spasms most of the day. Just trying to get that calmed down before something else happens. I think a lot of the pain and spasms are from the fissue I hope. It does not bleed eveyday and may be getting better. I don't dare sit up - may regress further and too painful even laying in bed. I would rather get a colostomy instead of a sphincter opertion if I had the choice. At least a colostomy is usually reversable and the pain goes away unless it breaks open again. Irrigating will get a lot easier in mid 2005 if the colosomy was longer term. Here is a link to a new product being developed.

http://www.zassimedical.com/products/cop.asp





David

[This message was edited by david65 on 10-04-03 at 12:10 PM.]

[This message was edited by david65 on 10-04-03 at 12:15 PM.]

[david65]

Also,


I wrote my doctor yesterday about a botox shot. I mentioned it to him back in May and he more or less didn't say anything on the subject, he just wanted to know where i got the botox idea. That is why I wrote him yesterday to get his view on the shot. Botox is suppose to numb the muscle for 2 or 3 months - it is also suppose to help the feelings of pain .... It can be dangerious I think, Botox is a poision... ?????????

[SCI-Nurse]

Thanks everyone for the great suggestions to David. Good luck David with your decision. Not an easy one for sure. PLG

[betheny]

David-
Read up carefully on the botox. It would seem to me that it would eliminate spasms, as it paralyzes the target site. However, there seems to be some controversy about it.

The surgery doesn't look like that bad of a deal. It would not prevent you from having BM; I'd be afraid of the reverse, actually. Get a GOOD surgeon if you go this route!

On that website I suggested, there was a woman burnt pretty badly w/Lotrimin. But this brings up a point:
SCI Nurse, how is a wound in this area to heal with the constant presence of germs? What keeps it all from being a giant abcess? Betheny

[david65]

Betheny,


I use collidial (sp.) silver to disenfect and then I try to keep dry, no powder. My wound is not internal but good hygeine can still be difficult. If you wound is opened then vitamin A can help to fight of infection. Vitamin C is also useful in creating new skin and fighting infection.

[SCI-Nurse]

Cutting or paralyzing the sphincter in a person with a SCI and a upper motor neuron bowel would make evacuation easier as you would not have to "fight" the spastic anal sphincter, but it would also convert your bowel to a lower motor neuron bowel. Those that have this condition have more difficult bowel programs, as there is nothing (muscle-wise) keeping the stool inside the rectum, so it is common for stool to come out with any straining (ie, during transfers, standing, ambulation, heavy wheelchair pushing or other exercise, etc.) that involves any valsalva. Most people with LMN bowel must do bowel care at least daily (manual removal and straining if they have abdominal muscles) and many find they must do it 2-3X daily in order to not have accidents. The stool must be kept on the very formed (nearly hard) side as well.

(KLD)

[david65]

SCI Nurse,


Can you elaborate on the lower moter neuron bowel part again. Does a SCI with LMN still use a suppository and do they still have bowel function except for incontinence?

Are there any SCI's who already have LMN bowels, like paraplegis or low injured SCI's. I

[SCI-Nurse]

David, a person with a lower motor neuron bowel has normal peristalsis and smooth muscle bowel function just as someone with an upper motor neuron bowel, so most still use a suppository, although not dig stim (which is designed to relax the anal sphincter). The only difference is the voluntary (striated) muscle at the external anal sphincter.

(KLD)

[david65]

SCI Nurse,

So does all Lower Motor Neuron bowels require digging stool out to evacuate, or does the rectal area still have the ability to eliminate waste as with the other bowel type.

I am trying to determine the distinctions correctly. Is basically, the only differences the incontinence or is defication require probing with the finger for any and all evacuaion of stool. Is a botox shot neccessarily going to stop the reflexive part to fail, the sphincter muscle does not aid in a bowel movement or prevent the reflexive part either is my main question. It would not help my fissure to manually remove stool, but yet on normal people, a botox shot has a high success rate on fissures healing. I doubt it they dig out stools?

[SCI-Nurse]

Many people with lower motor neuron bowel problems do manual removal of stool, or, if they have abdominal muscles often staining (valsalva) is sufficient. Stool essentially falls out. The anal sphincter provides continence to some extent in people with upper motor neuron bowels, and stool may stay in the rectum for some time until bowel care is done. In people who are AB, Botox may be used to slightly weaken, but not paralyze the anal sphincter, and they also have the advantage of being able to feel as soon as stool enters the rectum, giving them time to get to the bathroom before having a bowel accident.
I am certainly not an expert on anal fissures, but I will try to ask our GI physician about this when I seem him next.

(KLD)