BOTOX INJECTION IN MUSCLE FOR ANAL FISSURE OUTCOME

Sounds familiar 'TMI' - I was too taken into hospital - exactly one week after a 2nd round of Botox - also on morphine drips and other pain meds.

After several days I was well enough to go home but its taken my around 6 months to get pain under control.

I put the extreme pain down to a not successful botox treatment and being hacked around whilst under.

I will NEVER again go in for any treatment - let nature take its long course.

I do hope you get better real soon. Like you say the pain is intolerable and wrecks your life at its worst.

Hi. I have been tortured by an anal fissure since November 2013. I finally couldn't manage work in late January and have been off sick since then. looking after my children has been such a challenge too, mainly because I struggled to stand up as this triggered spasms. 6 weeks of GTN 4% and Lidocaine didn't provide much relief. After being pretty much bedbound and still in excruciating pain I went to A&E twice in 3 weeks. The second time I went, 6 days ago, I was admitted to hospital and a number of colo-rectal surgeons met with me. I was given Morphine to help the pain in the short term and then yesterday finally went to have a Sigmoidoscopy, a camera procedure, under general anaesthetic, to make sure it was just a fissure. When I came round after the anaesthetic, they confirmed that I did have a nasty fissure but that they had injected the muscle with Botox to tackle the spasm issue. It is thought that once the muscle is relaxed, the fissure has a better chance of healing alongside the ongoing use of GTN ointment. I was allowed home the same night and was in no pain whatsoever (assuming this was due to some local anaesthetic too. This morning I have had a bowel movement which triggered a slight stinging pain, but after a very short lie down this subsided quickly. I have not used any pain relief medication since prior to the procedure and will continue to take Movicol in an evening to keep my stools soft. Although I have felt some mild twinges when standing, these have settled quickly with short rests, whereas before I could find not respite and had excruciating pain. The Botox actually takes up to 14 days to take full effect but already it is so far so good. I will keep an ongoing update for all those who are interested. Thanks

I had Botox nov 2013- gave me fantastic relief until xmas, then gradually the fissure and pain and spasm returned. the worst thing is I can't get a BM without using my hands, the spasm is too strong.

The issues started in July 2012 and I returned to surgeon last week who wants to operate with a flap?

I pleaded fo further Botox but it is getting me own and because I can't exercise I'm getting fatter.

My work involves travel and that is getting mor difficult- I like to be near my wn bathroom?

ANy ideas to avoid surgery?

Thx

I‘m really sad to hear that your fissure comeback after Botox, these things are just horrific aren't they?! Is it worth going onto short term laxatives such as bisocodyl to keep your stools very soft and then using GTN ointment 4% as frequently as you can tolerate it until you are healed. Lidocaine anesthetic ointment may give you half a chance of some comfort as well as something warm like a hot water bottle to relax the spasm if you cant get to a hot bath. My doctor said that keeping stools softer is the main way to prevent recurrence so diet overhaul is the main goal. Never ever force whilst on the toilet, better to get some assistance via short term laxative or the fissure will keep splitting. Are you Abe to have the Botox soon?...

Hi fellow sufferers, I've been reading this discussion on and off for the past couple of years but decided to join in - mainly to see if talking helps the pain! - after the last two hours of pain to the point of screaming.

I'm a 45 year old male who has had rectal pain since the early nineties. Over the years I've been diagnosed as having piles when I haven't had them, not having them when I clearly have, I've had a sygmoidoscopy twice, both times failing to find anything wrong, tried every cream available on the NHS (including being told exactly how much one of them cost, as though I was a one man drain on the entire budget) and have battled with constipation with little or no help since year dot. Finally a few years ago a pharmacy assistant suggested Movicol, which has been a revelation. I take a sachet a day, and up to 8 during bad periods. Sometimes, however, it has no effect for hours, and other times, due to the extreme nature of my spasms, even passing (sorry!) liquid faeces hurts like hell.

Last year I saw a consultant in Canterbury who insisted I take a gut motility test - swallowing traceable capsules and over a 7 day period with no laxatives being x-rayed several times. Deep joy. More constipation, more pain. Anyway, he put me in touch with a colorectal specialist at Medway Maritime hospital with a view to having botox. He also failed to ever get in touch with the findings of the motility test. I had a consultation last June and was finally operated on last Wednesday, after much prompting from me and finally my GP.

After the op the consultant spoke to me the minute the general anaesthetic wore off, so I have no recall of what he said. I was in so much pain I was given, over the next two hours, five lots of morphine intravenously and released with no aftercare information and a packet of codeine pills. Oh, and some paracetamol! I was in extreme pain which, like all of us, I am used to but this increased over the evening. I couldn't urinate and my abdomen swelled up and so we rang 999 and I was taken to Ashford A&E, having more morphine in the ambulance. The paramedics and the A&E staff were fantastic, but all I got was a catheter and more morphine. Since leaving hospital I have eaten only soup and bread, drank lots of water and vegetable juice and taken movicol up to ten times a day. Most of the time pooing has been not too painful, as I am passing virtually liquid. I had the catheter removed yesterday as it was clear to me that I'd only gone into retention due to the severe pain, and I'm urinating fine now.

However, since last night the pain and burning have increased ten fold. When I go to the toilet I pass very little but have explosive wind that HURTS. I'm not sure if it's because I don't have enough in me to pass, that maybe I should be eating more, but I'm equally scared of eating too much as if it hurts like this now, I imagine passing even a soft stool would be too much to bear. I have baths that have no cold water in them, as anything cooler offers no respite, and my spasms seem to be back to the level of the bad old days. I feel on the verge of despair, the pain is indescribable, and I'm wishing I never had the op. The only pain relief I have that has any effect whatsoever, and that incredibly limited, is codeine or co-codamol, which I'm loathe to take.

Sorry for such a long post, I just needed to get that off my chest. Can anyone vouch for the efficacy of diclofenac? Anyway, thanks for reading, and thanks to all who have posted - it's so nice to know it isn't just me, that I'm not just making a fuss or have a particularly low pain threshold.

Jamie

Hi Jamie

At the height of my fissure I was taking Dicolfenac and I cannot say on its own it made me pain free, as I was taking Diclofenac, Traumadol and Paracetemol at same time - sometimes Naprosyn as well.

I had had 2 rounds of botox and never again will i let them near me - made things worse 2nd time around - I was rushed into hospital a week after the op and had to be given morphine drip and various cocktail of pain meds to get me out of agony.

I got some semblance of normal life after I discovered Macrogol (which I think is ams as Movicol) - i got onto anoheal (Diltiazem)

http://www.stmarksfoundation.org/uploads/docs/patientinformationleaflets/PIL%20Diltiazem.pdf

between perservering with both the cream and macrogol - my poo eventually became less violent and more dropping out without exertion. The cocktail of liquids I took previous just gave me piles and that in turn made everything worse. My advice is keep of of anything that makes your poo liquid (easier said than done if your sphincter is in spasm) but as soon as you can. Like you passing wind hurt and as good as it was to even get wind out the payback was it hurt!

Also, like you I had a doctor tell me the cream was over £100 a tube too which I replied 'well prescribe it - because Im worth it' humour can sometimes involuntary kick in despite the hell of the pain associated.

Is it a fissure or very bad piles you have (or both)?

Hi Jeff,

I have a chronic fissure and two piles.

Do you think that keeping poo liquid is detrimental? Like I said I'm wary of letting things firm up to a soft stool, and of course have been given no info from the consultants. In an ideal world I'd have everything between my lower intestine and bumhole ripped out and replaced with ceramic and surgical steel. Think I'd need to go private for that? :O

I totally relate to the need for a surgical steel rectum. Jeff is most experienced here i think....Jamie it sounds awful! was it botox that u had? My update 2 wks post botox is: spasms are less frequent but still very intense when they come (roughly 30 mins x 4 daily compared to relentless prior to botox) Still triggered by BM's and standing for too long (max painfree standing time is 10 mins). Im also not happy that its causdd tissues to sag due to relaxed muscles, it feels like hemorrhoids but isnt and it rubs too! Have tokeep it lubricated bot to chaff the fissure now. Nightmare! I spoke to consultant who is convinced botox will still be taking effect and that at 2wks its too early to say that its not working (ive noticed some are pain free right away) He said that In 6wks he believes I will be better. Question is, will I get to 6 weeks and still be sane?!..Thats 5mths of sufferring and being jnable to work. Im heading for half pay at 6 mths off on sick leave too. we will see what happens. I am glad the pain stops more quickly but having to lie down all the time or bathe isnt practica. At least its l

lessened but theres still an anxiety and dread knowing I still have to deal with the pain for an unpredictable amount of time. Ive gone back to stimulant laxatives until im healed as they are most predictable and reliable one for me (most detrimental too I bet).

Hi Jamie

I totally relate to the desire to keep poo liquid as I made sure that it was water like in order to actually go without excruciating pain. What the rush of liquid poo (sorry it's difficult to be descriptive without being a bit gross) did was cause more piles as that sudden rush is an express train to more piles. So getting away from things that cause diahorea such as senokot max or hydrochloride magnesium is best. I take Macrogol or Laxido, normally 2 sachets a day, which normally keeps poo soft and somewhere in between hard and runny - if I have anything resembling a hard poo my healing fissure will grumble.

It's been around 2.5 years or more since this all kicked off and I am thoroughly fed up of it but what can you do except fight it and try to get better. I'm 51 so I guess as you get older your muscles get weaker and your more susceptible - I have a large bastard external pile appear which I am terrified will thrombose so doing what I can to stop that happen. I had a thrombosed pile before and that is agony. Got it through coughing too much from chest infection and sinusitis.

My consultant was at Salisbury district hospital and although sympathetic I kind of get feeling that treatment and aftercare is totally inadequate. Consultant said pain from fissures has had him see 6ft rugby player weep like girl as it is so unbearable. Having someone around you who is sympathetic and understanding is important. I sometimes wish there was a local support group as talking with others with same problem would help.

Whilst a fissure is actively open and raw it's essential I think to get the area cleaned ASAP after bowel movement - so hop right into shower and squirt water up there till it's totally clean.

Get proper pain meds from GP - a rotating set of Diclofenac, Traumadol, Naprosyn and Paracetamol (500mg) was what got me through post poo hell. Drink loads (min 2ltrs) water a day.

My experience is that fissure can heal but it is by no means a cure - it can reoccur/reopen and piles are but a strain away - your going to need a lot of strength to get through it and it will feel lonely at times and unbearable.

At least popping on here to chat is one way . . .

Worthy of mention - to relieve stinging after trip to loo I used distiller witchazel - get it from Boots or Superdrug - soak 2 cotton pads (ones you use for cleaning face) in the witchazel and apply directly to area of fissure - helps to gently clean area and soothes.

Also, if your anal muscle is in spasm your GP can prescribe diazepam (Valium) which as well being used for depression helps the body to relax - I used it for a month and it helped ease me up when at worst.

TMI and Jeff, thank you for your kind words and advice. I have a GP appt this morning - telephone, of course - and will ask for better pain relief and maybe that 2% cream I keep hearing about. I will also ask for some injectable anaesthetic gel. I was given this a couple of years ago after a pile thrombosed and I was taken to A&E. I'll get some witch hazel, but am stumped as to how to put ANYTHING in my bum without clenching up and/or screaming the house down!

Hope your doctor was sympathetic and gave you what you asked for?

The thrombosed pile is just agony squared and the worst thing is that unless you get seen with 48/72hrs A&E won't touch it. The their is the skin tag associated with thromboses pile - like a balloon deflated - oh the bloody joys!!!

I think a sense of humour is the thing that's helped the most. If you can crack an inappropriate gag between gasps, you're not letting it get the better of you I got a home visit after getting slightly narky with the GP in a phonecall, after she said 'can I ask why you can't attend surgery?'. They sent a young trainee who was, in all fairness, concerned and listened to me. I have tramadol, naproxyn and dilblahdeblah 2% cream which my wife will get later. I'll also get some witch hazel and I've been slathering on the Betnevate, which seems to help to a degree.

I think that, while in med school, doctors should be put through some non-injurious pain to varying degrees, right up to what we suffer, just to put a little understanding and humility in them. I appreciate they use our pain as a gauge, and have to remain impassive to a point but the Johnny Ball think of a number aspect of grading discomfort doesn't mean much. I told the guy today that it was a cross between having a lit cigar shoved up your fundament and a well-sharpened pencil stuck into the side of your rectum. He at least had the decency to wince!

Well done on getting some proper pain med and I liked your informative description for the young trainee! :-)

Keep us informed how you get on . . . I got some diazepam today - my doc is at least willing to give pretty much anything I ask for which is the opposite of what some doctors do.

Jeff ;-)

Im glad you got the supplies Jamie. Fingers crossed!

Finally a pain free day for me (probably due to no bowel movement and lay horizonal all day). Im dreading the loo trip tomorrow as I feel human again now. Im lucky enough not to have the hemorrhoids like you guys but also need to avoid falling victim!

best wishes

Ps A bit like Jeff's witch hazel wipe, i use some Dr Organic teatree wetwipes from Holland and Barratt. Same principle, nice and soothing. I might try the witch hazel too.