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Small prolapse after anal fissurectomy?

Posted , 2 users are following.

bud-hertz
bud-hertz

Hello folks,

I'm week 4 post-op from my fissurectomy with sphincterotomy, and I'm still experiencing all the pain and blood I've seen posted elsewhere in these forums.

However, I'm having additional symptoms, or at least I think I am. A BM typically goes something like this:

  1. Very sudden urge to go to the bathroom, as though holding it in for a minute more will result in incontinence (and sometimes does before I can make it to the bathroom from say, the bed.)
  2. Immediate evacuation of mostly particulate and blood, plus maybe a single small solid stool if I'm lucky.
  3. The feeling of another, more meaningfully sized stool coming almost all the way out, but then stopping. However, there is almost never an actual stool down there, but I will feel my rectum bulging out as far as 1/8"-1/4".
  4. Once I have this "hung" feeling, it's almost guaranteed very little more stool will actually come out. I might pass some more blood (either fresh or clotted), or even some more particulate stool, but rarely anything more.
  5. Sometimes I can succeed in evacuating another stool by standing up for a moment, focusing on relaxing the rectum and even manually pushing the bulge back in. I'll then gently rotate my torso from left to right while rubbing my belly beneath and slightly to the left of the navel. But, I generally can't attempt another BM until I feel that super urgent feeling from step 1. Otherwise, when I sit down, I feel the bulge from step 3 start to almost immediately bud back out.

Essentially, I feel the only way I can poop is if I evacuate everything before the bulge comes, which is a window of about 10-15 seconds, if that. Otherwise, I have to stand up, relax, and wait for the explosive gas feeling to build back up.

My fear is the sphincterectomy-as intended-loosened the anal muscle that held my guts back. I do have a precedent for said bulge (prolapse?).

I had a leg surgery a couple years back, and the anesthesia and heavy duty pain meds made me extremely constipated-like 9 days with no BM! Finally, after some laxative suppositories and good old fashioned straining, I felt a stool pass, and shortly thereafter felt the bulge happen.

I’d told my surgeon about this, but they didn’t seem to think it was a big deal. I’ve mentioned the word “prolapse” in my follow up appointments, and he still doesn’t seem convinced that’s what I’m experiencing. The first hypothesis was irritation, so I was ordered to stop using baby wipes and stick with tp. The second hypothesis was an impaction, so I downed a bottle of magnesium citrate and suffered a day and a half of hyperactive BMs 3 weeks post op. This is obviously no fun with standard fissurectomy recovery symptoms, but made much worse in conjunction with steps 1-5 above.

I’m honestly in the process of seeking another opinion. But what do y’all think, have I convinced myself that I have a prolapse, and my surgeon is right to more or less rule it out? Or does this sound like what a prolapse feels like? If so, what do you think are the implications for my fissurectomy recovery?

Thanks for reading my wall of text.

0 likes, 2 replies

2 Replies

  • bud-hertz
    bud-hertz

    Posted

    Additional info:

    1. I was on Colace for a while, but have switched to Miralax. Take this twice per day.
    2. I take 2tbsp of psyllium husk twice a day with water
    3. I eat a high fiber diet
    4. I probably visit the toilet 4-8 times per day, leading to some pretty miserable afternoons and evenings. Most visits are pretty insubstantial as far as actually mass of BM goes, but there’s always plenty of blood and more recently, clots
    • rej31770
      rej31770 bud-hertz

      Posted

      First, I would seek a second opinion. Second, I would highly recommend stopping the fiber supplements. It creates too much bulk to be able to pass your stool quickly and efficiently, and you're taking a very substantial dose. I also thought I had a prolapse post surgery. [I had LIS in Oct 2018] I had the same feeling of "bulging". I talked with my surgeon and he said that the area is very swollen post op and that if I was having to strain at all or go more than 2 times in a day, that would cause the swelling to become worse. I stopped taking the fiber supplements. I started a week of OTC senna laxitives (approved by my doctor). 2 tablets the first night before bed with 16oz of water then 1 tablet every evening before bed with 16oz of water for 6 days. In that week I had easy BM's every morning with no straining or excessive bulk. It really allowed it to heal and settle down so the swelling reduced immensely. I also did 3-5 very hot sitz baths a day. I now take 400mg magnesium citrate in tablet form and 100mg colace every evening before bed, and I drink close to a gallon of water a day. I hope you can find relief soon. Having to deal with this every day is just awful.

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