Refused Surgery

Hi guys this is my 1st post here so bear with me....I'm 18 and ive had this fissure since i turned 17...its a worrying thing for a 17 year old to see blood in the toilet....ive been through the whole process of being told it will go away but ive been taken into A&E twice because i constipated myself for a week i was THAT scared of going to the bathroom....ive also been told by my own family that im exaggerating the pain but i think they realise the severity of it now....anyway i had to undergo a colonoscopy (?) a few months ago to check for crohns, colitis etc but came back all clear and they told me the fissure was 80% healed and it should be healed in 4 weeks...but months later here i am still in pain!!! they are still refusing me the surgery (& possible relief) because of my age even though the surgeon has never rendered anyone incontinent before and i will have to go private if i want the botox treatment (expensive & still not guaranteed success) the weird thing is its only painful when i go to the toilet and i never really have those spasms where u cant sit down

p.s. everytime i go to the toilet i am using glycerin suppositories because the outpatient department told me to

Its really getting me down because I feel like ill always have this what should i do next anyone?

Hey kyriakos,

Whereabouts are you located? Are you in Greece? Just guessing based on your name and the fact that you mentioned Accident & Emergency, a term I only learned (I live in the US) when I worked in Europe (Norway) for a few months.

Anyway, I'm sorry to hear about your troubles. I can't help much because I'm only just starting my own battle with a fissure (complete with the painful spasms that make sitting down very uncomfortable), but there are lots of other nice folks here who will chime in. I definitely know what you mean about the pain, though, I think it takes someone who's had one to really understand how bad it feels.

I was wondering, though, have the doctors offered anything else to try other than the glycerin suppositories? I'm currently trying topical 0.2% nitroglycerin ointment for my fissure (not sure if it's helping yet), and I know others have tried ointments based on Nifedipine and Diltiazem. My doctor didn't know anything about any of these, and I had to tell him to look up 0.2% nitroglycerin before he would prescribe it to me. I'm not sure what the case is in Europe but I know in some countries this kind of ointment is available from the chemist without any prescription.

Anyway I'm sure someone with more knowledge and who has beaten their fissure will give you better feedback soon, but for what it's worth, I completely understand the terrible pain, both mental and physical, this condition causes...

hey, im from britain with greek parents....im on diltazium cream because the nitryglyercin gave me the worst headaches imaginable...and you're right when u say only a person who's had the pain understands it

Ok dang looks like you're actually ahead of me as far as the treatments you've tried And man you're up late (or maybe early) today! I know what you mean about the nitroglycerin, I get those weird throbbing headaches and lightheadedness with it too.

Is it only because of your age that the doctors won't refer you for surgery? My doctor was willing to refer me to for surgery right away, in fact he did it before even telling me to try more conservative treatments. So I kind of had the reverse problem.

Anyway I'll let the more experienced folks on this board try to help you some more, there are lots of them here but they're probably mostly off for the evening already. Please stick around, these guys have been a HUGE help to me and I'm sure they'll have some ideas for you.

Take care, and cheers

the headaches i had with nitro were so bad i was rolling out of my bed in the pain :/
yes he said because of the incontinence risk they wouldnt do it for someone of my age so im considering looking for someone who will

thanks u too

Kyriakos,

You can check Kim's sticky threads for starters; they give a lot of info here. My fissure healed and many others here have as well. Good for you that you don't have Crohn's or colitis. Your current condition will not always be this way. There are many options available to you after ointments--Botox or LIS. Are you keeping your stools soft? That is a must. No others can understand the mental and physical angst that goes with having an AF. A/D's have helped many deal with the mental anguish. Yes, you are up in the middle of your night!!!

Welcome to the board, Kyriakos. Did they tell you why being 18 is too young for the surgery? That's sure a mystery to me. How long have you been on the diltiazem? It takes it about two weeks to begin to help. Botox is also another option, as mentioned, though the success rates are about the same as diltiazem. Are you taking as many hot soaking baths each days as you can?
Yes, only someone who has gone through this can understand what it is like!

hi cherylk i take docusate sodium tablets to soften stools and the glycerin suppositories help in a way so i don't have to push but i have never been constipated...still hurts though

kim they said that the incontinence risk was too high for someone of my age so i guess im just expected to sit and suffer it ive been on diltazium for about 5 months now....and no i dont take baths because we only have a shower and i dont know anyone with a bath

I think you could probably use a portable sitz bath, which you fill up with warm/hot water and (I think) place on the toilet and just sit on. Not as effective as a tub, because the water will cool off a lot faster.

My sitz bath has an attachment to keep the water continually warm, but I used to just pour it out and refill it as necessary. Why don't you try Miralax/Movicol. You should NEVER push. Take it from me--I used to do that at times (strain). Can cause hemmroids big time. You're too young for all of that!!

I say get a second opinion ! If you can afford a private consultation go for it !
You are soooooooo young and should not have to suffer like this, find a good colorectal surgeon who wants to help you

Oh and NEVER EVER STRAIN !

Hi ,
I feel for you , im in the same boat, the surgeon ive seen isnt keen on surgery either because of my age and the fact i want at least one more baby but like you i cant take the pain any more, im on the diltiazem and GTN ( i suffer the headaches and the dizziness as its better than the anal pain, i got botox a month ago but to my extreme distress it hasn't worked. ive just been given lidocaine which is an anasthetic, not sure if its working as i only started it today , along with the tramadol and gabapentin its dulling the pain so i would see if you can get something to mask the pain for the time being, ~(mind you , you will feel like a zombie but its better than the pain)
You should just keep going back to the doc and surgeon over and over until they do something, thats what im doing just now, i am either at the docs or phoning every day but i know its like hitting your head against a brick wall.
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18 isn't that young at all. I'm only 21. I can't believe a doctor would refuse to operate on you when you're legally an adult...

Hey Kyriakos,

Haven't heard from you for a while, how are things? Hope you're still okay and hanging in there man.

Let us know how it's going, since we last spoke I've tried Valium (diazepam) and it seems to help with my spasms. My understanding is that Gabapentin (marketed as Neurontin here in the States) is more of a pain killer but Valium is more of a tranquilizer and muscle relaxer. I'm not trying to give you medical advice, of course, but maybe it's at least worth discussing with your physician? The Valium doesn't constipate me either which is really nice.

I still can't believe they won't authorize LIS surgery for you, though, after all the treatments you've tried already that just seems crazy. In the worst case, would it be possible to get it done in a different country? I don't know how the European health system works (especially since the UK isn't part of the EU), but 18 is supposed to be a great time in life, you shouldn't have to suffer unnecessarily when there are still alternative options -- albeit with some risk -- to be explored!!

Hi just wanted to say i've been put on Gabapentin, you are right NeuropathicGuy it is a pain killer but its specifically aimed at nerve pain which should technially help the fissure pain, i have been on that a week now and i think between that and the Tramadol something is working. It makes me feel like im on another planet and really clumsy not to mention it plays havoc with my stomach but id rather that than the alternative. I get to see my surgeon a week Tuesday !!!woo hoo, i am going to demand he gives me surgery or he will have a dead body on his case.