Help!!! My ass is causing unending AGONY!

hoping4arealchange
on 12/10/11 12:48 pm - Portland, OR
Last spring my ass was burning.  I had seen a post about fissures and thought I might have one.  I went to see a colorectal surgeon and he said I had perianal dermititis.  I got calmoseptine and balneol and starting taking sitz baths.  The pain went away. 

I started having similar pain the Sunday after Thanksgiving.  I thought it was because I had overdone the carbs.  I have pretty much not eaten a simple carb since that day.  The pain starts in the morning about 15 minutes after I poop.  It usually lasts about two hours and then I'm fine until the next day when I poop again.  The pain has gotten progressively worse and there are many days that I am in pain for 8 or 10 hours.  I have had many telephone conversations with the colorectal surgeon who says he doesn't need to see me.  He said it sounds like I just have a bad case of the dermititis. 

I talked to my DS surgeon, Dr. Keshishian on Wednesday.  He said it sounds like a fissure or a fistula.  I have an appointment Monday morning with the colorectal surgeon.

I got a prescription for lidocaine which is supposed to numb my rear-end.  I would say that with 8 hours of pain a day, it's not working.  On Thursday the C.S. called in a prescription for Diltiazem (used for fissures) even though I haven't been seen or diagnosed.

Walking seems to help, while I'm walking.  And the sitz bath helps, while I'm in the water.  I have been taking some of my daughters left over vicodan, but it's not a very strong prescription. 

I have only been eating one meal or less each day and drinking 3 protein shakes.  I am determined not to eat until I'm seen on Monday.  Even with as little as Im eating I still manage to have 1 or 2 bowel movements a day.

Should I go to the emergency room?  I don't want to go because it will be expensive and painful and I don't think they'll be able to help me.  If I go I will insist on seeing a gastro-enterologist, but Dr. K says I need to be examined by a C.S. and I have an appointment on Monday.

Help!  Any suggestions, advice, similar experiences?
Thanks
dawn
    
Blank Out
on 12/10/11 1:59 pm
DS on 05/24/10 with
 In the meantime, are you taking an acid reducer?  I have found this to help!  Also, don't underestimate witchhazel on your bottom every time after you poop!  It is so soothing!  Just a couple ideas until you get into the doc...
     
HW/ 302  SW/287  CW/140  GW/135

(deactivated member)
on 12/10/11 3:36 pm
Definitely keep the appointment with the colorectal surgeon on Monday for a physical exam.  Telephone diagnoses are notoriously inaccurate.  Hopefully, the surgeon will have some definitive answers and a treatment plan for you.  In the meantime, continue what you're doing.  

Avoid straining with bowel movements and avoid spreading your butt cheeks far apart which can tear potential fissures and make a bad situation worse by increasing their size.  Are you on an acid blocker such as Prilosec?  Sometimes when stomach acid goes straight thru it can burn the skin.  Moisture barriers help.  Applying Maalox topically will also neutralize any acid on irritated skin.  

I hope you feel better soon. 
hoping4arealchange
on 12/10/11 7:22 pm - Portland, OR
Thanks for the information about the acid blocker.  The doctor has never mentioned that.  I ran right out and bought some.  I will keep the Monday appointment and hopefully be properly diagnosed.
dawn
    
KathyA999
on 12/10/11 4:46 pm
VSG on 08/09/10 with
So this reply is going to be TMI for those who don't suffer.  Look away if you must, LOL! 

I have had simpy horrible butt-pain recently.  I went on Amazon, looked up Preparation H and started reading comments from other users.  Many recommended this stuff, so I bought it:

www.amazon.com/gp/product/B000F34TCC/ref=oh_o03_s00_i00_deta ils

It's probably the best thing I've found for soothing/cooling my poor butt.  It has a kind-of minty effect somehow.  That plus some witch hazel, which I gently apply beforehand, with a baby wipe.  (Preparation H sells wipes that already have witch hazel, and I bought those too, but they don't have enough, IMO.)  People on Amazon recommended some kind of pill to go with the ointment, and I bought that but it made my GERD flare up (I do take an Rx PPI twice a day), so I quit taking them.  The ointment plus an analgesic like Tylenol helped me get to sleep.

I also tried the Lidocaine - I agree, it wears off after about 5 minutes.  Other people have recommended Desitin, but haven't tried that yet, and of course good ole Prep H.

This is a seriously life-affecting issue, believe me I know.  I hope your C.S. can help you, and I hope these recommendations help in the meantime.

What finally helped was cutting back on the Miralax.  You know, this hi-protein diet that VSG-ers are supposed to be on, even with high fat, you have to do SOMETHING to get things moving.  But I was taking Miralax every day, and my "movements" were so loose they were making my hemmorhoids so much worse!  I now take the Miralax every other day, which is MUCH better, it produces a more normal bowel movement.  So I now have to use the witch hazel / ointment occasionally.

Something else occurred to me, that a probiotic might help you.  If it's some kind of bacteria that's creating the dermatitis, perhaps a more beneficial bacterial mix would help?

Good luck!


Height 5' 7"   High Wt 268 / Consult Wt 246 / Surgery Wt 241 / Goal Wt 150 / Happy place 135-137 / Current Wt 143
Tracker starts at consult weight       
                               
In maintenance since December 2011.
 

Lisa A.
on 12/10/11 7:16 pm - Windsor, NY
Oh I know this story all too well. Just make sure you stay away from sauces and spicy foods. Another thing that helped me alot was taking 3 advil every morning. This has really helped reduce the inflammation. I also have a fissure and see a colorectal surgeon.
    
LosingSally
on 12/10/11 7:39 pm
Dianna Cox managed a fistula, or a fissure ( sorry not sure which) without surgery. She has a treatment method down pat, I believe with the help of a doctor, but the mix of treatments seem to be mostly trial and error.
In the end ( yeah pun!) her rear was healed and so were some others who followed the protocal.
Please contact her.
Best wishes.
newyorkbitch
on 12/11/11 6:03 am
DS on 03/06/00 with
 I had a fissure repaired surgically, recovered in a few days, and have never had any issues since.  I saw no reason to suffer needlessly. 
hoping4arealchange
on 12/11/11 8:53 am - Portland, OR
Did you have the fissure surgery before or after your DS?  Some people worry about incontinence.  I am not trying to brave my way through this.  The problem is the doctor keeps diagnosing me (perhaps incorrectly) over the phone!  I really don't do pain well!  I would get loaded to zone out, but I'm coming up on 10 years of recovery.
dawn
    
newyorkbitch
on 12/11/11 9:56 am, edited 12/11/11 9:57 am
DS on 03/06/00 with
 I had it after my DS.  I have had zero issues since,  of any kind.  

You need a good colorectal surgeon.  And not somebody who diagnoses over the phone.

The risk of incontinence is small,  and it also depends on the size and nature of the tear.  It's obviously extremely important to have the procedure done by a colorectal surgeon who has done lots and lots of fissure repairs.
hoping4arealchange
on 12/11/11 8:50 am - Portland, OR
Yes, I actually saw and saved Dianna's post a year ago.  That is how I knew to see a colorectal surgeon.  I printed out her post to take with me on Monday.  The hard part has been waiting for the appointment and getting through the constant non-stop pain!
Thanks,
dawn
    
(deactivated member)
on 12/11/11 12:43 pm - San Jose, CA
Going to the ER is pointless if you have an appointment with the CRS tomorrow.  They aren't going to operate, and you already have something for the pain - if you need more, you should be able to get some without making an ER visit.

Use the lidocaine or benzocaine (AnalEaze from an adult toy store) immediately before and after a poop.  Once the spasms start, they take a while to stop, and they are agonizing, I know.

If you can tolerate an attempt at a medical (rather than surgical) cure first, I would try it.  I have cured two minor fissures since my DS medically (the nitro paste, nifedipine, sitz baths, lidocaine/benzocaine treatment).  But if it is already deep, that's not likely to help, and surgery is necessary.  It hurts something awful for a few days, but then the relief is complete.  Treating a fissure medically takes weeks and sometimes doesn't work.  It may be a (pardon me) crap shoot (chute?) to decide what to try first.

I had my sphincterotomy years before my DS.  The fissure was misdiagnosed for 3 years.  I'd like a refund or do-over on those years.  I could only walk for 10-20 min before the pain was too much; poops were miserable; and the treatments I had to endure for the mistaken diagnoses of levator ani trigger point spasms and internal hemmorhoids - OMFG.  So many procedures with someone's finger up my ass - unaware that they were further tearing the fissure in the process.

Ask the CRS to give you some topical anesthetic to numb your ass before he does anything - don't know if it will help, but you can ask.  When I got my sphincterotomy, it was scheduled as a sedated exam with possible further surgery - I could no longer even tolerate any examination it hurt so badly.  (I told the CRS that if he had to do any cutting, could he please also do an external hemmorhoidectomy, which he did - that may have also contributed to the severe pain immediately after surgery, but the overall result was worth it.)

I still don't know if we DSers are more likely to get fissures than the general public, though I think we are, or if it's just that we're willing to talk about it.  I think MILLIONS of non-DSers have fissures and just suffer silently with them, too embarrassed to go to the doctor or too afraid to find out that it means they are dying.

Remember - the most important mantra (after protein first, yadda yadda yadda) of the DSer is to Let **** Happen.  Don't strain, don't pull the butt cheeks apart, try to not allow yourself to get either constipated or for your poops to be too loose or acidic.  This is good advice for anyone, but since the volume of our poops and the possible acidity can be a problem (bile acids in particular), we are more susceptible, I think.

Speaking of which, I have noticed that when I have to fast, or don't eat for a while for some reason, I get acidy diarrhea about 8-10 hours later - I think it is because there is no food to bind to the bile acids, which drip constantly from the biliopancreatic limb in the absence of a gall bladder, and they end up moving through my gut faster, and burning my ass on the way out.
flucca
on 12/12/11 2:52 am - Fort Lauderdale, FL
VSG on 08/06/10 with
 Had this exact issue about three months ago, horrible, agonizing pain.  Anyway, to cut a long story short, I tried the ointments etc for a few weeks with no relief...........instead of surgery, the Colorectal Surgeon gave me an injection of BOTOX to the anal sphincter (done in outpatient ER)  three days later, complete relief and no issues since.  Hope this may help you too.
newyorkbitch
on 12/12/11 4:14 am
DS on 03/06/00 with
Depends on the fissure itself...whether or not botox can help.