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Colorectal Diseases

Multiple bilateral sphincterotomies? No Good

09/23/2009

Question:

I am a 34 year old male. I have a history of Hashimoto`s Thyroiditis so have a pre-disposition to constipation. Three years ago I underwent my first colonoscopy with unremarkable results. A large polyp was removed and an anal tag. Both were benign. About a month later I passed a hard stool and was in great pain with a large amount of bleeding. I saw a GI doctor who referred me to a surgeon who performed a sphincterotomy. It seems that the removed polyp rather than healing ulcerated and traveled to the exterior of the anus appearing at first to be a simple anal fissure. The operation solved the issue for a short time. I have, however, had issues since then with anal fissures in that same spot. I was diagnosed with bi-lateral Bell’s palsy in August of 2008 and am one of the 1 percent to have lasting neuropathic pain associated with the seventh cranial nerve, so have been on long term pain management care under supervision of my neurologist and physiatrist for almost a year lessoning the pain medicine small amounts all the time. However, due to the pain medicine I have had constipation issues and have had to have another operation. This one did not even last 2 weeks before having new complications. My surgeon referred me to a specialist surgeon who only deals with issues of the GI tract worried that it might be something more such as cancer or Cohn’s disease (both run heavily in my family, my brother who is four years older just finished his second round of colon cancer treatment and two first cousins and an aunt have battled croon’s all their lives) The surgeon however without any exam and having not even read my referral paperwork decided that I needed Botox treatments. I am not one to questions a doctors decision. I am studying to be a nurse and if that has taught me one thing it is that I do not know near the amount of information that a doctor much less a specialist knows. But I fell confused that my referring doctor sent me for one reason and the new doctor ignored that reason completely saying it wasn`t an issue at all. Should I be concerned? He mentioned in his report that my abdomen was supple and without tenderness, but he never asked me once if I was tender. I am tender in my right of belly button and upper left quadrant on the left side... Just feeling a little overwhelmed. Going on 8 months with excrutiating pain while trying to use the restroom. I`m just worried,and not normaly a worrier.

Answer:

Sounds like Botox may have been a good recommendation. You're already had your sphincter divided, and may have Crohn's disease. Additional surgery could be risky. Chronic anal fissures are usually the result of continued anal trauma- from difficult BM. Hard compact stool can cause this, as can chronic diarrhea. If you have BMs that are not soft, "fluffy" and easy to pass, this would be the first issue to address and correct to promote healing.

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Response by:

Janice Frederick Rafferty, MD Janice Frederick Rafferty, MD
Professor of Surgery
Chief of Colorectal Surgery Division
College of Medicine
University of Cincinnati