Fistulas & Fissures, Oh My!

The fissure/fistula/?? Saga

After a year long bought of GI problems, I was diagnosed with a c-diff infection.  The short version is that I took a course of clyndamycin following the removal of my wisdom teeth, and the antibiotic killed off the good bacteria in my gut.  The good bacteria previously served to keep the bad bacteria (c-diff) in check.  When the good bacteria was gone, the c-diff ran amok.

Unfortunately for me, while my doctors initially thought I might have a c-diff infection, the tests for it all came back negative (this is not uncommon).  After a third negative and nine months of diarrhea, my doctor decided to treat me for it anyway and I was put on vancomycin.  Vancomycin costs, gram per gram, I'm told, more than gold.  For me, it was a miracle drug and I'd have sold my car to pay for it.

Clindamycin can be a wonderful drug, it's one of the few out there that can be use to combat MRSA.  However, if you are prescribed it, I would encourage you to talk to your doctor about whether or not this is the right drug for you.  I have always tended to avoid taking antibiotics unless necessary, both to avoid side effects and to avoid the problem of drug resistance.  I wish I'd put more effort into avoiding the clindamycin. 

During the course of my presumed c-diff infection (I say presumed because we never got a positive result, but the doctor thought that's what it was, and I responded to treatment for it), I developed rectal bleeding.  We went back and forth on trying to figure out what the cause of the rectal bleeding was.  Although I'll spare you the details now, I may go into them later.  It appears I have a fistula.  Sometimes it acts like a fissure, sometimes a fistula.  It is literally a pain in the ass all the time.

The way to figure out if I have a fissure or fistula?  An exam under anesthesia.  I can't find a good link to describe that procedure, but basically you are put under general anesthesia (my proctologist reluctantly agreed to use MAC but the surgeon who did my second opinion and who had operated on me with local before said he'd only do it with general) and they poke around in your rectum to see if they can determine what the true problem is.  If the problem is indeed a fistula, they'd either do a fistulotomy at that point or put in a seton stitch.  If it's a fissure, they may be able to fix it surgically, stretch the sphincter, or shoot it with botox.  Nothing is guaranteed to work, and there's a risk of incontinence (particularly with the fistulotomy, which appeared the most likely option for me).

So basically, I could be put under anesthesia and then wake up to find out what had been done (if anything had been done, b/c doing nothing was also an option after they did the exam), and what had been done might lead me to be incontinent (relatively small risk but a risk nonetheless).  No thanks. Right now I'm taking the devil I know over the devil I don't.  The surgeon that I did the second consult with (and who I've known for awhile and trust a good bit) recommended against surgery due to potential risks and failure of the procedure to do me any good, the person he sent me to recommended against surgery, and ultimately, the proctologist who initially recommended surgery changed his mind on it (I'd had some healing take place).

If you came across this page via google because you're trying to figure out what to do to treat your fissure, fistula, or inflammatory bowel disease (which I apparently don't have but it was questionable at one point), feel free to email me to chat.  I've had a colonoscopy, biopsy, and so many rectal exams I've lost count so I may be able to give you some idea of what to expect.

So what am I doing about my fistula?

Bidet:  To treat the irritation and pain, I ordered a bidet from Amazon.  It installs right on your toilet (the link should give you an idea of what toilets will work) and is pretty inexpensive.  This thing is awesome.  I get most of my pain and irritation at night, and this helps a lot with treating it.  It also allowed me to clean myself without having the irritation and pulling of wiping with toilet paper.  I had a period of weeks where I had no bleeding at all, and this is the only thing we can really attribute it to.

Be warned - there's a fine line between external cleansing and an enema.  Start off with the power on low so you aren't shocked by it.  I was a bit worried about the water being unheated, but after I've used it awhile, I think I prefer it that way.  It helps numb things a bit, which is great for night time relief.

Ointment:  My proctologist recommended Calmoseptine.  This stuff is awesome.  It's basically a diaper cream on crack.  When you first put it on, it gives some immediate relief.  Not totally numbing, but some relief.  I apply this in the morning, and will sometimes reapply during the day.  I think that Walgreen's always has it in stock, but for any other pharmacy, they will have to special order it and that takes a day or two.  The pharmacist may not know the name, so bring the name of it with you if you want it.  I buy it in the tube, it also comes in a little tub.  It's hard to get off your hands (I put it on toilet paper and then wipe it on) so I would prefer to not use the tub.

Donut pillow: So far, not helping that much but not hurting so I'm going to see how it goes at work.

Switching positions:  This helps some, I've found that sitting cross legged helps take pressure of my fistula.

Walking:  I've found that walking helps, although I may get increased drainage from the fistula when walking, it's preferable to the pain, and the calmoseptine helps with the irritation. 

Sitz bath:  Sitz baths didn't help me at all although others have found them to be helpful.  I tried them with Epson salt (FYI too much salt in the mixture is like pouring salt in the wound... the wound in your ass... it doesn't end well, trust me on this one) and I've tried them without.  Neither helped, but like I said, other people have found them to be very helpful.  I just found myself irritated that I was sitting on the toilet with my inflamed bum in a pot of water.

What makes it worse?

Your guess, most of the time, is as good as mine because it can seem really random.  I have found that riding long distances in the car worsens things.  I'm considering getting a standing desk for work so that I can be off my butt for more of the day.  I've also found that running gives me more pain.  You'd think that if walking helped, running would be ok, wouldn't you?  Nope.