Stubborn fissures

[Brian'sMom]

Anyone have any advise on how to heal stubborn fissures? We've tried A&D ointment, Desitin, neosporin and soaks. Its about 2 cm above the opening of his anus. It seems like we get it looking good, and then he'll have blood in his stool. I SO HATE THIS DISEASE!! The nurse said they aren't serious and can take a long time to heal, but I don't ever like seeing blood. I can't be positiive that its coming from there or from intestine. We do labs in 2 weeks, so that will tell the answer. I also feel like our doctor hasn't educated us at all about fissures. I plan to grill her about it next visit so I know what;s causing it.

Also, Humira was great the first year...now his inflammation rate was good 3 months ago, but he doesn't have very many formed stools. Before it was like he was cured. And its not an issue of needing to go weekly, cause he has loose stools right after he has the shot too. He doesn't have cramps, so that's good...just logs very rarely...and this fissure thing.

Kathy

 

[Keepingfaith]

Hello Brian's mom! I am sorry your loved one is having issues with fissres. I hate them and they can hurt almost as much as the intestinal inflammation. I am sixteen and I have found that only three things help with mine. One is a steroid cream and the GI can prescribe that. It slowly overtime though can thin out the skin around the anus ultimately leading to more fissures so it can not be used long term but t works like a charm. Also there is a gel that comes in a tube the GI can prescibe. I can look at the name tomorrow if youd like. It has lidocaine and I believe a small ammount of hydrocortisne and man does it feel good! It is also less messier because it is a clear gel. Last but not least is Calmoseptine cream. You can usually only find it at walgreens but they have a site. You have o ask the pharmacist for it because they keep it behind the counter. It is OTC but slightly expensive. It works and is worth it though! It is designedpecifically for NG tubes[where the tube rubs across the face causng irritation] as well as fistulas and fissures. It provides a mositure barrier and thus can also help with infections that can happen potentially.

 

[Patricia56]

How long has he had the fissure?

Is it painful?

What position is the fissure (use the numbers like on a clock dial; 12 would be straight up, 3 straight to the right, etc)?

Are the edges kind of plump or puffy or does it look like a clean cut?

Are there any little pouches of skin around his anus?

Is there any tenderness next to or near the site of the fissure (you would know this by gently but firmly pressing on the tissues around the fissure)?

Has the doctor carefully examined his bottom including this kind of palpitation of the tissues?

 

[Sascot]

Hi, my son had issues for a while while his peri-anal abcess was bad. I'm not sure what it's called, but the GI nurse gave me a plaster which is like a "second skin". Basically you make sure the fissure is clean and reasonably dry then put the plaster right on top of it (I kind of had to mold it into his bum crack - sorry it tmi). Once it's on, it stays on for about 4 - 5 days and protects it and helps it to heal over, then if necessary have a shower and put another one on.
I was always paranoid it would hurt being pulled off the skin, but it never did and worked wonders (also helps it not hurt when wiping after the toilet)

 

[Samboi]

Sascot - Can you please find out what it's called?
I think I really need to try this option.
I'm pretty desperate to try anything.

 

[Jenn]

Hi Kathy,
Sorry to hear about the persistent fissure, how frustrating. It sounds like maybe the infrequent logs are re-tearing things just as they heal? His GI or nurse must have some suggestions, keep pestering them! Maybe regular miralax? I know vinegar in a sitz bath is a natural antibiotic and might help promote healing. Though difficult, some air time might help too. Maybe baby wipes to minimize wiping? I took stool softeners and used warm water rinses/pat dry instead of TP when I had a tear/stitches with childbirth.

Oh no about Humira! Seems its effectiveness peaks about a week after the dosage for Alex, but I don't know how it works really. Is Brian on the adult dosage? recently Alex's protein levels dropped and the GI threw around all kinds of things to try. He's on the pediatric dose, so thought about upping that. She wasn't keen on increasing the frequency, but said some current research promotes using two meds to cover all bases better, so maybe adding Azathioprine or prednisone. We are in a holding pattern, since he was sick at the time and is better now, but he has a scope next week and trying a pill camera and a bunch of other tests, we'll see.
Good luck!

 

[Patricia56]

Brian's Mom -

My questions were aimed at trying to figure out if the fissure is more likely to be a manifestation of his CD or "just" a fissure.

My son had fissures that would not heal. We did everything to treat them including everything suggested by Keeping Faith. Absolutely nothing we did made any difference in the fissures.

What healed the fissures was Humira- in other words getting him into remission. Once he got into remission the fissures healed up without a fuss in a matter of 2 weeks. And that was without us doing one single thing to make them better.

So, if our experience is any guide, if you can get the fissure to heal up - then it's from the constipated stools. If you cannot get it to heal up - then it's probably a sign that he is not yet in solid remission or is falling out of remission.

As for treatment, our Ped GI recommends Aquaphor be applied regularly to help seal out moisture and germs. Warm plain water baths as often as you can manage - ideally a couple times a day. Using wet wipes is good as long as the brand doesn't have any added stuff that will sting.

I got out the peri bottle I used after my kids birth and he used that to clean his bottom instead of wiping. Then patted dry with tissue. If you have one of those around or can get something like it (a plastic squeeze bottle with a lid that has a bunch of little holes) that might help.

 

[Brian'sMom]

Patricia,
It at 12 o'clock position. About 2 cm long. We seem to get it to look better, then...it opens back up. Its soft, and and like a clean cut. But he does have a few 'pouches' looking things...I think. They are not tender to the touch. He has been having more diarrhea than logs....so yes, I'm worried about the remission thing. He says he's not cramping at all tho...just that cut stings sometimes. We've been doing sitz baths and A & D ointment.

 

[Patricia56]

The pouches are called skin tags. They look like regular skin when they're small and they're soft and maybe a little squishy.

If the ones you son has are like the ones my son had then they are inflammatory tissue and a sign that he is not in good remission.

And I suspect the reason you can't get the fissure healed is the same reason.

If the doctor has not examined him or not done a thorough exam where he palpates around the anal area, I would suggest you ask him about that.

You might also want to be thinking about getting a 2nd opinion, preferably from a Ped IBD Clinic at a major medical center.

 

[DustyKat]

@Sascot...Could the dressing you are talking about be Comfeel?

@Kathy...Calmoseptine cream is good and another is Cavilon.

Dusty. xxx

 

[Sascot]

Samboi, I did ask about the dressing. The nurse I spoke to thought it was called Hydrocall/Hydrocoll Thin (not sure of spelling).
I will try to speak to the actual nurse who gave it to my son, but haven't managed to get hold of her just yet.

 

[DustyKat]

Comfeel is a hydrocolloid dressing. Does it look something like this?...

Dusty.

 

[Samboi]

Thanks Sascot and Dusty.
Fissures are the bane of my life and something like this could really help my battle with them.