fissure help

[tincup136]

Ok so i have posted about my issues before. I went to my GI on february 7th and he said my rectal crohns had much improved and did not see my fissures.  I know he performed a dilation on that date and a flex sig.  Well after procedure i kept feeling like the anterior and posterior fissure were acting up again.  So i went back to CRS and she said they had not healed.  She performed a DRE and anascope on march 5th.  I know they have not healed and do i have any options because the creams are not working.  If i did not have fissures i would not know i had crohns.  Very frustrating. My big fear in life is that i have anal cancer.  Since august of last year i have had 4 flex sigs, 2 anascopes, and 6 digital rectal exams by a GI and CRS.  Should this be enough to assure me i do not have anal cancer. Also will having so many exams keep irritating my fissure. Thanks.

[Dr. Kokil Mathur]

YES--STOP WORRYING!--sorry for the caps--but hope you are relaxed now ):

[xxjessica04xx]

My sons 9 an he throws up alot blood test shows he fine but i kno that waking up like a routine at least once a week at 3am 4am to throw up isnt normal get it be acid reflex ?? He jus throws up he could eat the same thing all week an jus throw up one pf those nights help please

[tincup136]

Sorry.  Biopsies were taken of rectum and only a couple from anus.  One biopsy from anus was quite large measuring .8 cm x. 4cm with a depth of 1mm.  It  came back as hyperkeratosis.  Is it also possible the raised rough area is scar tissue from that biopsy.  Obviously i want peace if mind.  So  I know both of my doctors have seen this area of concern and when i ask them if i have anal cancer they both say no.  Based on their opinion and all of these tests should i put this to rest and stop worrying.  Thanks and last question

[Dr. Kokil Mathur]

Well, this is the first time you are mentioning biopsies--and so if biopsies have been taken and they have come clear then there is no need to worry regarding anal cancer--it is pretty unlikely that you have anal cancer after so many biopsies going negative.

If there is a fissure and it is not healing then surgery is the only option. A chronic fissure will have raised or rough edges and if this looked suspicious of cancer then already biopsy may have been done. If the raised or rough edge has the appearance of edge of a chronic fissure then it is unlikely to be cancerous.

Apart from creams, sitting in a bathtub filled with warm water for 10-15 min twice daily, fissure symptoms can be improved by watching what you eat (log in what you eat and see which food items cause more pain), avoiding constipation,  and avoiding long sedentary hours in one position.

Hope this helps.

[tincup136]

The CRS did find a fissure.  I went to her 10 days ago.  I felt fissure like pain and raised tissue around
fissure site inside anal canal.  She looked with anascope and perforned a DRE.  I have had so many tests and biopsies over last 6 months.  I think
doctors have wanted to appease me.  Your answer did not give me much comfort.  I am now thinking the raised tissue which i believe is scar tissue is now suspicius.  I cant believe having so many exams (flex sigs and anoscopes)by a gastroenterologist and colo-rectal surgeon is not satisfactory to rule out anal cancer.  Are you actually saying i need a follow up with another specialist to rule out anal cancer.  Biopsies have been taken of rectum and one or two in anal canal.  

[Dr. Kokil Mathur]

Hi!

I can understand your worries. Well yes, so many rectal/anal exams can irritate the anal mucosa and an existing fissure can flare up. However, if the doctors cannot find any sign of fissures, then the anal irritation and pain may be due to worms in stool (so get a stool test done). Other causes could be undigested food like citrus fruits, grapes, certain spices, tomatoes, certain medicines like antibiotics and laxatives and certain drinks like beer, milk, tea, or coffee. These food items aggravate the already sensitive anal mucosa in an individual suffering from Crohn’s. Also fissure like symptoms could be due to Crohn’s.
To diagnose anal cancer, a doctor usually clinically examines the anal mucosa through naked eye or by an anoscope or by a proctoscope. A digital rectal examination is carried out to look for any lumps and any roughness and thickness in the anal mucosa. If the doctor finds any change in anal mucosa either visually or by feeling it by a DRE, or feels a lump, then a biopsy is taken from that region to look for cancer cells.

So, yes, if you have had so many examinations, cancer is probably ruled out. If there was a suspicious region then the health care provides would have notified the specialist. However, to ease your mind you could ask the opinion of a GI specialist or an ano-rectal specialist. I sincerely hope you will find this information useful in your discussion with your doctor. Hope you get well soon! Good Luck and take care!