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My son is 19 years old and has had diagnosed with Belle

Hi. My son...

Hi. My son is 19 years old and has had diagnosed with Belle Clapper deformity and ejaculatory duct reflux. We have had surgery and have addressed those issues. He has had several surgeries to take care of those issues. For a year Ethan had complained of pain after having a bowel movement I thought it was the pain from prior testicle surgery so I just made sure his stools were loose and encouraged him that he would be better. He then had gross amount of blood in his stools and got him in to a gastroenterologist. He scoped home and said he had a rectal fissure. Ethan tried different medications but nothing worked and the fissure already went through the second muscle layer. He had surgery to repair fissure and a sphencterotomy. The rectal spasm stilled but about 8 weeks after the surgery he started having spasms again. That came after having diarrhea and the fissure area was irritated. I think that the burning of the healing fissure area started up the rectal spasms. He has been scoped again and his rectum was so tight after they put him to sleep that they had to give him morphine just to relax his sphincter enough to put the scope in. They then dilated the rectum. The fissure looked healed. So Ethan has been taking B and O suppositories and oral Valium. He has not gotten a lot of relief. The doctor does not what else try. Ethan ya very depressed and in so much pain. What do we do and who do we see. Bi can’t tell Ethan that another doctor is giving up on him so I need to do something. Please help us

Doctor's Assistant: When was your son prescribed Morphine? How severe were any side effects?

He has aspergers and it’s take a lot to have bad side effects. The morphine helped the pain but it did not last long The spasms were back soon after. It’s hard telling your son that after all the crazy things he has been dx with and drs telling him that they can’t help him to have something that drs know about and not help. The surgeon that finally help Ethan was from Europe working in Denver. I know Ethan was probably one if the kids to have corrective surgery for his dx but he gave him hope until he had no pain. We thought that this was going to easy and it has turned into something horrible. He cannot even leave the house

Doctor's Assistant: Has he used anything besides Morphine for this?

They only gave morphine when he was a sleep and once when he woke up They did not send pain meds home Just the suppositories and Valium

Doctor's Assistant: Anything else in his medical history you think the doctor should know?

He has just had a long journey since the fourth grade. Everything from all the urology issues to meningitis c-diff to unable to absorb ferritin. He just wants to go to school and have friends. We thought all of the medical stuff would end after the sphincter surgery. His rectum is so tight that he can hardly insert the suppositories and the pain is horrible with the tightness and spasms We have tried a muscle relaxer and warm baths and herbs We will travel anywhere to fix this It took several doctors knowing Ethan’s problems before until we found a doctor that thought outside the box. Please help

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Answered in 42 minutes by:
4/20/2018
Connie Pennington
Category: Medical
Satisfied Customers: 681
Experience: Colorectal Surgeon at Colon & Rectal Surgery Consutants, PC
Verified

Hello, this is Dr. Pennington. I am a colorectal surgeon.

Recurrent anal fissure after lateral internal sphincterotomy is a problem.

Cutting the sphincter again, could damage it to the point of incontinence, but it could be done knowing the risk.

You may try to take him to a pelvic floor physical therapist, to teach him how to relax the pelvic floor.

Worst case scenario, a colostomy could be done to divert stool away from the anal canal.

I am sure they have tried Cardizem compounding cream? Lidocaine jelly? Hot water soaks?

It is a very difficult situation.

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Customer reply replied 4 months ago
He has not been on cardizem. I feel if we can get the recital spasms to stop he will be fine. How do we do that?
Customer reply replied 4 months ago
At this point with the recent scope he does not have another fissure

Ok, what I use is:

Diltiazem 2%, Lidocaine 4.28% ointment that is created by a compounding pharmacist.

Diltiazem is a blood pressure medication that when applied topically to the anus, lowers the anal canal resting pressure.

This may help.

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Antispasmodic's are good for the bowel, but I think this is a Levator Muscle issues, we call non-relaxing puborectalis. Valium is often given. Botox injections can work like a charm if you can find someone to do it.

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Customer reply replied 4 months ago
Oh my goodness thank you He has been on proctozal and nitroglycerin. Would that be the same thing? I hope not. You are giving me hope If our gastro doctor will not prescribe that new medicine who do you recommend that we see or can I fax you his records and precribe it I know his doctor does not want to do anything else. So I do not know how to approach him about it. I live in Joplin mo
Customer reply replied 4 months ago
I read up on Botox but I have no idea where to find a doctor. I would love for him to try the other medicine first What do I do?

No proctozal (a steroid) will not help a fissure or the spasm in the muscle. Nitroglycerin will give you a headache, diltiazem will not.

I can only prescribe meds for my actual patients in my office, and in TN. His regular doctor can call in the compounding cream, should not be an issue.

A pain management clinic is where to get botox injections, they can help you.

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Customer reply replied 4 months ago
Would you see him if his doctor will not help us anymore? The drive is nothing for him to be able to live his life. You are right about the nitro he gave him a horrible headache. We can make the trip with all his records Please

Goodness, surely his physicians can help locally.

I would be happy to assist you. My office number is(###) ###-#### ask for my office manager Lisa.

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Customer reply replied 4 months ago
Oh thank you. If his doctor will not would you be able to get him in soon. He is very depressed and frustrated. We just need to get the spasms to stop before it causes anymore fissures and pain You are a blessing Thank you

You are welcome, good luck to you.

It's an awful long way, but I can work him in if we take his insurance.

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Customer reply replied 4 months ago
Ok. Thank you so much. We have blue cross and blue shield. You are a blessing. My number is(###) ###-#### God bless.
Customer reply replied 4 months ago
Just one more question. I am sorry but do you think the B and O suppositories are making him worse? Do we need to quit them?

Yes, they will not help. Anything aggravates a fissure. Keep the BM's soft, and let him rest.

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Customer reply replied 4 months ago
The fissure is better The medicine was supposed to be for the pain and spasms. You are an amazing doctor.

Well, if it is not working, then I would discontinue them.

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Customer reply replied 4 months ago
Ok. Thank you. I will call his doctor and see if he will give the prescription you recommended. I hope he does but if not I will call your office on Monday. We can be there the next day if you could work him in. Do you know someone that can do a Botox injection if that medicine does not work? I feel the medicine will work though. You are so wonderful and a blessing to my prayers. Thank you

We are in office Mon and Thurs. Some Fridays. You would need to talk to Lisa.

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Would hate to have you drive this far!

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Customer reply replied 4 months ago
Ok thank you!!! Have a good weekend!!!!!!

We work for stars, but I will still be here after rating the question if you need anything!

Connie Pennington
Category: Medical
Satisfied Customers: 681
Experience: Colorectal Surgeon at Colon & Rectal Surgery Consutants, PC
Verified
Connie Pennington and 87 other Medical Specialists are ready to help you
Ask your own question now
Customer reply replied 4 months ago
Ok. I will give you the best rating!!
Customer reply replied 3 months ago
I just wanted to touch base with you and let you know that Ethan’s doctor prescribed the medicine you recommended. Thank you so much I appreciate you
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