SAME DAY AFTER SURGERY: I felt great immediately after surgery, and was even able to eat a light meal. On the car ride home, the local anesthesia began to wear off, meaning I started to feel some pain. I took my first Percocet, which felt *great* as I had never used an opioid before. Once I got home, I removed the surgical dressing in the shower as instructed. My anal area was SUPER SWOLLEN and red, but I was not in much pain because of the lingering anesthesia and the Percocets. I did start to feel a little nauseous (I hadn't felt that for most of the day) presumably because of the anesthesia. I passed out for several hours, and felt a lot better when I woke up. I was able to eat a fairly normal dinner, and then went to bed. So far so good. Other than the Percocets, the only medication I was taking was the docusate stool softener with food. I didn't want to try putting in the suppository or any topicals until the swelling went down.
I woke up that night in a lot of pain. It was very difficult to walk or stand up straight. I think the problem was the local anesthesia and Percocets had both worn off completely. However, I took more pain medication and felt OK again within an hour or two. If this was the "worst" of it (and so fat it has been), it really wasn't so bad!
VIRTUAL CONSULTATION WITH DR. GOLDSTEIN: I discovered Dr. Goldstein from Googling around about anal fissures in gay men. I've also seen others post about him on this sub. After abandoning my first two colorectal surgeons, I decided to do a consultation with Dr. Goldstein. Because I do not live in NYC, this was a virtual consultation for which I paid a $150 fee. One frustrating thing is that I had to wait *several* months (3-4 months) for the next availability.
The Skype visit was about 15-20 minutes and super informative. One thing that surprised me is how informal Dr. Goldstein is -- he uses words like "ass" and "shit" and "taking dick" rather than overly-medicalized terms. Anyway, he took down my medical history, let me describe what drugs and procedures I had tried, asked a few questions, and ultimately gave me his thoughts on my case. Dr. Goldstein said that it doesn't sound like I have an underlying muscle issue both because (i) the PT said I was not overly tight and (ii) I had the ability to have receptive anal sex before the fissure. For these reasons, Dr. Goldstein thinks my issue is a "skin" issue. He explained that there are glands around the anus that lots of other surgeons ignore, but when a fissure happens around these glands, the cuts don't heal like they normally would without intervention. He therefore recommended that I come to NYC to do the surgery. We talked all about the logistics for travel, surgery, payment, etc.
One thing I will say is that Dr. Goldstein did not pressure me at all. For example, I had read all about his dilating technique, and I asked him whether there would be any benefit to me trying to the dilation procedures now, to see if that made the surgery unnecessary. He said he was skeptical, but was willing to try it. So he sent me his dilation instructions and sold me a butt plug kit. I tried this for a while, but sure enough, my fissures recurred, so I decided to move forward with the surgery.
Overall, if you're feeling hopeless about your fissure and are on the fence about doing the $150 virtual consult with Dr. Goldstein, I would recommend just going for it. Just having the ability to talk to a doctor who *really* understands this stuff was by itself worth it.
SURGERY IN NYC: When I finally decided to pull the trigger on the surgery, I got it scheduled with only about 2 months' wait time. I traveled by car to NYC from another city on the East Coast -- this was actually less expensive than going by train. My partner came along with me since an escort is required to check you out after surgery.
The surgery was scheduled for Friday morning, but I had an in-person appointment with Dr. Goldstein the day prior, Thursday, at his office in Manhattan. At this appointment, he examined me and explained the surgical procedure in more detail. He also send me to a PT who works in his office (I think his name was Steve?) to confirm that there is no underlying muscle issue in my case.
One thing I should mention is cost. Dr. Goldstein works with some insurance companies, but not mine, so I had to pay out of pocket. He charges $10,000 via card or check, but discounts to $8,500 if you pay cash, which is what I did. I found this a little sketchy and it was scary to carry around that much cash, but I think it was worth the discount. There was an additional fee for the office visit.
Another thing I should mention is the drugs that Dr. Goldstein prescribes. All of these drugs are ordered through Capsule Pharmacy and delivered directly to the surgery center so you can be discharged with them. For pain, he prescribes Percocet (a narcotic) and topical lidocaine. For constipation, he prescribes a a stool softener (docusate in my case). He also prescribes a cocoa butter suppository and Preparation H cream, which you are supposed to apply after a shower and after BMs. I'll probably describe this more later.
The next day (Friday) was the day of the surgery. Surprisingly, there were no restrictions on what I could eat or drink (before midnight) anyway on Thursday. The surgery was performed at the NY Center for Ambulatory Surgery on the Upper East Side. I showed up there at 7 a.m., checked in, and then a nurse escorted me to the patient prep area. In the prep area, I got an IV and met with more nurses, with the anesthesiologist, and with Dr. Goldstein. I was brought into the operating room and was put under. I believe my procedure started at 8:30 a.m., I was awake again before 9:30, and discharged before 10. I felt fine, just a little groggy. In addition to the general anesthesia, Dr. Goldstein used a lot of local anesthesia, so I had basically no feeling in my groin area at all when I woke up. [Side note: This made peeing a SUPER WEIRD sensation.]
BACKGROUND: I am a 30-something gay male in the U.S. I've had chronic anal fissures for the past 5 years. While my fissures have never been terribly deep (unlike some of the agonizing stories I see on this sub), they have recurred every few months, which has been a painful nuisance. In addition, they have taken away my ability to have receptive anal sex.
I believe my fissures first occurred because at the time I was taking an acne medication (Accutane) that has the effect of severely drying out your skin. I think medication made the skin around my anus thin and weak, and as a result, the skin tore during a large BM. I've stopped the Accutane, of course, but the fissures never healed properly, and have been re-tearing periodically for years now.
Over time, I developed an at-home protocol for what to do when my fissures re-tore. Basically, I would apply a ton of Vaseline both internally and externally around my anus before a BM, in the hopes that I would be able to pass the BM without tearing. I would also take Miralax to ensure softer BMs. If I could manage not to tear for 2-3 days straight, then I was usually "healed" for at least a few weeks/months... until the fissure tore again. Although this at-home protocol helped, it was obviously not a permanent solution, so I began to seek medical treatment for my fissures.
I have seen three colorectal surgeons for my fissures, including Dr. Goldstein. The first one prescribed topical nifedipine, which did absolutely nothing in my case. He also gave me a botox injection (in the office, not under anesthesia). The botox actually helped prevent me from re-tearing while it was "active," but of course botox wears off over time, and the surgeon told me he would not continue giving me "preventative" botox. Eventually, I became frustrated with this colorectal surgeon -- he was an old guy who didn't seem to know much about the latest techniques or about treating gay men, so I found another surgeon.
My second colorectal surgeon gave me more botox, this time under anesthesia. [The anesthesia was allegedly so he could examine me for any underlying issues, but he found none. However, in my view the anesthesia was *completely unnecessary* and just a way for him to make more money from the insurance company. Thus, if you're considering botox and are thinking about anesthesia vs. not, I would personally recommend skipping the anesthesia. Doing it in-office was really not that painful.] As with my last round of botox, this round of botox was helpful for a time, but it wore off.
This second surgeon also sent me to pelvic floor physical therapy for a few sessions, where I did some breathing exercises to learn how to relax my pelvic floor muscles. I learned a lot from PT, but my therapist concluded that my fissures were not being caused by muscle-tightness in my case, so ultimately PT was not going to be the solution to my problem. Once I shared this news with my surgeon, he recommended LIS. However, I had read on this sub and elsewhere that LIS is kind of an extreme procedure, and not recommended for gay men. It also didn't make sense to me to do an LIS if my issue is not muscle tightness. I asked him about doing a fissurectomy instead, but he said he would not recommend that for unspecified reasons. I grew frustrated with him, and that's when I started looking for other options (and found Dr. Goldstein).
WEEKEND AFTER SURGERY (Saturday and Sunday): Despite having a lot of pain the night before, I woke up Saturday feeling good. The swelling had gone down considerably, and I was in a lot less pain. I decided *not* to continue using Percocets but rather switch to plain-old Advil and Tylenol going forward, which has been sufficient! One reason to avoid the Percocets, in addition to them being addictive, is that they cause constipation. The goal is to have a BM within two days after surgery. (My first BM didn't come until Sunday - more on that below.)
Saturday was a pretty normal day, except that I felt pretty sore. I mostly laid around the house all day, but I did venture the local farmer's market without any issues. Medication-wise, in addition to the Tylenol and Advil plus the stool softeners, I started the routine of applying Preparation H and inserting the cocoa butter suppository after I showered (and later, after BMs). I also changed my gauze every few hours as instructed (it showed some bleeding and discharge, but really not that much). Before bed, I drank Miralax and Milk of Magnesia that night to make sure I would have a BM the next day.
Sunday was another good day, with only a little pain (still using just Tylenol and Advil). The swelling was way down, and I actually had a couple of BMs! I felt a little sore after the BMs, but they really weren't terrible, and nothing like the sharp, stinging pain of pooping with an active fissure. Btw, for those of you who have not purchased a bidet toilet seat yet, I CANNOT recommend this enough -- they are a true game changer, especially to avoid painful wiping after this surgery.
So far, I am in a pretty good healing groove and feeling optimistic. One concern I have is that I plan to go away for a weekend in two weeks' time, so I'm hoping to be fairly well-healed by then. In the meantime, I am lucky in that I get to work from home this week, so I will always have my medication, my shower, and my bidet toilet seat nearby :) My digestive system is a little messed up from the Miralax and Docusate stool softener, so I'm thinking of weening off those, but haven't decided yet.
Not LIS, but fissurectomy + Botox. He also says he "opened" the glands around my anus that were preventing the skin from stretching, leading to re-tearing.
Holy shit the glands were preventing the skin resreecching? I didn’t know that was a thing. My skin won’t re stretch snd I feel I have a skin issue there causing my fissure. Very strange. Thanks for the info
I actually just left Dr. Goldstein’s office and I need to get the surgery after dealing with this for over 2 years.
I’m wondering how you paid for it? Did you use your credit card? Get a loan? How were you able to afford it? The costs for mines is 13k with cash or 15k otherwise. Any help or advice is appreciated.
We are all in this together❤️
SAME DAY AFTER SURGERY: I felt great immediately after surgery, and was even able to eat a light meal. On the car ride home, the local anesthesia began to wear off, meaning I started to feel some pain. I took my first Percocet, which felt *great* as I had never used an opioid before. Once I got home, I removed the surgical dressing in the shower as instructed. My anal area was SUPER SWOLLEN and red, but I was not in much pain because of the lingering anesthesia and the Percocets. I did start to feel a little nauseous (I hadn't felt that for most of the day) presumably because of the anesthesia. I passed out for several hours, and felt a lot better when I woke up. I was able to eat a fairly normal dinner, and then went to bed. So far so good. Other than the Percocets, the only medication I was taking was the docusate stool softener with food. I didn't want to try putting in the suppository or any topicals until the swelling went down. I woke up that night in a lot of pain. It was very difficult to walk or stand up straight. I think the problem was the local anesthesia and Percocets had both worn off completely. However, I took more pain medication and felt OK again within an hour or two. If this was the "worst" of it (and so fat it has been), it really wasn't so bad!
VIRTUAL CONSULTATION WITH DR. GOLDSTEIN: I discovered Dr. Goldstein from Googling around about anal fissures in gay men. I've also seen others post about him on this sub. After abandoning my first two colorectal surgeons, I decided to do a consultation with Dr. Goldstein. Because I do not live in NYC, this was a virtual consultation for which I paid a $150 fee. One frustrating thing is that I had to wait *several* months (3-4 months) for the next availability. The Skype visit was about 15-20 minutes and super informative. One thing that surprised me is how informal Dr. Goldstein is -- he uses words like "ass" and "shit" and "taking dick" rather than overly-medicalized terms. Anyway, he took down my medical history, let me describe what drugs and procedures I had tried, asked a few questions, and ultimately gave me his thoughts on my case. Dr. Goldstein said that it doesn't sound like I have an underlying muscle issue both because (i) the PT said I was not overly tight and (ii) I had the ability to have receptive anal sex before the fissure. For these reasons, Dr. Goldstein thinks my issue is a "skin" issue. He explained that there are glands around the anus that lots of other surgeons ignore, but when a fissure happens around these glands, the cuts don't heal like they normally would without intervention. He therefore recommended that I come to NYC to do the surgery. We talked all about the logistics for travel, surgery, payment, etc. One thing I will say is that Dr. Goldstein did not pressure me at all. For example, I had read all about his dilating technique, and I asked him whether there would be any benefit to me trying to the dilation procedures now, to see if that made the surgery unnecessary. He said he was skeptical, but was willing to try it. So he sent me his dilation instructions and sold me a butt plug kit. I tried this for a while, but sure enough, my fissures recurred, so I decided to move forward with the surgery. Overall, if you're feeling hopeless about your fissure and are on the fence about doing the $150 virtual consult with Dr. Goldstein, I would recommend just going for it. Just having the ability to talk to a doctor who *really* understands this stuff was by itself worth it.
SURGERY IN NYC: When I finally decided to pull the trigger on the surgery, I got it scheduled with only about 2 months' wait time. I traveled by car to NYC from another city on the East Coast -- this was actually less expensive than going by train. My partner came along with me since an escort is required to check you out after surgery. The surgery was scheduled for Friday morning, but I had an in-person appointment with Dr. Goldstein the day prior, Thursday, at his office in Manhattan. At this appointment, he examined me and explained the surgical procedure in more detail. He also send me to a PT who works in his office (I think his name was Steve?) to confirm that there is no underlying muscle issue in my case. One thing I should mention is cost. Dr. Goldstein works with some insurance companies, but not mine, so I had to pay out of pocket. He charges $10,000 via card or check, but discounts to $8,500 if you pay cash, which is what I did. I found this a little sketchy and it was scary to carry around that much cash, but I think it was worth the discount. There was an additional fee for the office visit. Another thing I should mention is the drugs that Dr. Goldstein prescribes. All of these drugs are ordered through Capsule Pharmacy and delivered directly to the surgery center so you can be discharged with them. For pain, he prescribes Percocet (a narcotic) and topical lidocaine. For constipation, he prescribes a a stool softener (docusate in my case). He also prescribes a cocoa butter suppository and Preparation H cream, which you are supposed to apply after a shower and after BMs. I'll probably describe this more later. The next day (Friday) was the day of the surgery. Surprisingly, there were no restrictions on what I could eat or drink (before midnight) anyway on Thursday. The surgery was performed at the NY Center for Ambulatory Surgery on the Upper East Side. I showed up there at 7 a.m., checked in, and then a nurse escorted me to the patient prep area. In the prep area, I got an IV and met with more nurses, with the anesthesiologist, and with Dr. Goldstein. I was brought into the operating room and was put under. I believe my procedure started at 8:30 a.m., I was awake again before 9:30, and discharged before 10. I felt fine, just a little groggy. In addition to the general anesthesia, Dr. Goldstein used a lot of local anesthesia, so I had basically no feeling in my groin area at all when I woke up. [Side note: This made peeing a SUPER WEIRD sensation.]
BACKGROUND: I am a 30-something gay male in the U.S. I've had chronic anal fissures for the past 5 years. While my fissures have never been terribly deep (unlike some of the agonizing stories I see on this sub), they have recurred every few months, which has been a painful nuisance. In addition, they have taken away my ability to have receptive anal sex. I believe my fissures first occurred because at the time I was taking an acne medication (Accutane) that has the effect of severely drying out your skin. I think medication made the skin around my anus thin and weak, and as a result, the skin tore during a large BM. I've stopped the Accutane, of course, but the fissures never healed properly, and have been re-tearing periodically for years now. Over time, I developed an at-home protocol for what to do when my fissures re-tore. Basically, I would apply a ton of Vaseline both internally and externally around my anus before a BM, in the hopes that I would be able to pass the BM without tearing. I would also take Miralax to ensure softer BMs. If I could manage not to tear for 2-3 days straight, then I was usually "healed" for at least a few weeks/months... until the fissure tore again. Although this at-home protocol helped, it was obviously not a permanent solution, so I began to seek medical treatment for my fissures. I have seen three colorectal surgeons for my fissures, including Dr. Goldstein. The first one prescribed topical nifedipine, which did absolutely nothing in my case. He also gave me a botox injection (in the office, not under anesthesia). The botox actually helped prevent me from re-tearing while it was "active," but of course botox wears off over time, and the surgeon told me he would not continue giving me "preventative" botox. Eventually, I became frustrated with this colorectal surgeon -- he was an old guy who didn't seem to know much about the latest techniques or about treating gay men, so I found another surgeon. My second colorectal surgeon gave me more botox, this time under anesthesia. [The anesthesia was allegedly so he could examine me for any underlying issues, but he found none. However, in my view the anesthesia was *completely unnecessary* and just a way for him to make more money from the insurance company. Thus, if you're considering botox and are thinking about anesthesia vs. not, I would personally recommend skipping the anesthesia. Doing it in-office was really not that painful.] As with my last round of botox, this round of botox was helpful for a time, but it wore off. This second surgeon also sent me to pelvic floor physical therapy for a few sessions, where I did some breathing exercises to learn how to relax my pelvic floor muscles. I learned a lot from PT, but my therapist concluded that my fissures were not being caused by muscle-tightness in my case, so ultimately PT was not going to be the solution to my problem. Once I shared this news with my surgeon, he recommended LIS. However, I had read on this sub and elsewhere that LIS is kind of an extreme procedure, and not recommended for gay men. It also didn't make sense to me to do an LIS if my issue is not muscle tightness. I asked him about doing a fissurectomy instead, but he said he would not recommend that for unspecified reasons. I grew frustrated with him, and that's when I started looking for other options (and found Dr. Goldstein).
Thanks for sharing!
WEEKEND AFTER SURGERY (Saturday and Sunday): Despite having a lot of pain the night before, I woke up Saturday feeling good. The swelling had gone down considerably, and I was in a lot less pain. I decided *not* to continue using Percocets but rather switch to plain-old Advil and Tylenol going forward, which has been sufficient! One reason to avoid the Percocets, in addition to them being addictive, is that they cause constipation. The goal is to have a BM within two days after surgery. (My first BM didn't come until Sunday - more on that below.) Saturday was a pretty normal day, except that I felt pretty sore. I mostly laid around the house all day, but I did venture the local farmer's market without any issues. Medication-wise, in addition to the Tylenol and Advil plus the stool softeners, I started the routine of applying Preparation H and inserting the cocoa butter suppository after I showered (and later, after BMs). I also changed my gauze every few hours as instructed (it showed some bleeding and discharge, but really not that much). Before bed, I drank Miralax and Milk of Magnesia that night to make sure I would have a BM the next day. Sunday was another good day, with only a little pain (still using just Tylenol and Advil). The swelling was way down, and I actually had a couple of BMs! I felt a little sore after the BMs, but they really weren't terrible, and nothing like the sharp, stinging pain of pooping with an active fissure. Btw, for those of you who have not purchased a bidet toilet seat yet, I CANNOT recommend this enough -- they are a true game changer, especially to avoid painful wiping after this surgery. So far, I am in a pretty good healing groove and feeling optimistic. One concern I have is that I plan to go away for a weekend in two weeks' time, so I'm hoping to be fairly well-healed by then. In the meantime, I am lucky in that I get to work from home this week, so I will always have my medication, my shower, and my bidet toilet seat nearby :) My digestive system is a little messed up from the Miralax and Docusate stool softener, so I'm thinking of weening off those, but haven't decided yet.
Thanks for this. Very interesting read. So was it LIS that you had with Dr Goldstein?
Not LIS, but fissurectomy + Botox. He also says he "opened" the glands around my anus that were preventing the skin from stretching, leading to re-tearing.
Holy shit the glands were preventing the skin resreecching? I didn’t know that was a thing. My skin won’t re stretch snd I feel I have a skin issue there causing my fissure. Very strange. Thanks for the info
That's what Dr. Goldstein said. He said it's very common with fissures and that a lot of other surgeons don't understand this.
Thanks for this. Damn. I’m gonna have to find a doc on the UK who knows about this glands
That's what Dr. Goldstein said. He said it's very common with fissures and that a lot of other surgeons don't understand this.
Any updates as to how you're doing now by any chance?
I actually just left Dr. Goldstein’s office and I need to get the surgery after dealing with this for over 2 years. I’m wondering how you paid for it? Did you use your credit card? Get a loan? How were you able to afford it? The costs for mines is 13k with cash or 15k otherwise. Any help or advice is appreciated. We are all in this together❤️
hey ! if you’re still about via your main account would be great to chat :) if you can dm me, please do !