So down and depressed - anal fissure

[Fugghetaboutit]

I had a thread about constipation recently and now I've developed a cut on my arse from it

It's been like pooing glass. Dr gave me fybogel and hydrocortisone suppositories yesterday.
I've been applying coconut oil as I read that helps. I thought it was getting better but when I had a proper look for the first time yesterday I could see the cut and it really upset me. H had a look last night and said it didn't look that bad.
Maybe I should ask for it to be stitched up?
The thought of going toilet is dreading and I have a newborn and toddler who hardly let me do anything let alone relax on the toilet I can only go after using a glycerin suppository now otherwise it's too painful.
Just when my vaginal stitches had healed this happened, it's really depressing me.

[StealthPolarBear]

:( did your doctor say how long to give it before asking for more help?

[Fugghetaboutit]

No but if it's not better by this week I'm going back, I can't take it it's so painful. I have a baby who literally won't be put down which is so frustrating so I have to time when I go according to her. I'm not meant to hold it in, makes it worse but I do because of the dc, plus I'm meant to bathe 3 times a day to help heal which I definitely can't do.

[magpie17]

Oh I feel your pain! I had this after the birth of DS, the broken glass feeling is really gruesome. What I will say is that I used the suppositories and it was healed within a week, no problems since. You have my sympathy.

[Fugghetaboutit]

Thank you magpie, I really hope mine is gone in a week. You've given me some hope.

[TheGreatSnafu]

Sorry it's so painful - they aren't likely to stitch it up but there is an ointment that is specific to treat anal fissures as it dilates the blood vessels and encourages healing. Maybe you can ask for that?

Some information about treatment options and pain management here:
www.nhs.uk/conditions/anal-fissure/Pages/Treatment.aspx

Hope you feel better soon.

[Fugghetaboutit]

Thank you. I've heard of that cream and read it causes severe headaches and dizziness, which I cannot afford to have with young toddler running around and breastfeeding baby and no one to help :( thanks for the link will have a read

[Rainatnight]

Oh you poor thing. I had this and it's a nightmare. I actually wrote an advice sheet for a friend who had it - I'll see if I can dig it out and post it.

[Rainatnight]

Here you are - I've not edited it. It refers to 'he' because it was written for a friend's friend.

The wonder drug is Diltiazem, and he must get some of this as soon as possible. I doubt if they have it out there (and it has to be made specially here in any case), but next time he or anyone else is home, that's what he needs to ask the doctor for.

In the meantime, here are the lifestyle things that can help (I'm not going to be euphemistic, because he needs help and I'm sure he's not going to be too precious about it!):

The main thing to remember is that anal fissures are a vicious circle (quite literally, I'm sure your friend would say!). It hurts and the body reacts in all sorts of automatic ways against this pain, usually by tensing the anus. HOWEVER, these automatic reactions hinder the healing process, both by restricting blood supply to the wound, and by creating more stress on the wound. What follows are therefore some tips to reduce pain and relax the anus, helping to break this vicious circle.

1. Fibre AND water, at regular intervals throughout the day. Bear in mind that fibre is useless without water.
   

The key thing to remember is that a fissure is a wound, and the softer the poo, the less likely you are to open it further.

1. Tension and clenching of the ass will make it more difficult for the wound to heal, as it decreases blood supply. However, the pain involved in having a fissure makes you much more likely to have a tense, clenchy ass (it's an automatic physical response to the pain). Your friend should try, insofar as possible, to be watchful to clenchy-ass and relax it. I once did a meditation class that advised us to imagine breathing through the anal mouth to relieve tension. Surprisingly effective.
   

1. This tension and clenching also applies to actually going to the loo, and can really exacerbate the problem. Pooing is painful, so the bum clenches against the pain. However, this makes things worse as this means that the only bit of 'give' in the anus is the wound, which opens further as the poo passes through. (I told you I wasn't going to pull any punches!). This makes it worse, and so exacerbates the vicious circle is set up.
   

So your friend should also try the ass relaxation techniques while having a poo. Rather than pushing, try to 'breathe' the poo out, letting the anus relax a bit on the out-breath.

Sitting in a warm bath just before having a poo can really make a difference, helping to sooth and relax the bum.

It is tempting to avoid having a poo because of the pain. Try not to do this as it only makes it worse (your body absorbs water from the poo while it's sitting in the rectum, so the longer you leave it, the harder it gets. And as highlighted above, softness is all).

1. Warm baths, generally, really do help sooth the pain.
   

1. Avoid sitting down for long periods of time (just get up and take regular little walks). Also make sure that his chair (particularly the one in his office if that's where he spends most of his day) isn't too soft. Soft chairs cause the butt cheeks to spread, which can really pull at the wound.

[Rainatnight]

The thing about the drug is really important. I got referred to a consultant who made it specially.

[Fugghetaboutit]

Thank you, that's very helpful' I've been using gylcerin to soften and lunricate the stool everytime in. Hoping that will help the healing process, plus having a quick bath after to clean everything, then I apply coconut oil but now I'll use a hydrocortisone suppository after.

Can that cream be used while breastfeeding? I searched for it and it days it's unlicensed in the UK - does this mean my Gp won't prescribe it?

The vicious cycle of clenching because it's painful - which then tears more is v true. I read about relaxing mouth during and that has really helped pass it. It's just the anticipation, I get so anxious and feel depressed. And my damn period has just started

[Fugghetaboutit]

I'm not in any pain after I go, it's kind of instant relief. Do you think this means I have a small tear rather than a chronic one?

[Dumbledoresgirl]

I've nothing useful to add but I just wanted to add my support. I also think you are tremendous for going to the GP so soon (assuming this was caused by your recent pregnancy/birth). I suffered with an anal fissure after the birth of my firstborn for MONTHS because I was too embarrassed to show my bum to a doctor. In the end, of course, the relief of getting treatment made it all worthwhile but it took me ages to pluck up the courage, fool that I am. So well done for not hiding with this problem for ages.

Re treatment, in my case it was nearly 20 years ago so I cannot be sure, but I think I had lactulose. I know it is safe with breastfeeding. Also, you used to be able to buy it OTT so it might be something else to try. It is a stool softener in case you don't know it.

Finally, persist with the glycerin suppositories. My dd had chronic constipation for about 18 months when she was a toddler. I'm not sure if she had a fissure but she used to scream and scream every time she had to poo, and she would hold on to it as long as possible. In the end, I was given glycerin suppositories to use and I only had to use 2 before she could poo painlessly. They really do ease the passage and give your fissure time to heal.

Best of luck.

[Rainatnight]

I'm not sure about breastfeeding, TBH. You'll have to check with your doctor. Poor you, it's the pits. But you're starting to get help, and that's the important thing.

[Fugghetaboutit]

Thank you both. After giving birth and everyone seeing and stitching up my vag, nothing seems embarrassing anymore. Plus the dr didn't examine me but said it def sounds like a tear so I guess didn't need to.
I'll definitely keep up with the gylcerin, I've just ordered the liquid one from amazon so I don't have to wait for it to melt so should be easier with the dcs running around/crying

[Fugghetaboutit]

So I went to the loo yesterday after using some liquid glycerin and it didn't actually hurt! First time in weeks it was such a relief! Maybe the hydrocortisone is working.

[Dumbledoresgirl]

Great news.

[Imnotaslimjim]

I've recently given in and visited the Dr after suffering a fissure since November.

They've given me the GTN cream. The online stories are horrific, but do keep in mind that people only talk about it when it goes wrong. For every person saying they suffered horrific side effects, there will be hundreds that have been fine.

I've taken a risk with it as I suffer migraines anyway but I figured a headache was a small price to pay.

Its been only 2 days and already I'm opening my bowels without pain or blood. Its almost a magical cure.

I hope you get relief soon.

[gingeroots]

I know a poster on the Tamoxifen ( ie cancer ) thread who has had major bowel surgery and attendent problems such as fissure ,uses Diltiazem ,and says it works .
If that helps at all .

[Rainatnight]

So pleased you're feeling a bit better OP.

[Fugghetaboutit]

Thanks for the advice and support.

They fybogel hasn't done much yet but I do need the extra fibre so I'll take it just for that.

I have movicol here, how many sachets should I take a day and when?

Feel like I need to go soon but have dinner bath and bedtime to get through first so it'll have to wait a couple of hours

[Imnotaslimjim]

Movicol is generally 2 a day, 1 at breakfast and one before bed. How is it feeling? I've had a little bleed this morning after opening my bowels, but it was darker than usual, which is odd. But it isn't hurting to go any more which is definitely the best part!

[Fugghetaboutit]

I didn't go yesterday as was so tired I just collapsed into bed.

Don't feel the urge to go today either but might take a suppository.

Can't be arsed with this shit (literally)

[Rainatnight]

Fugghet try to go if you can. It only gets worse if you hold on