Feeling so upset from medical advice, slightly graphic

[XForL]

I had a telephone consultation with a GP on Thursday because I have anal fissures that have returned but the Lactulose isn't working and I have so much impactation I just can't shift now for days. It's like the stuff itself is WIDER than my own bottom

It was a locum I spoke to

I explained that I was concerned because I simply couldn't go, but I have no urge to really push? It's absolutely disgusting, I'm sorry, but I have to push on the bottom of my vaginal wall to encourage anything out. But even that isn't working at the moment, and whatever is there is bulging into my vagina?!

He said constipation is common in pregnancy. When I said that I couldn't 'go' unaided with my fingers pushing down, he said he'd never heard of that before but to not do it! He gave me a lecture about it causing a UTI and that can be harmful for babies (I'm on iron tablets and a whole host of meds for extreme sickness, that coupled with not a great diet due to sickness means I'm very constipated anyway).

He said his advice was to up the dose of Lactulose and that should work. He said he doubts I'd need to call back as that should fix it

But I've done as he's said. And it's now Sunday and I feel like there's a head crowning. I'm sorry to be graphic again but whatever's there is far far larger than my bottom hole and I can't can't can't get it out. It feels horrendous. Plus every time I try my fissures are bleeding a lot and so sore

What should I do? Is he right or was he insensitive? My GP surgery is usually fantastic by the way!

@Midnightballerina don't read it then, what do you think graphic means?

I've had fissures. They are awful.

Try glycerin suppositories tonight. There should be a late night pharmacy somewhere. Put your feet on a washing up bowl turned over. If that doesn't work then a and e, or you may have a specific pregnancy triage at your local hospital.

Then for the rest of your pregnancy, use movicol

I'm shocked that your gp has not heard o6 vaginal splinting.

@Midnightballerina

You need your title edited this is more than ' slightly 'graphic. Noone needs to read about breaking up a massive shit with their fingers at Sunday teatime

It is clearly about bowel movements from the first line before any more detail is given just don't read about something like that if you're sensitive or eating soon/just eaten

Agree re movicol (or Laxido - same thing) much better than lactulose.
It is definitely fine in pregnancy. You may need a glycerin suppository to get things going.
All over the counter
Diltiazem cream helps the fissures but that needs a prescription
Ondansetron is a terrible constipator - even worse than iron

Suppositories and VASELINE, honestly it will make things so much easier.

Vaseline, glycerine suppository, gloves, putting your feet up on a step stool or squatting in the bath. You could use germaloids cream which has lidocaine on the area and internally prior to this to give you some analgesic effect.

Failing that A&E for an enema.

You will likely also need movicol if this is a re-occuring issue.

You can also get paracetamol suppositories if the pain is really bad (I was prescribed these with anal fissures and haemmorhoids post birth).

Doctor sound useless.

Hot bath -try and go on there

Worth taking paracetamol and half an hour later having a go , give it some time to kick in.

Sorry only read first few comments
I have a rectocele and this happens to me if i get just a little bit constipated. I have to put my fingers in my vagina and create a ‘wall’ against which I can push out. I take bulking agents and really watch my diet. Is this your first baby OP? X

@Midnightballerina

You need your title edited this is more than ' slightly 'graphic. Noone needs to read about breaking up a massive shit with their fingers at Sunday teatime

Such sympathy.

Where else is OP going to find a number of women who can advise her based in experience of similar.

Take your squeamish prudery and toddle off. Leave the thread to those who want to help or reassure rather than scold.

Oh bless you OP. I had this problem last year. Fortunately in my covid madness I had bought latex gloves. They certainly came in handy. I'll spare the details but only because other posters have mentioned it. Glycerin suppositories worked like a charm.

@Perching

Sorry only read first few comments I have a rectocele and this happens to me if i get just a little bit constipated. I have to put my fingers in my vagina and create a ‘wall’ against which I can push out. I take bulking agents and really watch my diet. Is this your first baby OP? X

No, 4th! I only have the one son now though

And one on way (I'm 10 weeks)

Hello, surgeon here….we get lots of folk in with similar issues. Try to avoid A&E, you’ll just be sat there for ages. If you can’t manage to sort it at home then ring 111 and try to get direct referral to surgery. Things we would do…lots of laxido/movicol from the top end, glycerine suppositories from the bottom end, followed by enema, plus manual evacuation if needed. If that wasn’t possible due to the fissures then we would take you to theatre and give a spinal anaesthetic to allow us to do it. The fingers in the vaginal thing is really common and not an issue, just make sure you wash your hands before and after.

I'd go to A&E - it sounds like a medical emergency to me, especially if you're pregnant.

@welshweasel thank you!

Thanks also to the person mentioning raising my legs tried it just now (a live update!) and it worked a tiny bit but just can't come through if that makes sense

I can't feel my rectal passage when going? As in I can't 'feel' a proper urge. Just the actual anus that is painful and has any feeling. The rest feels numb

Action Plan-

*Send OH for Vaseline and suppositories

• Take paracetamol

• Have a warm bath to help relax you

• Loo, feet up on stool suppositories and a ferret with Vaseline ( medical gloves)

*If that doesn't work then A and E tomorrow.

Best of luck.

Cosmocol is the same as mobilcom (but cheaper!). It softens the stool. I almost feel your pain as I have to take a sachet a day and suffer if I don't. Lactulose never did anything for me. I have also used glycerin suppositories before but I didn't have any fissures (but I do have piles!).

Good luck with shifting the waste. I also always use a small stool (!) at home to rest my feet on. It really helps.

Run a warm bath and try to poo in the water, it might help soften it as it comes out and then you can hopefully break up the crowning bit with your fingers, it's probably much softer poo behind !

@welshweasel Would they do surgery during pregnancy too?

I had a friend who had this due to her morning sickness meds - they wouldn’t operate then (he’s five now, so it might have changed!) but they did slowly work with her to break it out with their fingers. I felt so sorry for her… in the end she found it really embarrassing and warm baths at home helped her to do it herself, and then she went back the next day for them to check her over, and she had a higher dose of Lactulose for the rest of pregnancy to keep her more regular and stop it happening again, and surgery on the fissures after he was born.

You’re not alone

I wouldn't try an enema/suppository without medical advice, OP.

Can you contact your midwife/triage system? They're likely to be more sympathetic.

Could a real jolt of caffeine work on top of everything else? My husband is a doctor and says caffeine definitely has an effect on the bowels (must add haven’t asked him about this case, so this is unqualified advice from me!).

So if you had a GP appointment on Thursday (after a few days without a movement) I'm guessing you haven't moved your bowels in at least 5/6days? I honestly think you need to be assessed tonight by whatever your OOH service is.

I feel like maybe the fissures are maybe making you a bit scared to go and then the longer the stool is sitting in your bowel the more water is drawn out of it (similar to what happens to kids who get scared when potty training) and now has become more difficult to pass. They may want some imaging, but will maybe want to do a rectal examination to see if there is hard stool sitting there. Usually we would hit faecal impaction with lactulose/laxido/senna and an enema but can imagine they would be a little more cautious in pregnancy. Hope you get some relief soon but if it were me (previous general surgery nurse) i would be getting seen tonight.

Sugar free sweets, the ones at the Aldi checkout, worked for me. Gave me the opposite problem but cleared everything out.

Manual remove is the way to get it out, and they would do it in hospital with fissures or not unfortunately.
I have fissures, and ibs and I get so horrendously impacted I have to do this - it's horrible, there's no doubt about that and it hurts but being that impacted is very very dangerous.

Hi OP,

Not sure if this will help now, but I believe the adult version of movicol is available without a prescription from a pharmacy. I've read that its more more effective than lactulose and is completely non-harmful, even for long term use (my toddler is on it). I'm not sure about using during pregnancy, but I'm sure the pharmacist will advise. Good luck.