anal fissure - support and advice please

[Parietal]

My poor dd (6 years) has had a small anal fissure for 18 months. It hurts her to poo, so she only does that about twice a week and with a lot of trouble. The GP started her on Lactulose over a year ago which helped a little, and then we finally got a referral to the hospital a few weeks ago. DD had high hopes that the proper 'poo doctor' would fix things, but the doctor we saw was not terribly helpful. She had only arrived in the UK a few weeks earlier, and her non-medical English was weak. So when she recommended an over-the-counter cream "like vaseline but with vitamins" I couldn't work out what she meant. She gave a prescription for a stronger laxative (movicol) but not much else in the way of support. She just said this is common and can take a long time to heal.

So now I'm turning to the wisdom of mumsnet for some help with any of these questions:

• what can I do to help dd's fissure heal?
• what kind of cream do you think the doctor meant?
• is there anything else I should demand from the NHS?
• any positive stories of recovery I could tell DD so she doesn't feel so sad & lonely
• any charities or organisations that provide support for this kind of thing?

Thanks for any advice.

Why not ask to be referred to another specialist or seek a second opinion privately? If you're not happy with the specialist then tell your GP.

The most important thing is to reduce constipation, through diet. Lactose intolerance is a common cause, also lack of fruit/veg too little water to drink.

There is a really good cream called anoheal, its really expensive but effective on adults. Can cause itchiness/discomfort on application.

They do heal, tell her loads of peopke never hav them again.

Sorry dont know any charities.

Good luck dd, they are horrible.

Try Fybogel. It's the most amazing stuff - it makes poos sort of spongy so they just pop on out with no effort. I've checked and it seems to be OK for kids of six years old. It's quite expensive so see if your GP will prescribe it. I also agree that you should push for a different specialist - maybe a paediatrician?

Have a look at the ERIC website.

You will need to treat/manage the pooing issue for at least 2 to 3 years, so keep stools soft and make sure she goes regularly. This may mean using movicol/lactulose daily. Don't give a high fibre diet such as weetabix, bran, dried fruit as this results in large solid stools. Give cooked veg and fruit, stewed apple, vegetable soup, dried fruit that has been soaked and stewed - anything that holds moisture and is soft.

Vaseline applied around the anus can help the poo to slide out more easily.
If you buy some vitamin E capsules from the health food shop and break them open, the oil from inside applied to broken skin really helps healing. I wonder if that is what the doctor meant?

Avoid bubble bath as it can be very irritating and delay healing.

Anusol cream is soothing and reduces swelling and pain.

It is really important to get into a routine of having plenty of time to use the toilet at home before school. Worry about needing to do a poo at school is a huge anxiety for a child with this sort of problem and encourages holding on too long, which in turn makes the whole thing worse.

Sorry you had a poor experience at hospital. I hope you can manage to get this sorted at home. It does take a long time though, you have to persevere.

thanks for comments.

it is hard to know what to make of the advice we got at the hospital. i'm trying hard not to be biased against the doctor because of her background - I'm sure her medical knowledge is fine, but she couldn't communicate it well. and I don't know if we would have got a different outcome (in terms of prescriptions or a plan of action) from a different doctor.

so that is why I'd love to know what has worked for other people/children, and how I can support my DD.

DD1 had an anal fissure at about the same age ..it's horrible. I also had one post birth and it was like trying to poo razor blades.

LOTS of movicol.. and for a long time so it's so soft it slips out and the fear and pain is minimalised til it heals. And I agree...the usual high fibre anto constipation diet is not the way forward as you don't want huge poos!

It WILL get better.. DD1's did, mine did, and lots of reassurance and movicol IS the way forward .

Thanks Medusa

how long did it take to heal?

any creams/vaseline type things you would recommend? even for a placebo effect on dd?

Poor thing it's horrible. I would second movicol as the saviour, eat pretty normally, but have her drink lots of water. Up fruit and veg a bit with the movicol. You want the poo really soft, so might need to be more regular than once every few days as the longer it spends in the large intestine the more water gets drawn out, and the poo gets harder - and even if it's just the first 'bit' of the bowel movement that is harder, it can ruin the healing.

Ibuprofen after a BM helps stave of the spasms which cause the real ongoing pain.

Elizabeth Arden Eight hour cream is a good healer, also jojoba oil is very soothing.

Also using wet wipes after loo roll to really clean the area before any cream.

You will need to continue with the movicol for a long time after it has healed- I have read that the skin only has something like 40% strength back after 4 months and 80% after 2 years, so any recurrence can really be a set back.

It can be helpful to sit with feet up on a stool when on the loo to raise knees slightly above hip height - moves you to a position more like squatting and helps ease the movement a bit.

Can you tell I have suffered myself here? I take movicol (one grown up sachet) everyday and have done for a year. Started by taking one twice a day and dropped to one after 2 months had passed with no bleeding or pain. The pain stopped within days of starting to use it, but you do have to get the dosage right. I won't stop until I don't know when!

Poor thing it's horrible. I would second movicol as the saviour, eat pretty normally, but have her drink lots of water. Up fruit and veg a bit with the movicol. You want the poo really soft, so might need to be more regular than once every few days as the longer it spends in the large intestine the more water gets drawn out, and the poo gets harder - and even if it's just the first 'bit' of the bowel movement that is harder, it can ruin the healing.

Ibuprofen after a BM helps stave of the spasms which cause the real ongoing pain.

Elizabeth Arden Eight hour cream is a good healer, also jojoba oil is very soothing.

Also using wet wipes after loo roll to really clean the area before any cream.

You will need to continue with the movicol for a long time after it has healed- I have read that the skin only has something like 40% strength back after 4 months and 80% after 2 years, so any recurrence can really be a set back.

It can be helpful to sit with feet up on a stool when on the loo to raise knees slightly above hip height - moves you to a position more like squatting and helps ease the movement a bit.

Can you tell I have suffered myself here? I take movicol (one grown up sachet) everyday and have done for a year. Started by taking one twice a day and dropped to one after 2 months had passed with no bleeding or pain. The pain stopped within days of starting to use it, but you do have to get the dosage right. I won't stop until I don't know when!

Thanks for all the tips.

What foods are best? We've been on bran flakes & raisins but maybe need to change to something softer?

Parietal

I put a list of foods in my post, just in case you missed it.

I think we may have cross posted last night,

Bran flakes and raisins are really not a good idea. That will ensure the poo is very large and solid/hard. Very painful to pass.

Be wary of insoluble fibre e.g. bran. Unless you drink tons and tons of water, it can kind of set in the bowel like concrete.

Once you get the dosage right with Movicol though, you won't need to worry too much about diet. The aim is to make the stool really soft so it doesn't re-open the fissure every time your DD has a bowel movement. If she's only going twice a week I expect that's exactly what's happening right now, which is why it hasn't healed in 18 months.

Start on 2-3 sachets a day and see how it goes. Trial and error!

Fruit, especially berries, I avoided apples for a while because of the pectin but think this was superstitious in retrospect.

Brown rice (not white)

Baked beans, actually any sort of beans

Any sort of vegetables, including peas, cabbage, spinach, tomatoes

Lots of water or (sugar free) squash

Carbs and salty food draw water out of the bowel so drink more water to compensate

But I would agree once you get the dosage right with the movicol diet matters less, but you need to get her going preferably every day, so start with a higher dose as suggested and move down once you've got a better pattern.

@MedusaIsHavingaBadHairday can i ask how long it took you to heal your fissure. I still have mine nearly 2 years pp now thank you