Constipation + anal fissure: some might consider TMI.

[bonzo77]

I have recently been very consitpated. No tummy pain but great difficulty actually pooing. I also have a chronic anal fissure, and the two make a vicious cycle. I am using rectogesic, but as we are TTC I can only use it for the 2 weeks between AF and ovulating. I am sure that if I could only sort out the constipation then the fissure would be less of an issue.

Dried fruit just makes me fart, lactulose tends to do the same. I am trying to eat fresh fruit and veg and drink lots of water. TBH it has made no difference. I stay away from all painkillers with codeine (i had minor surgery yesterday and have only taken ibuprofen, not the co-codamol offered). I realise I had some opiate with the GA, but this is long standing constipation).

Today my poo basically got stuck half way out. I used some toilet roll and broke off the bit that was already out. Then passed the rest OK. The poos are sometimes quite dark, like I've been taking iron, but I haven't (and don't because of this problem). The fissure is bleeding a bit (on wiping, not in bowl) but not that sore.

So, any ideas? I think I need something to soften the poo, I'm not keen on a stimulant like senna. As a teenager I had a half hearted attempt at bulimia and used senna a couple of times. Not enough to cause any damage, it was just 2-3 times, but I remember it really really hurt and caused massive diarrhoea. I've heard of glycerin suppositories, but will they irritate my fissure? What about things like movicol or fybogel (can you get them without prescription?). Anything else? I know that whatever I do I will have to do it long term and drink more (i'm rubbish at this, but really do try to get 2L a day).

Try the orange flavoured fibre drinks you find in the laxative section. They used to be called fybogel, but now I Ithink they are under the senokot brand. They're not a stimulant, you can take them regularly and they are safe in pregnancy.

However, if you are eating a good diet with plenty of fibre and the constipation is different from before, you need to get it checked out as there could be blood in the stool. Try porridge for breakfast - full of fibre and great for a low GI diet and make sure you eat brown bread and brown rice etc.

thanks, the poo is not always dark, but I did wonder about blood making them dark. there is def blood on wiping as I can see it if I wipe when I haven't just pooed, though obviously that doesn't mean that there's not blood in the poo too. I've had this on and off for a while, probably since DS (22 months) was born and I stopped looking after myself quite so well.

Will try the orange flavour drinks you suggest. My fibre intake is not as good as it should be, I already have wholemeal bread, but will try the brown rice and pasta too.

ok, I have had this just as you describe, and the fybogel didn't help me at all. The extra fibre in the fybogel just created bulk and didn't actually help anything pass more easily, iyswim.

Lots of fruit, veg and water did the trick for me eventually but only when I also cut out a lot of the biscuits and cake from my diet too, and started exercising more (started after dd born and she is now 19 months - I think it's only recurred twice since her 1st birthday, when I put myself on a healthy eating regime).

ok, will def cut out the cakes and biscuits (thinking about it I have eaten lots of these over the last 4 weeks, and it has coincided with things getting worse). Fruit and veg and exercise will be harder, but will try.

Really hope it improves for you soon, it is utterly miserable x

Strangely this is the second post I've seen in 24 hours on this subject - I wondered if it was going to be the same person! (it's not)

The Bladder & Bowel Foundation have a helpline and a page on constipation.

The Patient.co.uk leaflet is detailed and has plenty of ideas on the many varieties of laxative (who knew?).

Good luck with sorting it! I find drinking plenty (mostly squash & tea) really helps.

auntie thank you. Really useful links. Pretty obvious to me that medium and long term I need to have more water, fibre and exercise, but I'm going to go tomorrow and get something to get things moving short term.

thanks bobby just found his article. Looks like botox in the bum for me!!

Nice! Think I'd try the less drastic options first

My boss does botox. I might get him to do it for me. How hard can it be?!

The fybogel drinks contain psyllium husks as their main ingredient - you can buy psyllium husk on its own in powder form or capsules (which I prefer tbh) from Holland and Barratt which works out very much cheaper and also means you are avoiding artificial sweeteners and flavours.

Take a couple of capsules with a big drink of water, when inside your stomach the psyllium husk absorbs the water and turns into a gel which softens the stool and the large amount of fibre moves it on out through the colon.

I'd recommend you to try this before anything drastic. Speaking as someone who, in your situation due to medication, actually said "Yes doctor that's fine I have no objection to a student being present while you examine me, see you downstairs in 2 mins" and then literally ran away out of the surgery never to return, I can tell you that they work.

You want to be careful, bonzo - what if it was so frozen that nothing would come out at all?

wild thanks, will think about that.

auntie OMG that would be awful! Imagine the blockage. Never mind the at getting my arse out for my boss!

I have anal fissures (not chronic, they come and go) and use anusol inside as per instructions on the tube and that tends to help heal the fissure. Obviously you then need to eat or take something to soften the poo and make it easier to pass so the fissure can heal.

Yeah, I use germaloids in between the rectogesic doses every time I poo, and during the 2 weeks between ovulation and AF. It's my bloody lifestyle that's the problem!

Dried apricots work a treat . And if you get crazy jacks organic ones they are very nice too