anal pain since childbirth - breastfeeding stopping healing?

[MaeBee]

hi,
tomorrow i have a hospital appointment again. i have, i think, an anal fissure.
i gave birth to my baby 8.5 mths ago, forceps delivery, episiotomy and all that, and a couple of weeks after got this extraordinary pain when shitting, and blood etc. firstly, was diagnosed as having haemorroids, but eventually they decided it was a fissure.
last appointment it was too painful for them to look, but they said yes, probably a fissure, suggested anoheal - which i have found is safe for breastfeeding and am using and helps - but im not healed yet.
possibly might have to have surgery, which carries a risk of fecal incontinence. ugh. but im getting desperate. at the moment the pain is manageable, but sometimes it hurts not only having a bowel movement, but for hours afterwards.
i havent had penetrative sex since the birth, feel too afraid and in pain, the vagina too close to the anus.
and, im worried it might be worse than a fissure. rectal bleeding, lost lots of weight, need to shit at 5ish most mornings, often really urgently and very loose (sorry TMI!) and ive been thinking its my period coming back but now imwondering if its abdominal pain cos of some irritable bowel disease?
anyway, if anyone else has suffered this please let me know! and, im breastfeeding, and ive heard from other bf mothers that there fissures healed after stopping feeding, maybe low eostegen interfering with healing???
dreading my appointment tomorrow, cos its embarassing and probably pointless (they havent yet managed an internal examination cos too painful), but then i dread going to the toilet every morning too.
wish me luck!

Maebee,
I gave birth 8.5 months ago and had 3rd degree tear. Ever since I've had pain on going to loo and a little bit of bleeding. It has progressively improved so thought it was going but sometimes its still really sore and bleeds a tiny bit. I've been reading about fissures and it seems quite common after childbirth. I stopped bf about 2 months ago and I haven't really noticed any difference.
Cos you're worrying about it you might be in a viscious circle ie worry, loose stools at 5ish cos you automatically wake and start thinking about it and losing weight from all the worrying. I hope it goes well tomorrow.. post back and let us know.

cant believe im actually complaining about losing weight post-pregnancy anyway! im about 1, 1.5 stone lighter than i was before i got pregnant. but that could be breastfeeding and not drinking as much.
what are you doing about your fissure? did you have surgery or use anoheal or did it just heal? i try to have lots of fruit, water, no coffee, no meat, no cheese etc. i also use ky jelly befor a bowel movement and that really helps. let me know how your injuries are going too.
will post back tonight.

Hello

No idea about early morning bowel movements, although it could just be stress?

However I am proud to say that I am a bit of a pro with anal fissures, having had lovely big ones after both of my births

I really don't think that breastfeeding makes any difference - what makes difference is giving it TIME.

First time took about 18 months / 2 years to heal BUT IT DID HEAL. Second time took less time (9 months?)

First one was awful - I would pass out with the pain and retch with the pain etc.

When it was BAD, I found that Vaseline helped - used it A LOT especially before bowel movements. That really made a difference to the pain and I would recommend buying in a BIG TUB of that.

The main thing is to keep the area really CLEAN - have lots of baths.

Fissures will heal but they heal SLOWLY because of course you do USE your arse rather a lot on a regular basis. I looked into surgery but advice seems to be moving away from this now because of the risks of complications.

So my advice is:

1. Drink lots (so you don't get constipated, which is just unthinkably nasty with a fissure)
2. Eat properly (see above)
3. Smear yourself in Vaseline
4. Give it time

Sex is stressful with a fissure I agree - you are just so tired of associating the whole area with PAIN rather than pleasure. I hope you can talk this through with your partner and maybe just stick to non-penetrative sex until you feel more ready to go for it (although it will not be as bad as you think!).

Good luck - I know how GRIM this is, and I hope you improve soon. xxx

P.S. I also found that Sudocrem / Drapoline was quite good - you've probably got a tub or two of that already.

thanks morningpaper...yep, a good smearing of ky jelly beforehand definately helps. im in a low pain faze again, so i guess its healing, again?, but ive been put on the waiting list for surgery. its about 2 months away, so im hoping i will have healed by then and dont need to go through wtih it. the dr at the colonrectal unit seemed totally incredulous it could be to do with childbirth!! he explained that hormones during pregnancy can make you constipated etc. i explained i had never been constipated in my life.
he couldnt do an internal, but he did look on the outside and couldnt see a fissure although i have the skin tags.
so there we are. god, i hope im not facing a life of fecal incontinence.
morningpaper, 18 mths for the first one to heal?? how did you manage to look after a bairn at the same time. i cant believe its been 8 mths of it. did yours keep feeling like it was healing, or was it painful each time? and did the blood coincide with the pain? i didnt bleed today, and it was less painful again, but thats not always the case.
i used to be so disgusted with talk about poo! now i seem to be obsessed!

Mine can be really painful sometimes then other times I won't have any pain or very slight pain. I guess when its been used more, it hurts more. It has steadily improved since the birth but still get a slight pain and some blood. I've not used anything on it except used to have lavender baths when it was excruciating in the early days but I might get some of the ointment you suggested and see if that helps at all. No one ever mentions this when you get pregnant do they... but I'm kinda glad to see that its not just me.
I hope it coninues to feel a bit better for you MaeBee.

MaeBee I would REALLY not have surgery yet!

Wait longer and speak to another surgeon.

I'm REALLY concerned that your surgeon didn't know it could be caused by childbirth - 10% of women have a fissure after childbirth, due to the pressure of pushing the baby out and the thinning of the skin.

I wouldn't take his advice on MAJOR surgery which could result in fecal incontinence when he is ignorant of this basic fact!

I saw lots of consultants and they said that surgery was up to me, but they wouldn't recommend it, because it doesn't have a guaranteed success rate and the fecal incontinence risk is quite high. Now I'm glad I waited because it's all fine 99% of the time.

I don't know whether the blood coincided with the pain - not sure really. I found that vaseline was the best thing for me though. I would really recommend trying a course of CONSISTENTLY using vaseline (say for a month) and if that doesn't work then try using Sudocrem (again for a month or so). I would do this before opting for surgery - but for me personally, ANY risk of fecal incontinence was much much worse than coping with the pain.

Hi Maebee, I had a fissure after the birth of ds1 (ventouse) which took months to heal (in fact I still get twinges 5.5 years on, but so infrequently I don't worry about it any more).

What worked for me was diltiazem cream prescribed by my consultant, follwed by months of making sure my poo was always soft. I find it sometimes gets less soft just before a period so I use lactulose and sennokot at that time of the month to try and prevent this. Personally I also find that plenty of juicy fruit in my diet (e.g. melon, nectarine) helps.

Wrt the breastfeeding, I remember seeing a thread on here some years ago where the OP had a fissure and was b/f. She also felt that she wasn't healing because of the feeding. When she did give up feeding, the fissure finally healed. I shall try to find the thread for you.

PS totally agree with MP, try to avoid surgery - my Mum had a chronic fissure and eventually had surgery and it didn't even work very well. I don't think she has incontinence problems but these can develop much later IIRC. My fissure took about 2 years to heal to the stage where I hardly ever feel it, so it is worth persisting.

here is the old thread

That's interesting jellycat

I suspect that breastfeeding women might under-estimate how much water they need to drink = harder stools. That sounded like that might have happened to the other poster?

MP, possibly, although as I didn't bf for long with either of mine I can't really comment!

thanks everyone for your advice. im using diltiazem cream at the moment; its brand name is "anoheal" which is great considering you have to keep it in the fridge for all to see! not that i have ANY pride left about my arse now.
the anoheal does really help with the pain, and i was really convinced i'd properly healed until i somehow resplit which is weird as my stools are always very soft. i also use babywipes instead of toilet paper, which helps keep it clean.
ive tried so many different things: vitamin E, comfrey, anusol (another brilliant name!), homeopathic stuff,diet. surgery really will be the last resort. although im so hoping it wont come to that.
my baby is 8.5 mths, and he now doesnt feed between 7 and 7 (at night) so am hoping my period will return and my body might heal better. i think bf really does take it out of you, partly hormonal problems (like estrogen causing vaginal dryness...maybe anal drynes/thinning as well???) and partly dehydration and lack of nutrients. anyhow, i am gradually weaning him, and hope to have completed by a year. so im on the waiting list, but fairly confident i can cancel if i seem to be getting better!
the problem is with anoheal is that you can seem to be getting much better, but only for as long as you use the cream. at least, thats what the consultant said. but, hey, he didnt seem to know as much as me! i told him that forceps deliveries have a 13% anal fissure rate, but he seemed sceptical!
i think im the expert on my own body, whatever he's studied. and yes, im trying to avoid surgery, cos i hate hospitals and doctors at the best of times.
thanks so much for all your posts.xx

Maebee - LOL at the brand names for all these creams
My DS is nearly 9 months so you must have a September baby too - why don't you join us on the september babies 2006 thread. I would link to it but not sure how but it is under the Post Natal Clubs section.
Mine stung a bit today but no blood so I hope its improving.. I hope you feel better too, at least you can laugh about it

Hello

Me too and its making me miserable! Had my dd 6mths ago and have suffered with this since basically.

The doc gave me rectogesic but haven't used it cos it says 'rectal bleeding' in the side effects and I'm scared it'll make things worse. Sometimes it seems to be getting better and then back to square one (sigh....) I worry about it and that's probably contributed to me losing weight too. It is horrid isn't it?

So far I've had reiki (sobbed throughout - yikes), ongoing homeopathy - the homeopath is trying everything I think! and oodles of water, fresh fruit, branflakes and sweet potato.

Funny how I was so obsessed trying not to get flppin stretch marks during pg when now I really couldn't care less. I'd dance down the street naked if I knew it would heal and never come back

Sorry no great advice. Just wanted to share the pain Hope yours heals v. soon.

I had an anal fissure after my first birth. I was too embarrassed to do anything about it for 5 months - what a prat!

Anyway, what worked for me was lactulose (I know, it didn't do much for my constipation in pregnancy either, but it did work for this problem) and drinking as much as I could and eating as much fibre as I could. The idea is to keep your stools as soft as possible so that the passing stool does not stretch the tissue in your anus. A hard stool is effectively re-opening your wound each time you have a bowel movement.

I sometimes get smaller fissures even now and can heal them without recourse to lactulose simply be changing my diet.

I am glad I did not know there was a possibility of needing surgery to correct the problem, else I would never have made it to the GP!

Maebee, I had a feeling you had the same cream. I was only supposed to use it for 30 days by which time I had developed an allergy to it anyway. By that time the fissure felt almost healed (after 8 months of pain!), but I did suffer a relapse afterwards. But it was never quite as bad as it had been at its worst and it improved slowly until one day I realised I hadn't had any pain for a while.

Lactulose works brilliantly for me too. It makes the poo so soft and it just sort of slips out which is what you have to aim for - otherwise the fissure just opens up every time you go. I used our bidet and wet wipes to clean myself after going because I couldn't seem to get clean any other way. I think that does help too. Also, wiping with ordinary paper really hurts and aggravates the wound too.

mine felt much better today! which is funny cos i was worried: we were meant to be having a quiet dinner with a quiet married couple who were coming round, and the wife didnt turn up...she'd run off with an 80's popstar who i wont mention online, so it ended up being quite a drunken affair when the friends brother turned up to support him and everything.
anyway, i was clever and had drunk heaps of water so no big hard poos!
i think i am healing again, am feeling more confident everyday.
myrtle and basset: i would really try using anoheal.it is helping with the pain and the healing. and it is compatible with breastfeeding, i checked with the breastfeeding network who are amazing. also, i dont eat eggs, cheese or meat anymore. that seems to help loads too.
jellycat: ive been advised to use the cream for another 8 weeks, and it is recommended for at least 8 weeks in the beginning so think maybe was different to yours: was yours a steriod based one perchance?

oh, and myrtle, mines an october baby: just!

No, but it wasn't licensed at the time so may have had more restrictions. Or it may have been the consultant who specified that I was only to use it for 30 days. I don't know. But I couldn't have carried on anyway because I was getting this allergic reaction. It was def. anoheal, no steroids (I would remember as I used to work in pharma and know a bit about steroid creams ).

PS glad to hear it's feeling better.

jellycat - what was the reaction to the cream? was it like a burning thing? im wondering if im beginning to get sensitized.
sorry if i seemed patronising about anoheal and anusol....i didnt mean to

MaeBee, I'm SO sorry to hear about your sore bum. I've had a fissure since my DS was born nearly7 months ago, and it was combined with slight foecal incontinence (yum), which made it AGONY after every poo and for about an hour afterwards too. This is because the poo kept leaking, making the fissure hurt like hell. There were many times when I was housebound by the pain, so I thoroughly sympathise.

The thing that seems to be working for me is working those pelvic floor muscles like there's no tomorrow - I currently do them to music, to make sure I do lots and lots rather than giving up after 10 lifts. You didn't mention whether you also have bum incontinence but you did say that your stools can be very loose. I find that if they're either very loose or very hard they cause more pain; you need to find a happy medium in terms of their consistency.

You sound like you're happier with the way things are going at the mo but if you need to bulk out your poos I'd recommend psyllium husk - you get it from health food shops. Get the powdery version rather than whole husks, which are vile in texture. Basically you should add about 2 inches of water to a heaped teaspoon and gulp it down every night. Doesn't taste particularly wonderful but it is BRILLIANT. It kept me regular throughout my pregnancy as it's pure fibre, giving your stools a lovely, soft but firm consistency (ohhh, yesss) so that it all comes out very easily with little left behind to stick to your fissure and cause you more pain.

I'm so glad to hear that there are lots of us who experienced fissures post-natally, none of my mates had them so I felt like I was the only one. I really, really hope yours continues to heal and that you can tear up your hospital appointment letter soon.

No offence! Yes, the reaction was a burning sensation. My Mum had the same cream and had the same problem so maybe it's a common side effect. How long have you been using it?

Do you have to get anoheal and lactulose on prescription?
I'm glad its feeling a bit better Maebee.