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!

lol @ anoheal

I hate the way you have to keep it in the fridge, "Oh, so I smear this on my arse, and then put it back next to the eggs?" lovely

I think that they heal SLOWLY because they will heal a bit and then tear a bit and then heal a bit and then tear a bit. But each time it tears I'm sure it tears a bit LESS, if you know what I mean. It's very gradual though. But try to think how bad the pain was, and compare with how bad you are feeling generally each month - and although the individual episodes of pain are bad, each month should get better.

Good luck!

Lactulose you can get over the counter from a pharmacy (but you can also get it on prescription which is worth doing if you don't have to pay prescription charges - otherwise probably not worth it because it is quite cheap, I think around £5 for a big bottle). Anoheal is prescription only. As far as I can tell (from a google search) it is still not licensed in the UK so has to be given on a `named patient basis' (this means the prescriber takes responsibility rather than the pharmaceutical co.). I had to wait some time for mine because the pharmacist had to order it in specially - it was hard to get hold of as it wasn't licensed.

anoheal is in "phase 3", so your doctor might not know about it. ask for it by name! it's diltiazem, a calcium channel blocker, and i still dont understand quite why it works....btw, havent bed for several days now, and its feeing a little better every time.
ive got psylium husk....i found it for 80p in the local shop. its about 100 times cheaper than in health food shops, if you can get it in indian shops. i do take it on the days i think i havent eaten enough fruit.
i found an excelent self help page, cant remember the website address but if you do a google search; anal fissure self help page, you get lots of personal testimonies and top tips on it....and thats where a few mothers say bf made it worse.
good luck to all the other sufferers!

OOh god, the pain and bleeding that came with a poo after DS2's birth was immense, dreaded having to go to the loo, I had 2nd degree tearing. I had to shut my eyes, double over and squeeze on to something whilst having a crap.
Dr didn't see anything wrong, mentioned a specialist, but never heard anything back it cleared up after 7 months or so, but when I get the urge to poo, I really have to find a loo within half an hr or so.

Eat lots of cooked green vegetables - great softening effect on stools.

Freely use baby's bum cream on (& slightly in) yours. Especially that white one that smells terrible but has fish oil in it.

Don't consider surgery. It will get better in time.

Just have to say what a relief it is to hear that others have had this too. I've been feeling so worried and alone with it, thinking I must be the only one. Feeling more positive now from reading the posts and a huge thank you for all the tips. Off to the Coop tommorow for a green veg spend....my poor dh...I can feel some windy days ahead

Will use the sudocrem as soon as I feel brave enough to go anywhere near that area. I must say it is just good to hear that given time, things will hopefully get better. I also have to race to the loo..wonder if that's damaged muscles from birth?...oh those days long ago when I thought 'pelvic floor' was a posh kind of lino..ha ha....

I ended up with a nasty anal fissure after a c-section with my DS last November. Think the painkillers made me constipated so I tore . It made me miserable for weeks and I barely ate, am relieved that it's not just me who suffered. Doc gave me Rectogesic which gave me the headaches from HELL! So I stopped it and let it get better in its own time. Think the pain was shocking though. However I was also told I could possibly have Botox in my bottom as it relaxes the muscles and helps healing. I didn't know whether to laugh or cry. My DP has been great, sympathetic but also finds it hilarious! All seems to be ok now.

tentacles: you all healed up now? hope so.
Basset: part of the probems are caused by tight sphincter muscles. its worth putting on anoheal and vaseline or ky jelly, not only cos they really help but also touching the muscle can actually help too. dont be shy about seeing yr doctor and insist onm anoheal not steroids as steroids may make it worse.
no blood again today, and only a bit of pain. i was tempted by cheese, but i know it doesnt help, so i resisted! ive also cut down on caffeine and i dont do meat, but i wont give up red wine whatever anyone says!
feel so glad to live in the uk with a free health service, no matter how dysfunctional it can seem at times. anoheal is $80 a tube in amerika, and theres no way i could afford that.
isnt it great too that mumsnet exists, and you can find this support and advice?! feeling gushy today, maybe my period is due back....hopefully my sex drive might return with it?!?

Yes, no pain now or blood loss, just the need to get to the loo soon after I feel I need to poo. Also I find myself having to go before I leave the house, sometimes several times. It's almost like I can't relax and go out unless I have 'emptied' myself

check out

www.boardsailor.com/jack/af

all you fellow sufferers! it was really useful to me.
Tentacles: how long since you have been painfree? are you still breastfeeding? one of my crazy theories about my bowels being irritated is that its a hormonal thing from breastfeeding. the other is that ive got some terrible bowel disease, but it depends on whether im feeling positive or frightened...which usually depends on how much pain im in!

Pain free for about 3 months, although, I have just noticed a it of bleeding this morning .
Still breast feeding

i daydream about reading on the loo again! my dp is always going in with a magazine, and im so jealous.

i rate the pain according to what i have to do! so theres the holding onto the radiator AND the bath AND chanting, and then at the other end theres a nohold just wincing one!

have been on nohold wincing for a few days now, and its such a relief, but still feel a long way off any library activity.

thought of another tip: i now shit with the toilet seat up, and with a big book under my feet, so its a bit more like squatting. this seems to help too. i should just squat on the seat, but i dont for some reason!

lol, poor you. I was wringing my hands together or clutching my top or nightshirt and pulling at that, burying my head, anything I could to try and make it go away.

can you get something with numbing effect really helped but always comes back when stressed it ireally is so sore empathy for you. had stretch in end and it helped alot no probs after.

Maebee - I used to bite down really hard on the loo roll when it was bad and clutch on to the radiator At the moment it is feeling a bit better and haven't had bleed for a few days, hope it continues..

You might try putting your feet on a low stool/couple of phone books. I was told that repositions you optimally. (What a conversation that was). Also coleslaw helps me when needed, and porridge in the morning is like a big push from abbove so less is needed below! Why does nobody tell you about these problems? If it helps I was in agony for a long time after my ds was born, and no problems after my dds. Take care.

Maebee - I could have written your opening post. I have talked about this before on MN and I hope you don't mind if I copy a previous post here rather than rewrite - hope it helps in some way.

I have been there too. I had a tear with dd, that several weeks later after a bout of post-natal constipation, became an anal fissure, which was one of the most painful and uncomfortable things I have ever experienced. The first cream the gp gave me to heal the fissure gave me the most terrible headaches (who knew you could get headaches from a cream) and after a lot of weeping and demanding, I got myself referred to specialist - he was actually a surgeon, as it turned out, who was assessing me for an op to make repairs down there, but he decided there was a better cream and that the op was not a good idea in the long term. He prescribed a cream called, wait for it, Anoheal (!! ) which I had to keep in the fridge for all to see. It did work though and I was religious about putting it on as I didn't want to have an op. They also gave me sachets of something called Movicol (I found out later you can buy it over the counter at Boots - they order it in for you) which I found much better than things like lactulose for making going to the loo easier while I was healing. I also had some bouts of thrush with the antibiotics but they cleared up in time. I do feel for you though - the whole experience for me, what with people's fingers up my bottom, applying endless cream, worrying about whether I would ever have a sex life again, was completely depressing and humiliating. It is all better now though, thank god, and I didn't have any problems after delivering ds2 2 years later. Good luck!

Meglet - interesting that you got one after a c-section. I had thought it was DD's big head and all the pushing that did me in and was thinking of this as one of the reasons why I might go for elective c-section for next time.

apparantly, assisted delivery, forceps and ventousse (sp!?!) that is, has a 13% chance of anal fissures being caused. i also had a friend who got bad anal problems from a c-section, cos the painkillers constipated her so badly. i had a planned homebirth first time round, and i too am so panicked about this happening again that i think i might have an elective cesarian next time, if there is one.

Wilbur - its so reassuring to hear you healed eventually! and a sex life back! how long did it take with anoheal? ive been using it for about 2months, and it does really, really help with the pain and make my anus much looser again, but dunno how close to healing i am.

have any healed people any theories on whether getting your period back helped healing??? im keen for mine to resurface!

MaeBee - healing took about 2 months for me (which was almost 4 months post-natal as the fissure didn't appear until dd was about 8 weeks old). I didn;t get my period back until I stopped exclusive breasfeeding which was at about 5 months, so I don't think the healing had anything to do with that. You could also look at some homeopathic stuff to support your healing - I seem to remember that staphisagria is good for healing these kinds of wounds. You could look it up on the net. Keep on with the cream though, it will work. And by the way, I had my next baby at home and the birth was so much easier and the post natal time was blissful compared to my previous c-section with ds1 and dd's ventouse delivery.

wilbur - cheers for info. its great news that subsequent babies have been easier! ive tried homeopathic stuff and didnt seem to help. maybe im too cynical! comfrey did seem to help quite a bit, but im unsure about using it at the same time as my anoheal.
my fissure too developed after the birth. its been about 8 months now.

stleger - i know! i read heaps of pregnancy books and midwifery stuff and not a snippet about fissures! i think they are a secret, like the fact breastfeeding can really hurt!

myrtle - hows it going today? i bled a wee bit. do you manage to get a bath in every day? apparantly sitz baths really help, they say 20 mins 3 or 4 times a day, but in the real world i guess managing a few times a week is better than nothing. it helps relax the muscles.

hi sorry to hijack. couple of questions:
What is an anal fissure?

Wilbur are you in a london borough? Mine wont let me have a homebirth this time due to previous cs with no1 and 3rd degree tear/haematoma with no 2. Am due oct and am being pressured to have ecs which I am currently resisting.

an anal fissure is a crack in the anus, which sounds mild but its absolute agony due to the nerve endings that are there! the pain makes the muscle spasm, so after a v. painful bowel movement you can be in pain for hours. its often confused with piles by doctors, but its usually much more painful.
they most commonly occur through being constipated but also childbirth, due to the straining and pushing, is heavily implicated, and esp with assisted deliveries.

manitz - don't know if you will see this. I had a c-section with ds1 and then a hosp ventouse with dd (afterwhich I had the nightmare bottom problems!). I am in Wandsworth and went first to Kings and then to St Thomas. Tommys dithered about whether to let me have a homebirth (I had moved house and was officially in St George's cachement, plus I have other medical history issues) and although they never said no outright, they kept saying they couldn't guarantee a MW for me. In the end, I was lucky enough to be able to afford an independent MW for my homebirth, which was worth every penny. HTH.

wilbur thanks. I think events may have overtaken my wishes now as I had my anomoly scan yesterday and it looks like the baby has a heart defect so I may have a termination/miscarriage/cs but certainly it will all be done in the hospital as i have totally given up on the whole home birth thing. Am going to post for a bit of advice on it.

FWIW I had similar - cs with #1 followed by 3rd degree tear etc. Had looked into a private mw but I can't afford it at all so was going to attempt as non-interventional as possible vbac2 in hospital. Now I have no idea.