Anal fissure(s)? (TMI alert)

[ItsAllGoingToBeFine]

Have self diagnosed anal fissure. Hurts like hell when I poo, bright red blood on toilet paper, and if I look in mirror, and push a bit I think I can see them. One at the top, and one at the bottom. Have never had these before, never strain on loo, and stools moderately soft. Have had first baby 4 weeks ago, and had fissures for about a week. Not getting worse, not getting better.

What can I do? (Will speak to HV when she comes tomorrow but obviously I trust mumsnetters over qualified medical professionals )

Keep your stools as soft as possible by drinking plenty of water (especially if the weather is hot and/or you are breastfeeding) and eating lots of moisture/fibre-rich foods like fruit and vegetables. Kiwifruit are an especially good stool-softener, for example, as are things like figs, berries, lettuce and tomatoes. Avoid eating very spicy/acidic foods that could cause irritation where there is any broken skin Avoid any kind of pushing if you can.

I would advise you to visit your gp. I had issues after ds was born and I had total tearing (he was 10 8 and had his arm in Superman pose! ) I was given lactulose to ensure ease of passing and fibrogel to bulk up and reduce possible infection. I was refered to a specialist because of the position and the fact I wasn't healing - the area was cleaned and made into a fresh wound that healed well and I have had no further issues.

Good luck

I've had (self-diagnosed) anal fissures in the weeks following childbirth

Excrutiatingly painful on passing a stool, am sorry you are in pain

Don't think i could 'see' them though? Might be worth a mention to your GP

IME they were like tiny cuts. On passing a stool they bled (bright red, as you describe) and the only way I can begin to describe it was like shitting broken glass. I know that's crude, but it's very apt!

Avoid constipation at all costs

Use Senna in the short term as well as drinking loads of water, and eat loads of soft fruits such as berries, prunes or dried apricots

Mine healed quite quickly, from what I remember

I had the same about 6 weeks after having DS (by CS so not caused by pushing .

I went to GP and he didn't actually take a look, just diagnosed me from talking about my symptoms. Which were very like yours.

He explained it was vital to kep stools very very soft, as otherwise the fissure will just keep retearing whenever you have a poo.

I think he prescribed me lactulose but I can't remember. Whatever it was it really helped and it all cleared up pretty quickly.

Hope you feel better soon.

A fissure is a tear in the lining of your bowel, like a paper cut, Im not sure you could see one. The pain from a fissure when passing a poo is unbelievable (notnowbernard is right with her description!).

Do you mean you can see piles (small lumps in/around your bottom - sorry if I am stating the obvious) when you strain? Sometimes you can get sentinel piles associated with a fissure, but I think the fissure has to be quite advanced before that happens. But from my reading of the subject (dont ask....) piles and fissures are two separate issues.

Im not familiar with the role of a HV, but is she able to do an examination? If not, best thing is to get yourself off to the doctor or nurse for an examination, as either way, if its piles or a fissure, they can prescribe creams that can help. Its a good idea to have a doctor check whenever you have bottom bleeding, you cant be too careful, and sometimes fissures don't heal very well. In the meantime, drink lots of water and dont strain to much when going to the loo.

Good luck!

I'm not sure I can see the actual fissure but I think I can see a thin straight line of blood IYSWIM. My HV is a nurse and is coming to me tomorow so figured I would ask her first as trip to the doctors is a major hassle at the mo (new baby).

Definitely painful - not dissimilar to baby crowning (and that tore as well)

Hmm, maybe I could see my fissure as training for having a baby

It does sound like you may have one of the little buggers, but def get your HV-nurse to have a look. There is a specific cream they can give you that works in many cases, but sometimes they heal by themselves. Mine did eventually go, but I think the area is a bit weakened because it does sometimes come back.

Water, water, water, and don't leave it very long between loo visits - it is tempting to do that because of the pain, but trust me, it makes it worse!

My GP prescribed Anusol pessaries - have found they really help.

Would moist toilet paper be a good thing? (have no bidet ) or would it irritate?

If you're talking about keeping the area clean, can you hop in the bath (putting baby in car seat) for 2mins and shower the area? Obv this weather doesn't help!

Mine has turned into a rather unplanned major weight loss regime . As I have IBS too I go to the loo 3/4 times a day and the pain is shocking, so I'm better off not eating. The plus side is that my food bill has come down .

Got to see the consultant next month for possible botox shots, the shame. Nothing else has worked. I only ended up with it as I was constipated after a cs due to the morphine, that was 3 years ago, bloody things are hard to stop once they have started.

I dont think drinking more water having a better diet does anything. The best best thing I found was "Ducoease" as advertised on the TV. Briliant wish I had found this years ago. I started having these cuts when I was about 19.

When better use a tad of Anusol cream to calm it all down. Also IBS tablets (you can get these either with GP or over the counter). A few days and it all clears.

I know the pain. I think my son has also inheritated the problem - I think we are all bum scratchers - always lubricating our bums!
Do not put Anusol on broken skin! use a greasy cream to keep the area moist and mend.

I had a blister on my bum after the birth of my son even though I had an emcs. Its the hormones effecting all bowels.

Try all of these and let us know.

I found the softer my poo was, the easier it was to go and was also much less painful. Also lessens the risk of the fissure 'splitting' again

So diet for me was a big one in the healing process

Cant take Dulcoease as BFing. Will try water and diet route for a bit (my diet is truly shocking at the moment!) Plan to get some Fybogel too.

re moist wound healing - would it be really weird to use Lansinoh? I have loads left from my nipple trauma

Another fissure sufferer here - not from birth, just general weakness due to trauma. Mine was/is def big enough to see - like a big knife cut - and has an unhelpful sentinel skin tag now, which makes it more likely to be aggravated.

Dulcoease is marvellous - and I think it is worth re-checking the 'can't take while BF-ing' issue. It says it on the packet, I know, but after talking to my doc about whether I could take it during pregancy, she said it was okay in small doses. Apparently they worry about it being dehydrating, as it lets your stool draw water into it as it passes through your bowel, which is what makes it bulky and soft (nice). But as long as the patient is aware of that, they can make sure they drink plenty of fluids. Which is good for bowel issues anyway. Maybe BF-ing is a different issue, I don't know.

If you really can't take it, then plenty of fruit and bran fibre will help. Whatever you do, don't take laxatives thinking it will make it easier, that's disastrous.

By far and away the most helpful thing is Xyloproct. A topical cream, you have to get it on prescription in the UK, it totally numbs the area and is an almighty relief. I tried anusol and another pile treatment, but they did nothing. Xyloproct is a lidocaine cream, and stops that awful 'afterburn'. It also helps the fissure heal because pain makes your sphincter tense up and close, which then makes pooing worse, which then makes the fissure worse, etc etc. I was almost housebound at one point with this - couldn't sit down to drive, was like having a lit cigarette under me! and xyloproct was honestly a lifesaver....

Having oatbran sprinkled over cereals every day keeps you regular as well as drinking plenty of water, Best of luck all of you.

After birth, your hormones effect the bowels, this is why the diet thing wont have an instant effect. As an occassional IBS suffer I have a great fibre diet but I still get the fissures and hard poos.

Think barkfox has some great points here.

Thank you, bacon - I feel I know more about fissures than I ever wanted to.

I forgot to say, I thought moist toilet tissue would help, but it really stung. I'm not sure why - reading the packet, citric acid was one of the 'ingredients', but I'm not sure in what concentration, so can't be sure it was the culprit. Anyway, ordinary toilet tissue dampened with tap water was much better and quite soothing.

Other (very blunt) advice I was given includes - what you really want for a fissure to recover is large, soft poos, ideally once or twice a day. So they gently stretch your anus, but won't scratch it.

Laxatives, or laxative effect food taken without bulking agents, just make you do lots of small more 'liquid' poos. Pooing a lot irritates your bowel and anus, and obviously if you are wiping lots of times a day, you're going to irritate the area more. That's why you want to 'soften' and 'bulk up' rather than take a laxative.

Also, lots of small poos might sound like a more bum-friendly experience - but an anus that isn't used to stretching in a relaxed way is much more likely to tear when you do (inevitably) pass a stool which is hard and/or large.

Someone asked if lansinoh might help. I'd be careful if you are dealing with a very open, bleeding fissure, because the main challenge is just keeping it clean - but if a fissure is just 'grumbling', then as a preventative measure, it might not be a bad idea at all. I've been known to use Elizabeth Arden 8 hour cream to soothe some minor scratching (figured it was developed to treat burns, so why not). Lansinoh would certainly be a darn sight cheaper.

I had to have surgery with GA to completely remove one and it really is the last thing you want.

I'd bypass the HV and go straight to GP for an examination.
Faecal softners are first line treatmant I think, then steroid creams/pessaries if they don't work.
Don't wait too long if anything doesn't work though.

I had a thrid degree tear with DS (2.4) and I have suffered with anal fissures ever since. They clear up on their own. You can use anusol though. Don't strain, keep stools soft.