anal fissures (sorry for the lovely topic)!

[mattlou2]

Hi,
I've suffered on and off with anal fissures for many years but began a flare up in October after not many problems.
I gave birth in August and had no problems during the pregnancy or post birth until October (unrelated).

I have been referred to a specialist now as it is so chronic and I cannot get it to heal. However, I'm pretty certain that they won't want to do anything whilst I'm pregnant.

For anyone who has had this problem also you'll know just how agonising it is!
I control it the best I can with diet and regular bowel movements but it is still painful even when not at its worst.

I am terrified about giving birth again, as with my first son I was cut.
My second child I tore in the scar tissue . I presume I will tear again as it is only more tender since having my second than it was the first time.

The tear I have in my bottom is directly opposite where I tore and I am really worried that the pressure of the baby coming out and the fragile area of the scar and the already existing tear I have will cause for a increased risk of 4th degree tears (never mind the extra pain)!

I've been told to talk to my midwife as it is a severe case and I am soon to be under the hospital for it, I just wondered if anybody had any similar experiences and what the outcomes were?
Thank you

I don't have similar experiences but could you request a cesearean?

I can only be of limited help, having had 2 CS for unrelated reasons. But I feel your pain having suffered badly with anal fissure during pregnancy and since. You probably already do this, but mine was hugely improved by taking enough movicol to basically give me diarrhoea (2-3 sachets a day) and using germaloids ointment, lots of it, both round my anus and inside. When I am very very religious about the movicol i'm absolutely fine, and can manage on 1 sachet a day. it's free on prescription.

Regarding the delivery, I think your obstetric history alone would be enough to get a ELCS if that's what you want. Even if you do have a CS, I suspect that you will eventually need surgical management of the fissure, and I cannot see how having a VB will do anything positive for the fissure.

Well, I presume that given the fact it's being referred to the hospital my midwife should refer me to a consultant to decide on further action.

Although I am terrified about the problems that could await me with a natural birth, I don't want to opt for a cesearean if it wouldn't be necessary. As I have a 9 month old it wouldn't be ideal but neither would the potential alternative.
Having kids is fun, eh!?

Bonzo, I do use anusol ointment when it's really bad but went back to GP today who has told me to use it twice daily for the next 2 weeks or so.
She's also prescribed me some more lactulose which like the movicol keeps me near or to diarrhoea (without needing to go lots of times a day). I have to try and keep things moving so do eat a lot of fibre and veg and I steer away from pizza and white bread as that can block me up enough to cause me agony for weeks!

She's put the referral in today for the specialist which she suspects will take about 8 weeks and as I said she's not sure they'll do anything whilst I'm pregnant.
A Dr back in January mentioned the route of surgery (which again terrifies me)! All the risks of incontinence etc :(

Really not sure how worried I should or shouldn't be regarding a VB or if a csec would or wouldn't be better for me. Ideally I'd love another vaginally birth but not if it's going to aggravate the tear as it's painful enough already x

Bonzo, I do use anusol ointment when it's really bad but went back to GP today who has told me to use it twice daily for the next 2 weeks or so.
She's also prescribed me some more lactulose which like the movicol keeps me near or to diarrhoea (without needing to go lots of times a day). I have to try and keep things moving so do eat a lot of fibre and veg and I steer away from pizza and white bread as that can block me up enough to cause me agony for weeks!

She's put the referral in today for the specialist which she suspects will take about 8 weeks and as I said she's not sure they'll do anything whilst I'm pregnant.
A Dr back in January mentioned the route of surgery (which again terrifies me)! All the risks of incontinence etc :(

Really not sure how worried I should or shouldn't be regarding a VB or if a csec would or wouldn't be better for me. Ideally I'd love another vaginally birth but not if it's going to aggravate the tear as it's painful enough already x

Sorry I am new here :)

Oh I know your fear. I had chronic fissures after my first birth. Oh the agony. I was more terrified of my making them worse by giving birth than I was about giving birth. Unbelievably, they were much better after my second birth and healed quickly. I was told the increased blood flow in the area during pregnancy helps and I tore again and was stitched up and this may have helped. Either way and I'm touching wood here, they have not returned yet and that was 2 and a half years ago. I had them for over 2 years and could not seem to get rid of them. Perhaps pregnancy will help you also. Good luck.

I should have added that the fissures did not cause a problem during the birth.

Hi lornemalvo.
When you gave birth, was there a current flare up? Sorry if TMI but when I go the toilet (even when I'm loose) it's a ripping feeling! When really bad it is like passing razor blades and even at its best at the moment the pain takes my breath away.
Afterwards I get a burning/aching/throbbing pain which can last for hours! Just sitting down is agonising and even when the pains have subsided, penetrative sex can create a burning sensation in my bum. That's the main reason I'm concerned about how bad it could get with the pressure of a baby pushing down on it (on my scar also which is directly opposite as I say)!

I keep thinking it'll be fine and then I remember just how painful going to the toilet is (for houra/days/weeks) what the he'll is giving birth going to do! :( x

I can't talk about fissures, but in terms of your scar tissue I had a similar experience - large episiotomy for forceps delivery first time round and large second baby tore it up eighteen months later. My scarring was very painful second time, much more so than after the cut, but it is totally fine now. What I found helped was arnica pillules (bit woo I know) and massaging the area with oil. Any old oil will do so long as it's hygienic but stimulating blood flow to the area and keeping it flexible will reduce your chances of tearing again. Hope the consultant offers some good advice, in seeing mine next week and will ask about the tearing specifically.

I like germaloids as it's very thick and sticks better. I put a tiny scrap of loo roll on my bum hole to save my knickers!

It might be worth not going overboard on fibre: it can add bulk and make your poo quite bulky. Definitely drink loads of water though. I'd take a gentle iron tonic, like floradix, if you are not anaemic to stop you becoming so. Cos iron tablets bunged me up big time. In my last pregnancy they have me Galfer (ferrous fumarate syrup) which is not constipating at all.

I'll have to try germaloids if I don't find any improvements these next 2 weeks then.i take it that's fine for use in pregnancy?
I've stopped taking my pregnacare regularly as I still have baby brain from 2nd son (scrap that 1st son) lol...This pregnancy has finished me off.

Anyhoo, I generally eat weetabix for breakfast with small amount of sugar or a banana. I've switched white bread to wholemeal and I try to have veg with every meal. Probably don't have quite enough, but am generally loose so seem to have found a balance and will be better now with the lactulose! That stuff is a close friend.

So have to do the toilet roll in the knickers! Silly me!! X

Sorry mummytomog, yeah although I have concerns about tearing again I don't feel overly worried as I experienced that worry with my last and although I did tear again, it all came together in the end and I don't have any big problems from it (little bit of tenderness but nothing unmanageable).
If you are overly worried defo speak to your consultant but with my last it was kind of brushed off and I was told it depends on if you have a stretchy scar or not. There was 5 and a half years between my first and second so I had definitely healed. I'm a little more concerned this time as it's been such a short time but definitely more worried about it causing me longer lasting day to day troubles with my already existing problem.
Hope all goes well :)

Sorry, just reread what you said... I don't know if or what they can offer given the pai after your second birth. I recovered much more quickly.after only tearing with my second compared to the cut with my first (although the scarring was worse and a slight change in appearance compared to the nest cut) but again, nothing drastic compared to other stories I've heard. The episiotomy also wrecked my pelvic floors which I found improved after my second. Very strange.
But anyway, I think after each child we come away with different stories and different problems (just got to prevent and be prepared for as much as possible)!
Hopefully this time will be better for you x

A relative had a fissure which she finally managed to get rid of by applying coconut oil directly to the area. I don't know the details of how often to apply I'm afraid, bit it's worth a Google. It was a miraculous cure after using whatever the gp prescribed and gettn nowhere.

anal-fissure.org/how-to-use-coconut-oil-t5429.html

Thank you, I shall try that as I've heard a few people recommend coconut oil for many different things :)

Do you use a stool softener? If not, you need a prescription for Movicol. It's safe in pregnancy.

I have just got some more lactulose today but yes, softness is always paramount! I've sacrificed pizza for that s**t! Lmpao (laugh my painful as off)!

I really hope it works for you mattlou