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I hope you have room for one more! I have had so many problems with my bottom I think people are getting sick of my whining!

My latest problem is anal fissure which I developed after hemorrhoid surgery. I have suffered with hemorrhoids for 4 years since my last pregnancy. During delivery I damaged the pudendal nerve which innervates the rectal region which caused constant pain and problems with mucosal prolapse and diminished sensation.

The doctor has me on the beta blocker cream to help relax things because she is reluctant to do surgery on me because I am at a higher risk of having incontinence.

My biggest obstacle is the amount of pain I am in and that my doctor doesn't seem to appreciate how much it hurts. I can hardly sit, drive or have a normal life. I take 8 advils a day (two are vicoprofen) and it still hurts. I have to go back in 3 weeks to check on the healing and then stay with the regimen another 3 weeks after that and then I may do the surgery. I am in so much pain I even asked about a colostomy.

Of course having BMs hurt but the pain doesn't seem to go away. How do you all function?

I am so scared this is going to last forever. I can't imagine having a fissure as long as you guys have! I also have this skin tag that is swollen with part of the fissure on it that I wish she could just cut off now!

I am so glad to hear that some of you have recovered and thank you for providing a forum for this problem.

Lecia

Hi Lecia and welcome to the board!

It sounds like surgery is not an option for you. To be honest, it is how most of us here have overcome the beast. It also sounds like you are on either dialtezam or nefedipine.

How high up into your anal canal are you putting the cream? i found that I had to use larger amounts and get it up into the sphincter area (which is where most of the pain, particularly the spasms, are). Just putting a pea-sized amount on the fissure site may not be enough. The more I used, and the higher I placed it, the more I seemed to heal. It *certainly* controlled the pain better!

Also, could you describe how you've modified your diet (?)

Any stool softeners (you'll need those!)

How long after your BM does the pain last. Is it over by noon? Does the pain come and go in waves or is it constant?

As for not being able to sit, drive....I understand that completely!

Hugh :joker:

Hi Hugh,

Thanks for replying to my post! I am using the dilitiazem cream just on the outside. I asked if I should put it on the inside and she said no just put in on like you would lip balm just on the outside. The tear isn't too far up and part of it goes into this knot or tag that is very swollen. I wish she could just remove that. It feels like a external thrombosed hemorrhoid but I have asked twice and was told that it was part of the fissure.

I am taking a small amount of miralax and about 20 fiber tablets a day. I eat All Bran buds in the morning and about 5 servings of fruits and veggies a day and drink about 64 oz of water. I have gotten my stool to be soft but not unformed that it is diarhhea but it still feels like a brick coming out. I get into the tub afterwards and them put my dilitiazem and lidocaine cream on. The pain lasts pretty much all day though improves. When I get in bed at night I feel pretty decent and then I when I wake up I go through it all over again. I have been tempted to just stop eating so I wouldn't have to go to the bathroom.

Hope you are having a good day and thanks again for taking the time to respond!

Lecia

Hi Again,
Well, don't stop eating! And don't avoid having BMs, as that will only aggravate your problem.
I'm concerned: Some folks can get too much fiber and this can be just as bad as too little. Have you tried getting fiber from natural sources? Cooked veggies and fruit?
Be careful about things like roasted peanuts that may not digest and will irritate the fissure as it goes by.
The sphincter is *most likely* the source of the spasms that continue to plague you through the day. I personally am not convinced that a dab of dialtezem on the fissure itself is enough. A good dose delivered to the sphincter is better: But I'm no doctor.
I used a anal-syringe type thingy that came with Proctofoam. I would put in about the amount a person would use with toothpaste on their toothbrush. Maybe a bit more. I would use the syringe to get it up there as far as I could. The shape of the syringe allowed me to insert it much easier than, say, a finger.
From what I've read, Nefedepine is somewhat better than dialtezem; It worked pretty good for me. Consider changing.

While surgery isn't an option, Botox might be. It has helped some people but the cure rate isn't high enough for insurance to pay for it.

You can try eating less, too. But do eat, and if you eat less, take a vitamin supplement. Zinc is needed by the body to heal, as is vitamin C.
B vitamins are great for various mucous membranes, tissues, and nerves.
While they won't help with the pain, they may help your body to strenghten. Magnesium seems to help a LOT of folks.
My best days came when I had less BM volume, so eating less might help.
Finally, keep your stools formed by all means! Loose stools were the WORST for me. Stay away from catalopes, BTW, as they will give you a loose stool!

I'll keep thinking!
Hugh :joker:

Oops, I re-read your post and see you are on the veggies and fruit: You *are* getting too much fiber when you add that to the fiber pills and the bran. Consider dropping the fiber pills completely. I never used them (though many on the list *have* and they do work) but since you are getting that from your diet, save some $$ and maybe some pain as you have too much volume/bulk passing through and that isn't good.

Yeah, I was wondering if I was overdoing the fiber thing! You know when you think some is good so more would be better!

Would less fiber mean less volume or just harder stools? Because of my nerve damage there has to be a certain amount of bulk for me to know when I have to go.

I go every day at the same time. I wondered if it would help to go less. Do you know if things like soup and protein shakes produce stool?

I will ask my doctor about the other cream and if using it inside would be something to try.

I did look into botox but because I have nerve damage I don't think I would be a candidate but I don't know that for sure. I have an appointment in Feb. so I will ask then.

Thanks again,
Lecia

ps I was wondering how some posters, like you, get those pictures in their profiles-those are neat!

Hi Lecia,
To get the picture, just click on profile (after you log in) and then click on avatar and follow the instructions. You'll need to make sure your picture/photo is the same dimensions as is stated on the avatar page I think it's 200pixels high and 150 pixels wide (or vice-versa). :cyclops:

Yes, less fiber will mean less volume. I don't know how that would affect you ability to sense a BM coming on. Less fiber will not mean a harder stools. That is determined by how much water is in the stool. So keep drinking/using stool softeners. Caffeine will rob your stools of water, but I don't see my two cups of coffee everyday has having any real effect -- I drink enough water to counter that.

Do ask about the nefedepine! My rationale is that the more you relax the sphincter (as opposed to just the anus) the less it's going to spasm and cause pain.

Hopefully you can heal/repair that nerve damage, but I know from my wife's experience that nerve damage does take longer to heal than, say, a wound or even a broken bone. But they do heal, unless the nerve has been cut or otherwise recieved extensive damage.

Hugh

Thanks for the info! How is your wife doing? How long did it take for her nerves to heal?

The doctors have told me I probably will not improve much beyond this point because there has been no improvement in 3 years between the EMG studies. But I still have hope that I will get much better and have a more normal life!

I cut down on the fiber some yesterday and there was less stool today so that was good. I also take flax seed oil and fish oil to keep things lubricated a bit.

Lecia

My wife fell and crunched her face last June, it took 3-4 months for the nerves that were affected to heal. She recovered completely.

Glad that cutting back on the fiber helped! Check the RDA on your bran flakes (for fiber) and use that as a guide to give yourself a rough idea of how much more you need the rest of the day. I think All-Bran with the yogurt bits will give you a whopping 40% for the day!

I use flax seed oil, too, and another 3/6/9/ Omega oil. Try to avoid the fish based omegas as they can be contaminated with mercury!

Also, if you can, try being hungry for a few days -- still eat, but eat less and see if if makes a difference in the level/intensity/ and or duration of your pain. It seemed to help me for a while backin October, but when I got to feeling better I began eating more and kinda fell off that regimen (I like to eat!)

Hugh:sunny:

Glad to hear your wife recovered completely! Can you tell me what omega supplement you take? I am taking Fisol which breaks down in the small intestine so you don't get that funky taste in your mouth.

I looked on the cereal box and the Bran Buds I eat have 13 grams of fiber per serving. I probably have twice that because my cereal bowls are pretty big. I don't enjoy eating it but I figure it is for medicinal purposes.

Fortunately I don't have a big appetite so that keeps me from overeating. I have lost 20 pounds since this pain started (I was down to 98 pounds) but am trying to eat some higher caloric foods like ice cream so I have put back on 8 lbs. I wonder if ice cream could be hard on digestion.

I wanted to mention I take acidopholis supplements too. Do you think this helps?

Thanks,
Lecia

Can you tell me what omega supplement you take?

I'll have to check that later (if I can remember!); I'm at work now. But they are gel caps -- I don't get any taste!

I looked on the cereal box and the Bran Buds I eat have 13 grams of fiber per serving...

You'll get used to the taste; I know I had to, but I've been eating "nuts and twigs" for years now! Experiment with different kinds (if you haven't already) & find one you like. Look back at that label again, it should also show you what percent of the RDA of fiber it contains...

I Fortunately I don't have a big appetite so that keeps me from overeating. I have lost 20 pounds since this pain started (I was down to 98 pounds) but am trying to eat some higher caloric foods like ice cream so I have put back on 8 lbs. I wonder if ice cream could be hard on digestion.

Wow, you are TINY! I lost too much weight due to my fissure, too! Now I'm just 154 lbs at almost six feet. Tall & skinny! I usually weighed between 165-175. Maybe you *don't* need to eat less (add some fat to your diet, it won't hurt if you don't over-do it -- Just NO trans-fats!) As for the ice cream....

W
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Dairy is a no-no on the "Anal-Fissure" diet! 1) the sweets will pass through your system too fast 2) Milk can give you too-loose stools (especially if you're like me) 3) Cheese can constipate.

Stay away from sweets and dairy if you can (wait until you're not in so much pain/are doing better, and indulge a little if you must!)


I wanted to mention I take acidopholis supplements too. Do you think this helps?

Absolutely. Anytime you can keep your digestive system functioning properly, it's friendly to your fissure. In this case, you are less likely to have diahrrea and, I guess as a result, have better-formed stools!

HOPE YOU ARE FEELING BETTER TODAY

Hugh

I checked the cereal box and 1/2 a cup gives 55% RDA for fiber and I usually eat 1 1/2 cups. I guess that, plus the fiber supplements and all the fruits and veggies I am getting was overkill!

I am a vegetarian who eats some dairy but no eggs. Like I mentioned I love ice cream but drink soy milk and rarely eat cheese. Maybe frozen yogurt would be a good alternative?

Do you think acidophilus is enough or should I get a broader range of probiotics?

I'd love to give up the fish oil but I wasn't sure where else to get the Omegas that I need so on that vegetarian point, I have had to compromise especially when I was pregnant and nursing.

Things feel better today. I actually woke up without being in major pain like I had been since by the morning the painkillers have worn off. The more I move though the more it hurts. I am guessing it is from friction?

Thanks for taking the time to answer my questions!

Lecia

>>I guess that, plus the fiber supplements and all the fruits and veggies I am getting was overkill!

Yikes!


I am a vegetarian who eats some dairy but no eggs. Like I mentioned I love ice cream but drink soy milk and rarely eat cheese. Maybe frozen yogurt would be a good alternative?

Sure! Just try doing without the ice cream until you get a handle on managing your pain, then indulge a little!

Do you think acidophilus is enough or should I get a broader range of probiotics?

I am just not familiar with probiotics! I don't see where it could hurt to increase the "spectrum," I guess.

I'd love to give up the fish oil but I wasn't sure where else to get the Omegas that I need so on that vegetarian point, I have had to compromise especially when I was pregnant and nursing.

OK, I take "Nordic Naturals" Complete omega 3-6-9 which I got from my wife and I don't know where she bought it. I'll ask her this weekend when I see her! The other one is an organic Flaxseed oil (Rexall, so lots of Mom & Pop drugstores should carry Flaxseed Oil). It just gives the Omega 3.

Things feel better today.

GREAT!


I actually woke up without being in major pain like I had been since by the morning the painkillers have worn off. The more I move though the more it hurts. I am guessing it is from friction?

Maybe, and from bending, turning, twisting, all the thing we do everyday that normally we don't think about until we get a fissure.

Thanks for taking the time to answer my questions!

No Problem, here's to having an even better day tomorrow!

Hugh

Okay, Hugh-just two more questions I thought of and then you can have the night off!

I am noticing some itching a little bit-does this mean it is healing?

Secondly, my doctor said when I get better I need to avoid exercises like squatting and lunges to avoid hemorrhoids and anal problems. I was wondering if you know anything about using a pilates machine or total gym? I was thinking maybe this would keep the pressure off the rectum but allow for me to get some exercise since I would be exercising in a recline position.

Thanks again for your support and willingness to share!

Lecia

hi lecia,

i am sorry you are dealing with this........

but there are some great things that i have gathered over your replies. i will throw out some suggestions and see if you are game to make some adjustments.....

1. Excellent that you are eating All Bran Bran Buds. I do too!!!!!

As you learned, there is 13 g of fiber per serving and that serving is 1/3 cup. So if you do like me, I eat a whole cup in the morning - which comes to 39 g of fiber. Can you imagine how much good fiber that is and you get it all in the morning!!!! Amazing. And then any addition fiber you have during the day is a bonus.

I would recommend that you consider doing away with those fiber supplements because the All Bran Bran Buds will be enough if you get the 1 cup in. Or you can have 2/3 serving for breakfast and have the other 1/3 for a snack....these are great to eat alone or with dried fruit. But definitely aim at having the full 1 cup serving per day.

2. I think if you take away the fiber supplements, and keep your water constant, I too drink 2 liters of water, roughly a bit more than 64 oz per day.

3. Stress plays a big part in your bowel movement. I find that when I am super stressed, my elimination is not the best and sometimes I either get constipated or I get too liquidy.

It is difficult to feel like a free spirit when you are scared to go take a crap!!!!! That is the most difficult thing to work out. Lots of yoga breathing, patience, and some hope will help.

Some things that I do now religiously in taking a crap....yes, it's a lot of work, but it has kept things going well:

**soothe your anus with some nice warm to mild hot water soaked up in a wad of toilet paper before taking a crap. applying the warm water will help loosen the tenseness that we have as we are awaiting the painful dump.
**if you can find some, use Palmer Cocoa Butter Formula with Vitamin E Moisturizing Body Oil. Apply a nice dab on your anus and work some into the anus as comfortably as you can without pushing yourself to pain - only go as far as you can without pain. Once you hit pain, you've gone to far. You'll be amazed that over time, you will be able to get further without pain.
**if you can squat on the toilet, this would help facilitate the elimination. i squat now. i can't think about going back to sitting. squatting for me helped alleviate pressure where the movement was going against the fissure. this helped me out.
** once you have had your BM, then use the best possible baby wipes around - hypoallergenic and without fragrance. wipe but still wipe gently as if you had a baby's anus.
**if you can take a shower post BM, then do so with warm water. let the warm water wash over the anus and keep it clean. ABSOLUTELY NO SOAP in the anus. if you can't take a shower, get another nice wad of warm toilet paper and wipe gently clean. then pat dry.
**if you took a shower, then use a blow dryer post shower to really dry your anus.
**you can then finish apply a very thin thin coat of the body oil or Palmers also makes a smoothe cream.

4. It's great that you are a vegetarian. This makes this suggestion even easier. Get a Macrobiotic book to read. There are two that I would recommend:

The Macrobiotic Way: The Definitive Guide to Macrobiotic Living by Michio Kushi

The Hip Chick's Guide to Macrobiotics by Jessica Porter

*****

Although you won't see a difference if you apply the first three steps until about 3-4 days, the fourth one will also help you over time.

It's not easy as it seems like there a lot of changes to make but they are changes for the better.

good luck......

ps. i would avoid all dairy. you can get probiotics via capsule form from a health store if you are concerned about replenishing the cultures found in yogurt.