I've posted elsewhere about my recurring (borderline chronic) fissure.
It's been 8 weeks since I got my most recent fissure on Dec 4. The first fissure I got was in late March and didnt heal till May, when I discovered magnesium. However, every 4-6 weeks, after it felt all healed, and even after I knew it had healed (saw a colorectal surgeon in Nov), I'd get complacent or be overzealous with fiber and re-tear.
So this is just a summary of what has worked for me 8 weeks out.
Week 1-3: the acute stage:
- magnesium, magnesium, magnesium. 1000mg/day, generally alternating with 500-600/day if 1000mg gave me the shts (which it almost always did unless I ate tons of fiber).
- no more psyllium husks supplements. the retear was caused by huge and i mean huge stools from taking too much fiber supps. On a naturopath's advice, I replaced psyllium with "gentler" chia seeds and flax (I take it ground, even tho she recommended the whole flax seeds...I wanted the additional health benefits of the omega 3s with the ground seeds)
- i was already a vegetarian, but i went practically vegan -- lots of yams, cauliflower, kale, tofu, berries, etc. no more dairy, altho the naturopath said yogurt was ok and i'd have some once in a while (i always meant to buy kefir, but never did). no more cheese, which made a huge difference for me, since i ate way too much of it. i can tell the difference when i;ve eaten it. (fyi dairy can cause inflammation, which is not good for a healing butt or in general)
- less sugar and processed foods -- i am a sugar addict, the first week i went mostly without but it was HARD. especially leading up the holidays. and my willpower was not that great with the sugar. but sugar can also cause inflammation.
- 1000mg turmeric daily to fight inflammation (best to take in conjunction with black pepper) and liberal use of turmeric in my cooking.
- sitz baths, at least 1/day for 10-15 min
- hot water bottle on bum at night
- nitroglycerin ointment 2x day
- lots of water
- vaseline in/around anus before BMs in the AM
- vigorously shaking ass cheeks with hand if I felt a re-tear was imminent. I swear this helps, perhaps not mechanically in any way, but maybe it relaxes me as i focus more on shaking than on the BM itself.
- occasional use of glycerin suppositories in week 3, but it did burn the first time (wasnt healed yet)
Week 4 - almost healed
- I went to my parents' place for xmas for a few days, so lots of things changed! My healthy diet went out the door for a couple days (but actually wasnt too bad in hindsight). No more sitz baths as that was impractical there. I didnt take turmeric and I wasnt vigilant about everything that I consumed. I figured glycerin suppositories and magnesium would keep me safe (they did)
- I started using "sitting pretty balm" once in a while -- a variation of the "bottoms up balm" that the naturopath prescribed, rectally and around the anus. It doesnt spread that well. I mostly continued use of the nitroglycerin.
- Reminder: flying dehydrates you, esp when you have the flu! I almost had a scare after I flew back, it didnt help that I snacked on dehudrated fruits, which are loaded with (mostly insoluble) fiber. But i had the flu so sleeping was the main priority. Yikes. I consider myself lucky!
Weeks 5-6 weeks -- pretty much healed, but still vulnerable to re-tearing
- I started using the magical spa travel bidet (nasically a waterbottle with a nifty spout) that you can spray your ass with after a BM. I wish I had had this earlier during the acute phase. I use it whenever I am at home, even at week 8, because it makes things feel so much cleaner!- Phasing out nitroglycerin use. The doc told me that it was useless if I was healed. It's to chill out the muscles that are spasming on account of the open fissure. I dont have spasms otherwise (I am so thankful for that after reading about so many members' suffering) I only used it once/day and used the sitting pretty balm once a day.- I tried to take an herbal supplement "bottoms up" by wise women (it's similar the bottom up balm, but the herbs in pill form) and it burned coming out, like i had eaten something spicy. not good for a healing butt. - continued with healthy diet and glycerin suppositories when needed (rare).
Weeks 7-8 -- almost out of the woods
- I found I could reduce my magnesium intake. I was taking 1000mg (although occasionally lower if it made things too loose), but found 700-800 mg tg of magnesium to be sufficient.
- Only used the nitrogglyc if i felt irritation down there. I dont think I needed to use it though.
- Tried to use the sitting pretty balm more often, but because it stains clothing I dont in the morning.
- For other health reasons (immune/inflammation conditions), I have added fish oil to my diet -- recommended dose 1000 - 3000 mg of omega 3s (content within the fish oil) per day - depending on how my other conditions are doing.
- Cut out other inflammatory foods after I ate a lot of marinara sauce and it burned coming out -- not only is it acidic, but tomatoes and their nightshade siblings are known to trigger inflammation. my naturopath told me this but i also found it on the national psoriasis foundation (one of my inflammatory conditions that flares up when i am stressed! stressed about breaking my butt again, often!)
- basically trying to go on an anti-inflammatory diet and eat foods that match my dosha in ayurveda -- in TCM I have spleen deficiency which to my untrained knowledge is similar to my vata profile -- cold hands and feet, strong dislike of cold, love of hot foods/beverages with warming spices (even though i live in the tropics -- i drink hot tea and soup daily)
- stepped up my turmeric to 1500 day (500 mg 3 x day)
- started using calendula oil rectally as it spreads better and the naturopath recommended it for any irritation/burning froma BM
- with less magnesium and a healthier fiber-rich diet, i dont have as many loose stools throughout the day -- i'd sometimes go 4-5 times a day if my diet sucked, but generally 3 if my diet was good, on my high dose of magnesium, and usually 2/3 were very loose / diarrhea-like (altho this never hurt my butt). I find myself only needing to go 1-2 times a day again like it was pre-fissure. However, because I am super-paranoid, I stepped up on my use of glycerin suppositories at night if I had only gone once that day (I always go in the morning) Just the idea of waking up to a re-tear -- no. Until my butt can handle denser or bulkier stools again (fingers crossed), I am not taking any chances. (FYI i didnt find that glycerin actually made things softer or slide right out -- they just made me had to go. I always dipped my suppositories in vaseline to insert, and i think the vaseline really helps as a barrier, which I like as extra security because my stools are firmer these days.
Weeks 9-12: things to explore as I continue eating healthy, taking a moderate dose of Magnesium, and use my balms/ointments
- dilation exercises (not anything crazy, but just feeling comfortable with ring finger's worth of pressure against the walls. i can still feel the area that was torn -- it is still sensitive and maybe it will be always. also this will help me get the balms and ointments up in there). possibly even going to a woman that does pelvic floor exercises. my colorectal doc said i wasnt tight enough for surgery and didnt note any pelvic floor issues, but my naturopath knows a PT who specializes in this, generally for women who have leaky butts, and I have the opposite probably, so...
- meditation, yoga, etc. - ghee and other ayurvedic diet/herb stuff. nothing dramatic, and i find that i already crave half the things that my constiution generally does (e.g. warming foods, warmth in general). i have always heard great things about ghee, and it is preferred for cooking at higher temps than veg oils whcih release free radicals if overheated.
- not eating after 8pm -- just to give my gut a good 12 hr break.
- keeping up with the rectal balms and ointments and the supplement -- naturopath told me to try the supplement again now that i am healed, and if burns again to discontinue immediately.
That's all I can remember for now. Will update if I can think of any butt-saving advice!