Hi guys,
Sorry for being such a pest, but I'm back with one more fissure-related question. It is: how much bleeding during a bowel movement is considered normal for a fissure and/or hemorrhoids? Is it usually just a drop or two, or could it be considerably more than that?
The reason I ask is that I had 3 pretty urgent bowel movements last night, and 2 more today, despite skipping dinner yesterday entirely. Each one of them has come with a good deal of bleeding. One involved some straining and resulted in a very red bowl of toilet water afterward. The weird thing is, none of the stools were particularly hard. In fact, they were pretty poorly formed and yet there was still blood.
This makes me wonder if perhaps I have something else going on like some kind of inflammatory bowel disease (ulcerative colitis or Crohn's) rather than just an anal fissure. I do get some mild lower abdominal cramps here and there but haven't had any fever though. I've also been diagnosed with external and internal hemorrhoids in the past as well, and never did anything about them, so it's possible those are bleeding too, but the amount of blood yesterday and today is more than I'm used to seeing.
So, when you guys had active fissures, was there considerable bleeding from them? Or can anyone chime in who's had hemorrhoids as well? I know this won't substitute for actually seeing a physician; I'm currently monitoring the situation for a day or two, and if it doesn't subside in that time, I'll probably pay a visit to the local ER.
P.S.
Kim, thank you by the way for the suggestion on using a syringe to get the ointment further up the anal canal. I picked up an oral syringe designed for babies yesterday and used it to apply the nitro ointment, and it does seem to make a difference (knock on wood). I can feel some mild burning when I apply it, which I suppose means it's working, and today's bowel movements (so far anyway) haven't seemed to hurt as bad, and the post bowel movement spasm doesn't seem quite as intense as it usually is. If it weren't for the significant bleeding I'd almost feel like I were making progress

Well, as long as you know this isn't qualified medical advice...!!
As an ex EMT, I know that a little blood can look like a lot. It does seem like your fissure is a strong bleeder, and just keep in mind that a few drops, if they hit the water, can make it look pretty severe when it *probably* isn't. I never had the water go red, I always had red streaks along the stool and pink discoloration on the TP. That said, other here have had a bit more bleeding. I can only say from what I have researched in the past, that bright red blood is a good sign, while darker or blackish blood, not so good. But yes, you need a physicians opinion. :)
Glad the syringe suggestion has helped! It sure helped me! I used a syringe that came with the proctofoam my GP initially prescribed me thinking I had only hemorrhoids. It was still pretty nasty, but waaaaay better than trying to cram it up there in that tight, painful spot with a cotted finger!
And, I'm happy to hear the pain levels have dropped some, NG....lets keep that up! Let us know what you find out about the bleeding if you see or call your GP!

I never had that much blood with a fissure, NG. When I had internal hemmroids bleed, it was all on the toilet tissue. My younger son has Crohn's. From my perspective I think you definitely need to seek out a medical opinion from a gastro doctor.

Yep, understood :) I'll eat up the advice here about how to apply nitro, what foods to look into, etc., but definitely understand that only a physician who sees me in person is qualified to assess bleeding extent, causes, and so forth.
The blood is definitely bright red, not maroon or black like what's typically associated with upper GI bleeding. So it's likely coming from the rectum, which doesn't exclude the possibility of ulcerative colitis or Crohn's, I suppose, but at least means there's a good chance it may simply be fissure or hemorrhoid related bleeding, from what I understand. The one thing that did freak me out yesterday (graphic description warning!) is that I could actually smell the blood before I even looked down and saw the red water. I've definitely got blood on the toilet paper, too, not pinkness but flat out bright red blood. Honestly if this were Vegas, I'd confidently bet the house on it just being blood from the fissure and hemorrhoids, but somehow bets like that aren't as easy to place when I feel like my life is at stake :) These days I wish I'd gotten those hemorrhoids taken care of in the past so that I'd at least know if they're the ones acting up. Oh well, live and learn, I guess, after all I just got out of my 20's AKA "Back When I Was Invincible".
And yeah I know exactly what you mean about the finger and nitro The syringe works ssssoooooo much better!!! It took using the syringe for me to really understand what people mean by nitro side effects, though. When I was just putting it around the anus, I'd get a mild headache for maybe 5 minutes afterward. But putting it inside using the syringe definitely whallops me a little more and for a bit longer.
Thanks again and cheers!

Well, maybe that whallop means you'll be getting the best dose for the fissure! My understanding is that the headaches get better over time, so that may be encouraging to hear!
Early thirties? You are still invincible, buddy! Your fissure is just a pest that you will deal with!

cherylk wrote:I never had that much blood with a fissure, NG. When I had internal hemmroids bleed, it was all on the toilet tissue. My younger son has Crohn's. From my perspective I think you definitely need to seek out a medical opinion from a gastro doctor.

Yeah I've frankly always been a little suspicious about the state of my GI tract, even before the fissure thing. I've always had digestive problems, and for years and years I had nothing but loose, watery stools. That was when I developed the internal and external hemorrhoids. They've been with me since 2005, with symptoms being itching and burning and minor bleeding on occasion. But I was a huge coffee, beer, and spicy foods consumer during that span of time, and I always chalked it up to that (I've since quit them all entirely).
I've talked with my doctor about Crohn's and ulcerative colitis before, but he doesn't believe that I have either because I've never had any of the associated fever or noticeable inflammation (I've cleared multiple sedimentation rate and C-reactive protein blood tests with perfectly normal and minimal values). The only possible symptom of inflammatory bowel disease I do have is the occasional lower left abdominal discomfort (my doctor chalks that one up to constipation) and now of course the fissure.
Reading online, however, I see some reports of folks who never had fever or other classical signs of Crohn's or ulcerative colitis, either, and still ended up having the disease. So maybe this fissure will end up being some kind of blessing in disguise that gets me to the doctor for a proper diagnosis of the underlying condition. I have to admit, part of my delay in seeing the doctor and requesting a colonoscopy is because I know they'll want to do an anal exam, and I'd need to prep for the colonoscopy, neither of which I'm looking forward to while I've got the pain from this fissure. I'm hoping (perhaps vainly) that the nitro will heal the fissure quickly, and I'll subsequently be able to get a colonscopy to see what else I've got going on.
When I only had hemorrhoids, I saw the same symptoms as you: just some occasional blobs of bright red blood on the toilet paper when wiping, and on very rare occasion a drip or two in the toilet bowl. It was only after the fissure symptoms arose that I noticed blood-streaked stools or more significant blood in the toilet, so you're probably right that I should suck it up and get myself checked out. I'm sure they have some way of minimizing pain for any of the required exams since this can't be that rare of a situation...

Kim wrote:Well, maybe that whallop means you'll be getting the best dose for the fissure! My understanding is that the headaches get better over time, so that may be encouraging to hear!
Early thirties? You are still invincible, buddy! Your fissure is just a pest that you will deal with!

Haha yeah actually I'm 30 on the dot, turn 31 in a few weeks. I lived the invincible life for years during and after college (you know, beer at 10 AM and McDonald's at 10 PM), and always told myself and others around me that I'd shape up once I hit 30. I kept my end of the bargain, truth be told, but apparently I should have shaped up a few years earlier. Guess I'm kind of paying the piper a bit now!
I did call up my doctor today as well, and he put me in for a referral for LIS. So that option is now on the table anytime I want to exercise it. I'm probably going to give the nitro a tiny bit more time to do something, but it'll depend largely on the level of pain and what happens with the bleeding. I've also quit the stool softeners for now, hopefully fiber and water is enough to do the job, stool softeners seem to have a weird impact on my system.
I had a bit of a breakdown last night, after the bloody bowel movements I got real flustered and spent the whole night crying, I just felt so guilty for being sick all through my wife's pregnancy and for possibly having something serious that could affect our lives forever. But today I'm trying to have a more positive attitude, and if the nitro can at least get me over the massive pain that comes with each bowel movement, then that'll be at least one step in the right direction -- fingers crossed!
Anyhow thanks again to all of you, in all honesty I'm a bit of a cynic when it comes to most things, and to have a bunch of strangers not only listen and also reply to my whining when you've all gone through the same thing and even worse is amazing and kind of flips my world view right on its head :)

NG,
I didn't want to alarm you, but I did see a significant amount of bright red blood from my son's stools and knew he needed to see a GI doc ASAP. He was diagnosed via colonoscopy, and I can certainly understand your apprehension of going through the prep and procedure when your butt already hurts!
Many of us have become cyber friends here, and I agree this board is very different from the "real world" where most folk do not show the level of understanding and compassion that many of the boardies here show towards one another! (especially those California people ) Where do you live in CA? My friend is here visiting right now from Navato (near SF). Good luck!

Hey hey hey watch it with the Californian comments! Haha just kidding, actually I spent my childhood in the midwest (smack dab in the middle in the little college town of Columbia, Missouri) and moved to California in my teenage years, and have to say there is indeed a difference in social attitudes between the two. In Missouri we hung out and BBQ'ed with our neighbors, left the windows and doors open on hot summer nights, and said hi to strangers on the street. In California, let's just say, not so much! Socially I like it better out in the middle of the country, but I'll be honest, since I'm Chinese, my taste buds like it better out here :D
Anyhow I live in San Jose, it's about 60 miles south of SF and can basically be thought of as the world's biggest suburb (read: yaaaawn). Lots of technology companies, though, so it's a good living for computer workers like myself. I spent a couple years living in Los Angeles, and would honestly move back there in a heartbeat if I could, but alas, the technology job market down there (or lack thereof) has other ideas. Novato isn't too far from here, San Jose and Novato are both part of the SF Bay Area, San Jose is in the south and Novato is toward the north.
And yeah, I definitely understand, no alarm caused at all. A colonoscopy is something I should've gotten done years ago when my hemorrhoid-related bleeding first started, rather than waiting until I have a fissure to contend with at the same time. I wouldn't be surprised at all if I did end up having some kind of inflammatory bowel disease given my symptoms. I know there are worse things that can happen, and am trying to keep a positive attitude about it -- easy to do when I'm not pooping, but infinitely harder during and after one! Man, I just wish the colonoscopy prep didn't involve massive amounts of liquid and laxatives, if it weren't for that I'd be on the phone scheduling one already!

NG, I think you are letting the pre-surgical clean-out loom too large. It's really not a big deal, not for most people. In fact, we've had one or two boardies who enjoyed their "cleanse." I had to go through it twice, and once it was just a chore drinking down the "oil," and the second time I did get some burning from the loose stools but didn't have to drink as much. All in all, I personally wouldn't dread it all if I had to do it again.
Sorry to hear you had it so rough last night. Just know it will get better. Keep a mindset that you are on the path to healing, it does make a difference. Try to not fall into the trap that is almost inevitable with AF -- letting it possess your thoughts. I do understand that you have the other underlying problems. Just allow yourself the knowledge that you are going to have all these problems looked at and hopefully diagnosed soon, and also that you are actively treating the fissure with the nitro. When you have a good day, great! When you have a bad day, just chalk it off and try not to let it cloud your whole day. And when it's truly dark, just know you aren't the only one who's going through or has gone through it. Each day is a day closer to resolution!!