Hi bum problems uk. How are you doing? I don’t think you’ve been on the forum since we last chatted (stalking you on your profile!) but just wanted to check in and see how things are re going with you? I really hope you’ve been having an easier time of it over the past month or so.

No change really here. Things got bad so I booked Botox for next week but then I postponed to give myself some more TTC time. Decided last week when things were easier and now they are bad again I think I’ve made a mistake. Anyway new op is in December and promised myself I’m not changing that date unless I’m pregnant by then. Every day is a lottery and after a bad couple days hoping for better times tomorrow.

Really hope all is well with you and you can share positive pregnancy healing fissure news!

Hi Conifer. Sorry for the delay, we've been on holiday in Portugal to enjoy the last adult time we will (hopefully) have in a while! So good to get some sunshine although the bum played up a bit while I was out there annoyingly despite drinking so much water and eating loads of fruit and salad! It could have been the heat anyway, or difference in water or thw fact we didn't do much exercise- who knows- sometimes if drives me mad just looking for the answer! I must say though it was only about a 4/10 pain wise at its worst so I think the rectogesic and occasional instillagel combo does help massively when having a flare up or week or harder stools. 26 weeks today so maybe ill still be blessed with a miraculous recovery but not holding out too much hope!

Sorry to hear you have what sounds like a pretty bad time, its so frustrating when you think all is going well and it raises its ugly head again. The bottom surgery, do they not recommend doing that when TTC then? I hope u get some relief soon, still on the vaseline mainly? I find the amount of water i drink to be a key determining factor in how well the laxatives work and how soft my stools are most of the time, but the week in Portugal was a strange one for sure. It could be that my portion sizes were bigger too! Hope you are ok xx

Meant botox surgery! :-)

I just want to add that I had a c-section in my last pregnancy to help not aggravate my fissure and the c-section recovery was a dream compared to the fissure! I hope you ended up getting one and are doing better. I’m now 6 weeks with my second pregnancy and had no fissures for 2 years after my last pregnancy but now it’s back and I’m so scared! Any more tips? Did you end up healing yours during pregnancy?

Thank you @Peggydoo, that's so reassuring to hear - I am now booked in for my C Section on 6 Jan so feeling hopeful I know how to manage the constipation that could come after the opp.

Congrats on your pregnancy but sorry to hear your fissure is back, especially after so long you must have thought you were healed. I can't say mine has healed (because if I do it will all go horribly wrong again I feel) but I've certainly had some restbite from it for the last 2 months- it's been amazing! I don't know if it's the muscles finally relaxed with the hormones etc or what but I'm so relieved it didn't get worse anyway. I've actually been able to eat some fairly normal foods and portions. I'm 35 weeks now so still keeping up the lactulose (I'm currently on about 35 mls a day), drink lots of water and 1 x fibregel sachet a day. If I have any mild pain then I use the rectogesic for a few days and it so far has calmed it (I do have a pile at the moment but so far this hasn't been anything like fissure pain, more of an annoyance). I did have a session with a pelvic floor physiotherapist too who taught me the importance of breathing in and out while going to the toilet, it may sound silly but I didn't know my pelvic floor relaxed on the in breath, which helps my stool come out so I can avoid any straining at all. This has made a big difference to my anxiety levels on the loo which I think helps. She said I had a tight pelvic floor so that could be something to consider or work on?

Wishing you all the best - feel free to drop me a line anytime

Thank you @bum_problems_uk I hate that you went through this too but it helps me to know I’m not the only pregnant person out there dealing with this. I’ve had these plenty of times but this one bleeds everyday and sooo much pain. I went to the GI dr yesterday and asked about lactulose but he said it causes stomach cramps and I’ve been on Miralax for so long I’m afraid to make the switch. But I need something to work better because I still have the first part of my poo hard, then the rest comes out soft. I feel like I’ve tried everything! Ugh! I’m also using nifedipine to loosen the muscles but PT is a good idea. Maybe I’ll try that. Did you try Miralax and find lactulose better? I’m not sure if I’ve heard of that ointment you mentioned (I’m in the US) but I’ll ask my dr about it. Did you ever try and suppositories etc?
I think you’re smart with the c-section, I swear it was much easier recovery for me than these dang fissures!

I'm in the UK so haven't heard of Miralax I'm afraid but I went straight to lactulose and fibogel combo as recommended by my GI dr. You start off small with lactulose (10mls or so) and then you can build up to 40-60mls a day if you need (I found as the pregnancy progressed I had to but seem to have stabalised on 35mls for now) but best to do anything more than about 20mls in 2 or 3 shots throughout day. I have heard of stomach cramping with lactulose but I've never had it fortunately, I think it's one of those things that either works for people or doesn't suit them. Drinking plenty of water with lactulose is needed to help those stools come out soft.

I think Rectogesic is called Rectiv in the US https://www.rectiv.com/en/about_rectiv

If you do use this ointment, use less than what the packet says and don't insert up the rectum, my GI told me to just put a small pea size amount around the entrance to the anus and it will soak in. This mitigates the headache side effect as you're using less. I've found it extremely effective if used either before or after a bowel movement.

Instillagel was something else I used when things were really bad- this is a local anaesthetic and I'd use it before a BM, and then rectogesic afterwards. Again something my GI recommended.

Pregnancy should be a time of joy, so I'm sorry you are suffering. I know exactly how consuming it is and just stay hopeful it won't last forever and you've healed before :)

Thank you so much for the suggestions. I also have a hard pile which I’m guessing is the dreaded sentinel pile I read about on here but the GI dr didn’t seem to know. Is yours hard like a rock?

I do have a sentinel pile and it has been hard when it was painful and inflamed (when the fissure was most sore) but now its just a flappy bit of skin. The pile i was referring to is actually a normal pile I think I've developed in last few weeks as a result of pregnancy.

fun and games! :)

Ok thanks! Yeah I’ve had piles for years but this one is like a small rock and so painful. The Dr prescribed hydrocortisone but I’m nervous to use that in pregnancy. Fun and games indeed happy you’re almost to the finish line! Will you plan to have some kind of surgery for the fissure after you heal from the c-section or just see how it goes?