Childbirth with a pre-existing fissure?

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Childbirth with a pre-existing fissure?

Postby bum_problems_uk » 23 Aug 2021, 11:02

Hi everyone
What a wonderful resource and community this seems to be! I'm so glad I've found you all.

I've been suffering with a fissure since April this year post IVF medication and pregnancy (yay) causing a really bad bout of constipating and subsequent anal fissure. I'm so glad I got pregnant but it has been really hard at times to enjoy my pregnancy with the degree of pain we know a fissure can cause.

However, I'm very grateful I've been seeing a colorectal surgeon in London who has been so lovely and has treated me conservatively, because of my pregnancy. (I'm 20 weeks at the moment). I'm currently taking 15 mls lactulose in the morning and 15ml lactulose in the evening, as well as 1 sachet of fibogel- I've had to increase the lactulose gradually throughout the pregnancy as my hormones increase but so far I've managed to keep softer stools with this and drinking about 3-4 litres of water a day and have cut out white refined carbs and eat a wholefood diet.

I've also so far avoided the severe spasm type pains I had several months ago although I do have recurrent bleeding and mild-moderate pain that comes and goes depending on how formed my stool is, along with a sentinel skin tag which can sometimes get swollen and painful- although I must say still nothing like the pain I had in those first few weeks of the fissure thankfully. I have been able to use rectogesic and instillagel (lidocaine) occasionally when I'm symptomatic. I assume the skin tag means this fissure has gone chronic and I'm not getting the spasms because of the hormone Relaxin that gets triggered when pregnant. My surgeon says he wants to properly investigate and perform surgery after I've had the baby and now is about managing and getting through the pregnancy with minimal pain and discomfort.

My main concern at the moment is childbirth! There is plenty of information out there about childbirth causing fissures, however what is it like to give birth with one? Does it make existing fissures much much worse than for someone who gets a fissure for the first time in childbirth? I don't understand how it isn't going to get really bad after pushing out a baby when I can't even get out a solid stool without bleeding and pain! My main fear is not so much the experience of childbirth which of course will be painful, but dealing with the pain afterwards when I have a new born baby to look after- a recipe for depression!

So I sit here and wonder if a C-section would be preferable or even if there is a case to request one with this problem. I also know that C-sections have significant recovery of themselves and can also cause the dreaded constipation from all the medications so I'm not even sure that is the right thing to do.

Does anyone have any experience of this with a pre-existing fissure? What did you do?

My surgeon is very reluctant to give his advice and wants me to discuss with my midwife and my obstretrics consultant however when I last spoke to my midwife she really didn't know about anal fissures, describing them as 'uncomfortable' which made me do a visible eye roll..

thanks for your time in reading this :)
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Re: Childbirth with a pre-existing fissure?

Postby patience_and_healing » 24 Aug 2021, 22:54

So sorry you are dealing with this during a pregnancy! I imagine that pushing a baby out isn't going to help the fissure, but hopefully it should improve as your body heals. As for other forum members who have had to go through this, I think missy_moo has experience with pregnancy and fissures. You can check with her.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
Currently in pelvic physical therapy
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Re: Childbirth with a pre-existing fissure?

Postby Conifer » 26 Aug 2021, 05:04

Hi there. I’m sorry to hear you are dealing with this through pregnancy. I am about to TTC again after 2 miscarriages this year that resulted in a fissure. I don’t have the option to deal with the fissure just now due to having been told I have a low egg count so time is precious. But I am so nervous about pregnancy with a fissure and facing months of dealing with it which bring so much anxiety I can hardly explain!
I’m interested about you using rectogesic though - have you been using this during pregnancy? My CRS said I couldn’t use it and wondered if you have been given the go ahead? It worked for me after 1st MC but not after 2nd. I’m now giving the Vaseline cure a go as a few people have had success here recently with this. I’m only day 3 but not too hopeful
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Re: Childbirth with a pre-existing fissure?

Postby bum_problems_uk » 26 Aug 2021, 06:04

Thank you for your kind message @patience_and_healing
@conifer I'm sorry you are suffering at what sounds like an emotional and stressful time. TTC with a fissure sounds hard, perhaps as hard as pregnancy with a fissure. My GP actually prescribed the Rectogesic when I was 5 or 6 weeks pregnant, she said there was little evidence on what happens with pregnant women but severe pain is not good for baby either. I took a chance due to the intense pain and spasms and I'm hoping it will continue to be ok. We had a good 12 week scan and today we have our 20 week scan so feeling a bit nervous and hoping all goes ok. My CRS who i saw after starting the rectogesic said it was ok, but then perhaps that's because i'd already taken it. Are you based in the UK? The BNF says 'not known to be harmful in pregnancy' but that could be because of lack of studies, it normally is: https://bnf.nice.org.uk/drug/glyceryl-t ... #pregnancy
Good luck with the TTC, try and keep positive and smiling, even though some days it is really hard- that's what my CRS says to me regularly! I do cry sometimes but try and think there will be light at the tunnel one day and take each day as it comes.
Re the vaseline, I have never had any luck with it but I know some people have.
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Re: Childbirth with a pre-existing fissure?

Postby Conifer » 26 Aug 2021, 07:45

Thank you for fast response. I hope your scan goes well today and that everything looks good and healthy. I’m hoping by some miracle my fissure clears up before pregnancy so really really feel for you having to deal with this just now. I already know pregnancy is not going to be a fun time given what's happened this year already so fissure pain for me will be added on top of a pretty anxious time I’m sure!
Thanks for sending the bnf link. I am in the uk. My CRS told me that the rectogesic only lasts/is active for 10-15 mins upon application and didn’t seem hugely concerned about using it when pregnant but was obviously not advocating it and said I shouldn’t use it but at the end of the day it was my choice. And I hear you re:pain and baby - it’s something I’m worried about and trying so hard to learn to be calm and relaxed!
The Vaseline is going ok for me so far - only day 3 and feel my spasms have dulled/stopped to the point I can cope with this for now. But it’s such a lottery I have no idea what tomorrow will bring.
I’ve pretty much decided I’m having a c section if/when time comes. I know there are other risks and other things to worry about but I couldn’t handle straining when al I do in life is focussed on not letting that happen during bms!
Sending you lots of good thoughts!!
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Re: Childbirth with a pre-existing fissure?

Postby bum_problems_uk » 26 Aug 2021, 07:57

Thank you! Sending you so much luck and hope you can heal it before pregnancy.

I am leaning towards the c-section too, and would have to try and avoid any harder meds that can make constipation worse, but tbh even ibroprofen would be a dream right now, haha!

If the vaseline does cure it, please do let me know :) I only managed about 2 days with it before my symptoms started again but I think that's more to do with pregnancy hormones causing harder stools, my lactulose consumption keeps going up each couple of weeks! It's so frustrating isn't it when you have these weeks of feeling better and hope and then it gets dashed at a slightly hard stool. Bets of luck with everything!
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Re: Childbirth with a pre-existing fissure?

Postby Conifer » 26 Aug 2021, 08:04

Thank you. And I will update on how I get on.

Just in addition have you tried laxido instead of lactulose? It’s another- I think uk- version of movicol (ie macrogol) but unlike movicol it’s safe to use in pregnancy. I’m going to be using it for life as a preventative measure I think - during 2nd pregnancy was taking it once a day and had no issues at all with constipation up until my MC at 9 weeks though perhaps was still a bit early to have issues with that (Also MC was a chromosomal thing so nothing I could have done any differently). I’m now taking it twice a day just to keep things mega soft but actually going to cut back to once a day as don’t really need the extra dose. I also eat 5-7 dried apricots a day. If your finding lactulose not so effective or want to change then I would really recommend laxido - can get on prescription or it’s about £5 for box of 30
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Re: Childbirth with a pre-existing fissure?

Postby bum_problems_uk » 26 Aug 2021, 08:16

Thank you- I have wondered whether my body just gets used to the lactulose and fibogel combo and then creates slightly harder stools. I'll take a look at this and if I have to keep escalating the dose it could be a good option. I also wonder whether I'll be taking all of this for life, I never had a problem with any of this kind of thing pre-fissure!
I have about 5 or 6 prunes a day and they definitely help.

I'm so sorry to hear about your miscarriages, that must be so unbelievably difficult to deal with anyway and then to get a fissure too is terrible luck. I don't think it was the pregnancy that gave me my fissure, I'm pretty certain it was the medication I was on from the IVF clinic (Progesterone) that caused it, I probably had crazy amounts in my system and I remember just having a terrible time on the toilet one day, what I would give to go back and have that week again with a better diet and what I know now!
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Re: Childbirth with a pre-existing fissure?

Postby Conifer » 26 Aug 2021, 08:23

I know - I can’t decide if I’d rather go back in time and do things differently or forward in time to when I’m healed and it’s all over!

I was on fibogel for a while and would have loved it if I didn’t have a fissure but made everything too bulky and sore. But then I discovered laxido - and I have no issue taking it forever. The alternative is just too much!

And thank you for your kind words. I’m facing ivf in January if things don’t go to plan due to egg count but I’m hopeful given my last 2 pregnancies were so fast (first month each time). Just hope things stick next time!

Wishing you all the best for yours though and let me know if things improve. I’ve heard so much about people healing in pregnancy due to increased blood flow and general expansion of the area. It’s what I’m hoping for at least!!
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Re: Childbirth with a pre-existing fissure?

Postby bum_problems_uk » 27 Aug 2021, 04:45

Haha good point on time machine!

Fingers crossed for you over the next so many months, they say that previous miscarriages are ultimately a good sign for going on and having a baby. I never even got a positive test once before IVF! If you do have any questions in future about IVF feel free to ask :) I was very lucky to get a result the first time, and found the process a lot easier than I thought (apart from the fissure of course!).
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