Hi everyone,
I'm wondering if anyone else has had a similar experience. A few months ago I started having a fair bit of bright red blood in the toilet after any "hard" bowel movement. This would be followed by intense rectal pain lasting usually for several hours.
If I was unlucky enough to have a BM at night before bed, I would be up for hours and get very little sleep. Not great when my alarm for work goes off at 5am.
The weird thing is this...the pain is absolutely at it's worst when I'm lying down. If I sit in a hard chair or walk around, the pain is mild and will go away after a couple of hours.
Finally, I couldn't stand it anymore and one Saturday a couple of months ago my husband took me to a clinic. The doctor examined me and told me I had an anal fissure. He put me on a stool softener and some suppositories.
I followed up with my family doctor a week later because it wasn't much better and she didn't examine me but scheduled me right away for blood tests, stool tests and a barium enema.
The barium itself wasn't bad but I got so constipated from it afterward that the bleeding came back and the pain flared right up again.
Since then I've had an ultrasound and am now scheduled for a colonoscopy. The barium and ultrasound were negative, by the way. The surgeon who will do the colonoscopy examined me and said he didn't see any sign of a fissure!
As my teenagers would say..."WTF???"
Has ANYONE out there had any similar experience? I'm going for the colonoscopy on the 24th and have been "fibreing up" like crazy trying to keep the 'ole stools soft and that does help a lot. Warm baths, using "tucks" to wipe...all that stuff. The bleeding is almost non-existant now but if I get constipated at all...look out! Pain like crazy.
Sorry to be so long-winded...hope I didn't break any rules like a dumb newbie!

Hey there,
Wow-sounds like you have been going through alot. I don't have any words of wisdom about a disappearing fissure though. It could be examination techniques or perhaps it did heal up quickly. Some are very superficial and heal up very quickly. Most of us get small tears from time to time that we never even know about.
There are a few of us here who have had colonoscopies so be sure to read those threads for tips about how to handle it and ways to keep your bms soft in the meantime.
We don't have any rules here-so make yourself at home and let us know how we can help!

Well, it sure sounds like you have a fissure. Maybe it was overlooked. I think you need a "third" opinion, maybe.
If you drink plenty of water and eat fiber, you should stay unconstipated, make that your goal..
After several months, though, it sounds like not only do you have a fissure, but it is chronic, meaning it will not heal easily.
Kim

Hello,
Take my advice and go to a specialist a CRS. I went to one and he has been wonderful. It sounds like the classic fissure symptoms you have. Trust me I have a chronic fissure. I was misdiagnosed by a PA saying I had a hemmie and I don't have any hemmies. The only doctor that helped me was a CRS "a coln rectal surgeon"
You are right make sure you have the fiber and lots of water. Personnaly I would stay away from the Tucks and use Baby wipes unscented.
Anything else let us know on the forum. We would be glad to help and listen.
Patty

Everyone,
Thanks for the great advice. I agree...I do believe I have or had a fissure. If it's healed, though, why would I still have pain? The bleeding is pretty much over, though.
As far as seeing a colon-rectal surgeon...great advice but I don't think such a thing exists in Canada. I tried to find one by "googling" but couldn't come up with anything. I think here it falls under general surgery. I did ask my doctor to refer me to a proctologist and she smirked and said there was no such thing in Canada. Hmmm....with all the assholes here you'd think we'd need them.
I'll definately check out the colonoscopy threads...I'm mainly worried about the procedure constipating me and then I'll tear again and be back to square one.
Oh, another thing the surgeon said is that I might be "having a spasm" when I get the pain. Not sure why a bowel movement would trigger a spasm but, as I said, this is all new to me.
Thanks again for all your good advice (yes I like the babywipes too!).

Hi!
When I had my fissure, I would always have pain after a BM which caused the sphinter to spasm badly causing more pain, the classic Catch 22. A Sitz bath immediately after a BM helped my pain a lot - besides cleansing, it helps relaxe the sphincter which increases blood flow which helps heal the fissure. Use plain, very warm (not hot) water for 10-15 minutes. You can do this several times a day.
My colorectal surgeon (CRS) also prescribed Nifedipine ointment to help relaxe the sphincter. Although I'm not quite certain when mine healed, I suspect it was after I started using Miralax, an over-the-counter medicine here in the U.S. Essentially, it's just a great stool softener. If you can CONSISTENTLY keep your stools soft, I think you have a great chance of getting the fissure to heal. I'd had mine for over 4 years.
The other people on this forum are wonderful. You've come to the right place for help and encouragement.

I wish you had a colorectal surgeon..just my opinion but that's the ony way to go! Good luck to you though.

Hi!
I have not posted before (or anywhere, for that matter!), and I hope I am posting in the right place. We'll see! I am female, and here is my story (I'm very sorry, but this is very long, so don't bother, if you don't have the time. I just want you to get a good picture of what is going on. I bolded my questions far below, for easy reference):
Last September, I wanted to get five pounds off quickly, so I decided to fast two meals every day for several days straight. (I have fasted uneventfully for spiritual purposes before, but only once a week.) At any rate, I was drinking Diet Coke during that four day period to help me get through the fast. By the third day, my stools were becoming dry and hard. I really never experienced constipation or hard stools before. In fact, my bowel pattern was always a very watery bowel with a lot of bloating during the week while at work, with soft stools and/or watery bm's on the weekend. So, really, I have the opposite problem. At any rate, by the fourth or fifth day on my fast, while trying to eliminate a hard stool, I could feel a deep tearing sensation, unlike anything before, which produced a lot of bright red blood. I didn't feel that bad that day (Sept. 7 or 8, 2006), but went into a lot of pain for hours the next day after my morning bowel movement. To shorten the story, due to a lot of pain, I went to the doctor early the next week, who gave me a rectal exam, and noticed that I had a fissure. I asked for something for the pain, but he said he was afraid that a narcotic would cause constipation. He did prescribe hydrocortisone suppositories, but I was not able to get them up myself. At that point, I was using OTC meds for the fissure (Advil), which were not making a dent in the pain (I only took 6 a day, like the box indicated - I'm afraid to go higher), drinking prune juice, and increasing fiber intake, in general.
When the pain did not subside in a few weeks, I went back to the doctor, and he was not able to examine me. I must of been too tight (he had thought I wasn't being ambitious enough when I couldn't insert the suppositories, but he must of seen what I meant when he couldn't do the digital exam himself!), and he said there was some sort of blockage. He sent me right away to a CRS. The CRS examined me externally (he said he'd never be able to do an internal without my being put under), and said I had a fissure. He put me on Metamucil, and told me to take sitz baths every time I had a bm.
The Metamucil worked for a few days, but caused straining, subsequently, so I had to get off it. I was only taking less than a teaspoon, but it just seemed to be too much. My watery bowel problem completely disappeared, and I seemed to have difficult-to-pass stools much of the time. I religiously gave myself sitz baths after every bm, and even carried the sitz bath with me when I went shopping. I seemed to be in more pain after the sitz bath (maybe the stretching while sitting on the thing pulled the fissure open?), so after a couple of months (late January), I quit that, as well. When I went to see the surgeon in December, three months into my fissure, he said it sounded like I found my own regimen, and that he did not need to see me anymore. I was in disbelief, as I was, and continue to be, FAR from being healed. I religiously did what he told me (Metamucil plus sitz bath), but I had to give up his regimen because I felt it was hurting, rather than helping. The only thing I did not do was take the narcotic he prescribed. I carried it with me every day for months and months, but was afraid of constipating myself with it, so I just tolerated the pain daily. I still have not touched it. The surgeon said the Metamucil would help with the constipation from the narcotic, but since the Metamucil seemed to make my bm more difficult (or maybe it was Metamucil plus all the vegetables, prune juice, other fiber together?), I felt I had no recourse, as far as pain management.
Okay, I know this has become long-winded (sorry), but here is my pain journey:
1) First three months - terrible, unrelenting pain all day, regardless of whether sitting, standing, walking, etc. I went to work through it all (I have to sit at a computer all day), but for a couple of months, I alternated sitting and standing every few minutes (did not really help). There was shooting pain, on occasion, too. Inflatable pillows and doughnuts did nothing either.
2) By December (month #4) - something started improving in a general way. I was in and out of pain, but there was reprieve, too. There was beginning to be a number of days where I wasn't in significant pain.
3) By February 1, I seemed to move forward again. I had no days of considerable pain all month (I have been recording my pain levels and bowel movements on a calendar daily for a year), and since then, have only had 2-7 days of bad pain per month. Pain was usually present every day to some degree at some point, but it wasn't the real bad pain, except for several days, or portions of those days. By February, I was long off Metamucil and had stopped the sitz baths (January), so I really was doing no self-remedy, except diet (which I still find hard to figure out).
4) This month I seem to have regressed. (Like I said, over the past year, I have never felt I was close to healing - pain is always present to some degree - and things always seem so vulnerable, and I, at times, feel myself tearing during a bm, sometimes for no particular reason.) Strangely, the roughest bms often leave me intact but sore, but the softest ones sometimes leave me in pain! I've had more days of pain this September (at least 7 or 8 by now this month than I have had since January). My bms have been soft for nearly two months, but then all of a sudden, they became a bit lumpy and drier last weekend. After a couple of days of that, my fissure must of reopened this past Monday (I hardly felt the tearing when it occured, as is typical), and I have been in virtually all-day pain since that day. It's so discouraging to be in the same place I was in last September (a year ago)! It seems like I lost the resilience I had developed by last February. So, here are my questions:
A) Has anyone had a setback like this? I've never ruled out surgery, but things seemed to possibly be healing, so I wanted to give it more time. The CRS preferred that I heal naturally, too. I was going to make an appointment with the CRS after the fissure had its first anniversary, just to see what his thoughts were now. Please recall, that he was the one who dismissed me in December, with only a 3 month old fissure (he must of felt I was progressing enough with my own regimen), and I never felt even remotely close to being on my own anyway. I was going to go for a second opinion in January, but things were improving, and I had a lot of overtime at work. I thought I would just take it day by day, and deal with it later, when there was down time at work. Plus, the thought of being examined internally with all the pain was just unbearable. I was so relieved that my CRS said he could tell I had a fissure by viewing me externally only (he said tightness was a cardinal sign).
B) Does anyone know if it is normal for bowel movements to change, i.e., harder stools, when you have a fissure? I know that doesn't make sense, since digestion begins in the mouth, and the stool quality is affected by type of food ingested, plus amount of water extracted by the colon and small intestine before the stool reaches the rectum. But, my watery bowel is practically gone (it resurfaces occasionally), and every few months, at least, my bms become somewhat more lumpy or drier, just enough to irritate or tear my fissure. Is there some strange way that a fissure can affect the motility of the colon or something to cause less smooth or more difficult to pass stools?
C) The bottom line is (related to #2), I believe my healing is affected to a degree by my not being able to keep my stools soft. As I said, my stools were always too loose before the fissure. Now I can't seem to maintain softness for more than a month and a half or so. I've tried Ducolax and Colace (currently), but to no avail (I only use a stool softener when I am in a difficult stool period). It might take a week or two before my bowel rights itself again, and I'm not sure if it is random or what. I've been drinking tons of water since Sept. 2006, but that doesn't seem to have an effect necessarily (50 - 80 ounces). I cut back on vegetables when I'm going through a period like this, but my digestion still doesn't right itself right away. I also drink a glass of prune juice daily. I don't know if my body just gets used to these measures, and then no longer responds, or whether fiber gets backed up in my system, or just what. I've pretty much (except for the prune juice, a tiny bit of healthy cereal, and lots of water) reverted back to my regular pre-fissure diet (chicken, fish, and vegetables), only because I'm afraid of having to do any straining. Oh, I also take a teaspoon or so of flax oil in the morning. How can I maintain soft bms? I've kept my diet pretty much the same, but my stools seem to inevitably get lumpy after a number of weeks, and I hurt myself. I've avoided corn, cooked carrots, and cheese (never ate cheese much to begin with) this past year. They never have bothered me before, but I am terrified of going near them now because of what I've read about diet and fissures.
D) Does anyone know of a prescription pain medication that works that does not cause constipation? I'm wondering why every CRS doesn't just prescribe it automatically, if there is. They know OTCs do not work in the prescribed dosages, and that narcotics (codeine) cause constipation, which is the last thing anyone needs, fissure or not.
E) My CRS said that you can't hurt a fissure by sitting funny, or anything, but I've noticed on a few occasions that stretching forward (reaching to turn the tv off), or bending down has led to pain for a few days, even when I have not had a bowel movement that day. Can body movement hurt the fissure (muscles are connected to each other, after all)?
F) My CRS did not like it when I told him I was using a stool softener (temporarily, and then I wean myself when the stools are soft for a week or two), since he said it can affect the motility of the colon. I thought a stool softener minus the laxative ingredient did not affect the colon long-term. Does anyone know if stool softeners affect the motility of the colon, i.e., are addictive like laxatives?
I'll ask about creams that relax the sphincter at a later date, as I've written way too much. I can't get anything up me anyway. I don't know if I could ever get a colonoscopy or the like if I am so tight now. I'd be afraid they'd tear the fissure even worse.
I don't have access to the computer again until Monday (24th), so I won't be able to read or respond until then.
Thank you all so much, and God bless.
AgonyAnn (Queen of Pain) [i]He cares for you. I Peter 5:7[/i)

Wow-you sure have been through a rough year. I can sympathize-I know we all can here. It is so frustrating to think one bad BM can cause year(s) of agony.
I think diet is very crucial-vegetables, fruit, high fiber cereal, little dairy and essentia fatty acids like flaxoil and fish oil every day can keep your bms more predictable but even that isn't a guarantee as stress, hormones, etc can affects the bowels. But do your best to make sure you get 30 grams of fiber a day. I also like to promote probiotics like acidophilis (I know I can hear everyone groaning, because I say it so often here) but that can keep things from being too hard or too soft. I like psyllium as a fiber supplement if you need to bump up your intake. I was told that BMs should be like fluffy clouds coming out!
In terms of stool softeners I don't think long term colace,MOM or miralax is an issue as these just work to bring more water into the colon. They do not stimulate the bowels. I hate when CRS are so negative about using something like this unless they actually have to evacuate using my anus! My friend who is a physician had her 9 year old daughter on miralax for 4 years because of chronic constipation without dependency or problems. I think these things tend to get less effective with time so I like to rotate or do half doses of each. If I have to be on a stool softener for the rest of my life I would rather do that then have to deal with a retear. I also put aloe vera on my bottom to help with fissure or skin tag woes.
In terms of medication I think for you to have noticeable pain relief you need to take 3-4 200 mg advil tablets. I don't find aleve to help too much but everyone is different. There is a prescription strength medicine that you might want to try out called Ultram. It is not a narcotic and has less potential for constipation. They even have it in extended release which I use some days.
Aloe vera can also help keep things soft either the juice or capsules.