Every day is a nightmare

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Every day is a nightmare

Postby livingabroad » 12 Nov 2014, 00:33

Hi, I'm Noah, I'm 24 and from the UK. I am glad to have searched for an AF support forum today because I am really struggling right now. My story I guess is split into 2 parts.

First, flashback to August 2012 when I was in East Africa.. I developed an AF as a result of my diet (I was chugging buckets of peanuts each day as well as generally not eating very balanced) and I was in massive pain with it. I bled most of the time when going to the toilet, and I was itchy quite often. It took me until November 2012 to go see the doctor about it (because .. you know .. i'm a guy .. :oops: )

The doctor inspected me, confirmed I had an anal fissure and prescribed AnuSol, to be applied every day for a week. Now, I have to admit I was a bit blaze back then because the pain wasn't too bad. I think I applied it to the area for about 3 days before I started to notice the effects. It was a bit of a faff applying the cream to that area to be honest, and as it was the first time I had done that, I stopped after 3 days.

After that, it pretty much subsided. Occasionally I would suffer one or two days with it (probably as a result of diet) and then it would go again. Each time I would pass a little bright red blood. But I was bearing with it.. and there were a couple of ocassions when I'd apply the AnuSol and it'd sort itself out.

Now the second part of the story -- in the last few months of 2014 I have moved to the Philippines. My diet has completely changed. I am eating white rice three times a day and getting some fruit and vegetables. When I first arrived I was okay. But then maybe about a month ago, I was bleeding a LOT for a period of about 3 days.

I applied the AnuSol (this is the same tube that I got in Nov 2012. It's in date until 2015, and I haven't used the applicator for hygiene purposes, I have been using a bit of gauze on my finger.) Although it says Do not store above 25 degrees, and of course it's very hot here in the Philippines so I'm not sure if it's spoiled.. it felt a little more runny than it did when I was in the UK. Is it still okay to use? Does anyone have experience of AnuSol? I'm thinking of having someone at home send me over a new tube as it is available over the counter in the UK.

Once I applied it, the pain and bleeding stopped. But I noticed I was getting really mucus-y stools (sometimes I would just pass mucus. This continued for a few days.

In the last week though it's returned and it's the most excruciating pain I've ever experienced. I'm not bleeding at all, but there are many problems that I think are contributing to it's acute-ness.

As you can imagine my diet and lifestyle have completely changed and I'm not in control of what I eat. I've stopped eating rice at breakfast, and instead take bread, but it's pretty much unavoidable at lunch/dinner time unless I want to eat just a handful of vegetables as my main meal for the day. I also suffer with extra acidity in my stomach, especially when I'm anxious/stressed. Recently, because of my adjustments and the culture shock, my anxiety was high and I was feeling a bit nauseous.

I noticed I was starting to become constipated. I am trying my best to drink water.. I have 1.5l bottles with me every day and I try to drink most of it (as well as the glasses of water I drink outside of these bottles, e.g. with my meals). I'm trying to eat foods that will "loosen" me up but nothing is working.. my stools just seem to be big and bulky because I'm currently only going to the loo once every 4 days (!) As you can imagine, I am in so much pain.

Another problem is that I cannot sit down on the toilet here for various reasons. So on my own private toilet I have to stand on the seat -which I think is fine because that's just like a squat toilet and it's perhaps more natural to be like that. But at my place of work, I cannot do this so I have to kind of hover awkwardly; and the toilet is up on a ledge (difficult to explain) so I have to contort my body just to go, and it is causing me agony. When I'm done my legs are like jelly because of all the tensing. I could try and make myself only go at home, but because of the constipation really I'm "Whenever I feel like going, I go" because it's a rare treat right now.

So many factors, and I'm sorry for rambling.. but I just need to get this out to people who understand. I don't know what advice I'm looking for, but support would be good. Right now I feel like my body is shutting down because I'm not digesting my food, and when I do it's painful coming out. And of course being 6000 miles away from home is not helpful. I'm reluctant to see a doctor here (which goes against everything I believe in) but feel like if it gets worse I might have to.

I'm fairly limited to what I can do other than try and change my diet - suggest to the community I am living with if we could eat some fruit (the worst thing is that I *hate* papaya, lol, so I will have to force myself to like it). I've been eating smooth peanut butter and drinking coffee which I think I have to give up.

What are natural ways to help me out with this?

Another thing is that I don't have a shower or access to warm water.. I just use a bucket of cold water to wash with twice or three times a day. Toilet paper is of low scratchy-scratchy quality but perhaps I should do as the locals do here and wash with water every time I use the toilet (not appropriate when I'm in a rush as often I am - my BM are never timed appropriate to my routine.. whyy!)

Anyway, thanks for reading this.. I'm sorry it's long and not at all structured. I just really needed to vent, and know that I'll be okay. Seriously if I have had little sleep the night before, and have had a long day and I'm feeling sick - I feel like I'm going to die or something. Or that I'll have to give up everything here and just go home.

:groan:

ETA: I'm also taking multi-vitamins which as a result of the added Iron is making my stools black and tar-like. I'm not sure if i should come off these and switch onto the multi-vitamins I have without Iron.. Here is a list of vitamins contained.. could any of these be contributing to solid, bulky stools?

[+] click
Vitamin A
Vitamin D
Vitamin E
Vitamin C
Thiamin (Vitamin B1)
Riboflavin (Vitamin B2)
Niacin (Vitamin B3)
Vitamin B6
Folic Acid
Vitamin B12
Biotin
Panthotheic Acid
Vitamin K
Calcium
Iron
Magnesium
Zinc
Iodine
Chromium
Copper
Manganese
Molyodenum
Selenium
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Re: Every day is a nightmare

Postby Scientist2516 » 12 Nov 2014, 11:02

Wow, Livingabroad, you have a LOT to struggle with. It sounds like quite a nightmare. Where to start.......?
Looking at your list of vitamins, I see calcium. Calcium can be constipating. You do need vitamins, though. I wonder if vitamins from your daily vegetables would be enough. I wonder if you are getting enough protein. White rice is not very nutritious. You might try a protein supplement.

If you are constipated and have little control over your diet, you could try an over-the-counter stool softener, like miralax (movicol in the UK). I don't think you should take any supplemental fibre if your stools are big and painful. But a stool softener should get things moving through your gut, and make BMs less painful.

You are right to increase your water consumption. Maybe up it a bit more? Coffe is dehydrating you. You can drink it - it probably stimulates your gut, not a bad thing. But you need to drink extra water to make up for the diuretic effect of the caffeine.

Can you take warm baths, sitz baths or use a warm hot water bottle or heat pad to soothe the area? I know you are in a hot climate, so maybe that doesn't sound appealing, but warmth applied locally helps healing.

I note that anusol is a hydrocortisone cream, and you don't want to take that long term with a fissure. It thins the skin, so will ultimately work against healing. It would be much better to see a doctor and get a prescription for nifedipine, diltiazem or nitroglycerine. These are all muscle relaxants that will relax the painful anal sphincter spasms, and also relax anal blood vessels, allowing a healing blood supply. (Heat actually does the same thing).

I understand your reluctance to see a foreign doctor. If you go armed with information, you can ask for the prescription you want.
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: Every day is a nightmare

Postby Scientist2516 » 12 Nov 2014, 11:06

One other thing - stress is definitely a contributing factor. At least, for me it is. The internal anal sphincter (the one that's torn) is not under conscious control, but the external anal sphincter is. I find myself clenching my bottom when I'm anxious. I've tried to learn to consciously relax my bottom. I think the clenching keeps the blood out of the area, making fissure problems worse. I also try to let go of stress. It's hard, but I tell myself that being stressed is helping nothing, and probably causing me pain. Gradually I'm getting better at relaxing my bottom. So give that a try.
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: Every day is a nightmare

Postby Savaici » 12 Nov 2014, 14:43

Hi Noah. Sorry about the pain, and having lived in strange places too (I am English too, but live in the US) I have an inkling of what you are going through... 

There must be other fruit you have access to - mangoes and such - if you don't fancy papaya. Also, as scientist has said, you need to see a doctor, a colon and rectal surgeon, and believe me, seen one arse etc. This is their job. Don't get angst about it, just think of it like it's no big deal seeing a doc and it won't be. 

You need to have smooth soft toothpaste like poop, so you need some help in the form of a stool softener. Even Milk of Magnesia will do. That is what I take. I eat white rice, potatoes, etc too, but I also have some fibre beans, carrots) to keep things from getting too hard, and I am scientific about it. Not too much, just enough. LOTS OF WATER!!! especially as you're probably losing a lot (unless it's not humid where you are). 

Anyway, come back, ask questions. We are here to help. You might want to read this forum link to members in Philippines: search.php?keywords=Philippines&terms=all&author=&sc=1&sf=msgonly&sr=posts&sk=t&sd=d&st=0&ch=300&t=0&submit=Search

All the best, and again a big  :wel: to you!!
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Re: Every day is a nightmare

Postby msimon » 12 Nov 2014, 17:44

Hi Noah. I am sorry to hear of your struggles. You have already gotten lots of great advice on here but I didn't see anyone mention anything about iron supplementation. Iron (as well as calcium) can be very constipating. You may actually want to forgo the multivitamin, unless you can find an iron-free one. Some forms of calcium are more constipating than others, such as calcium carbonate is more constipating than calcium citrate. More magnesium can balance out the calcium as well. You can get that as a separate supplement to pair with you multivitamin. It may also counteract the iron. I hope you can find some relief soon.
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: Every day is a nightmare

Postby livingabroad » 20 Nov 2014, 02:14

Thanks everyone for your kind words of support and your advice!

After speaking with a couple of people at home, I built up the courage to go to the doctors. So I took the 12 hours journey to get there, and I've just returned.

Firstly I met with a GP and I explained the problem, she suggested I speak to the gastro specialist (200 pesos down the drain) - she didn't examine me at all. So then after waiting a couple of hours for him to arrive, I saw him.

He too didn't examine me (he examined my stomach, but nothing else) instead taking my word that I had an anal fissure (at least I had a doctor's appt in 2012 in the UK who diagnosed me then so at least I know my problem..)

Then he suggested I have a colonoscopy to check everything is ok and I don't have the "Inflammatory bowel disease". The procedure would be under anesthetic because of the pain of the fissure. When I asked about whether it was local anasthaetic, he said no - I would go under fully. I got a bit choked up at this - I am not reading to be fully anaesthetised in a country thousands of miles from my family and home.... plus, it's would cost between £300 and £400 (which my insurance wouldn't cover because of it being pre-existing problem)

Anyway, I asked if he could prescribe me some medicine, and he prescribed some laxative (Movelax) and also an ointment Faktu (policresulen + cicnchocaine HCl) which I can apply on the anal area. He said it's an anesthetic ointment and I can use it longterm. Does anyone have experience with this one?

He said he understood that I could find it difficult to find the "equipment" to take a sitz bath, but said it would be enough to hover over a bucket of boiling water and let the steam do the rest, rather than actually bathing it.. He also said bananas were a no-go (especially the small ones they have here) and papayas really are the best...

I don't know what to do about the colonoscopy, I really think it's unnecessary - but I just wish either doctor would have examined me with their finger just to verifiy what my problem actually is....
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Re: Every day is a nightmare

Postby Scientist2516 » 20 Nov 2014, 09:15

Movelax is lactulose. It should help your constipation and hard stools.
Faktu seems to be an anaesthetic, as you say, plus an antiseptic.
If the anaesthetic works, it should give you relief. I am wondering if it will address the actual problem, ie the fissure. Doctors in the USA would normally prescribe a muscle relaxant like nitroglycerine, diltiazem or nifedipine. The steam will relax you, but it's not as easy to hover over a bucket as put ointment on!
In fact, I doubt whether I COULD have hovered over ANYTHING when my fissure was bad, so you may have to figure out some other way to apply heat to the area. As I've mentioned, a hot water bottle worked well for me.
Sorry your doctor visit was unsatisfactory. I agree that an exam of the external anus would have been a great idea, and I too would be hesitant to have a colonoscopy and GA. I have to tell you that I had a routine colonoscopy when my fissure was at its worst, and I had a sedative, not a GA. I had no pain whatsoever. The worst part of the whole thing was that I had to stop taking ibuprofen for 3 days beforehand. Other than that, it was fine. However, your fissure may be different.
Hmm, wish I could be more help.......let us know how you get on. Can you email the doc you saw and ask for a prescription for nitro, dilt. or nifedipine? That would be standard of care in the USA and UK.
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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