Guide to coping with anal discomfort

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Guide to coping with anal discomfort

Postby cuzco » 29 Mar 2015, 17:31

Hi all,

About a year ago I developed an anal fissure. Rather than being patient and following my doctor's orders, I obsessed over ways to speed up my recovery and ended up making things worse (thanks internet!). I've learned many things about the perianal area along the way and wanted to share my experience with you.

This guide is intended for people that have already seen a doctor and have ruled out anything serious. You've either been diagnosed with an anal fissure/pruritus ani or it's healed but you still experience discomfort in the anal area. If that fits you, then follow the steps listed below. The common pattern here is to reduce the number of variables, rather than adding to them.

1. See a colorectal doctor! I can't stress this enough. Make sure the doctor has taken a good look (via a scope) and feel of your anal area. My first CRS avoided doing this because of my discomfort, but this ended up being a bad call that cost me a lot of grief and time. The discomfort of a good anal examination is worth it. If you're not happy with your doctor, find another one. Get a second opinion if you can afford it.

2. Understand the phases of wound healing. Read this article front-to-back and come back: http://www.clinimed.co.uk/Wound-Care/Ed ... aling.aspx
The eye-opener for me was understanding that inflammation (swelling, redness, pain) is a good thing. It means your body has detected an injury and its begun the first stage of wound healing. Expect inflammation to last several days and avoid trying to do things to reduce it (steroids, ice packs, anti-inflammatory drugs); your body needs it to heal itself. I made the mistake of trying to fight inflammation with ideas I found online and it just made things worst (more to come on that). If you no longer have swelling it means you're on the 2nd or 3rd stage. Now, chronic inflammation (2 weeks+) is something you should keep an eye for -- this means that something you're doing or an irritant is coming in contact with your skin that is causing the healing cycle to restart. It's also safe to take Tylenol for the pain because it won't reduce inflammation.

3. Less is better. Avoid making drastic changes to the routine you had when you were healthy. You might read something online and want to try it out; don't do this and be patient! Chances are you will make things worse down there. Remember that humans have been around for 200,000 years and only recently had access to wet wipes, medicine and fancy creams. Your body has all the tools it needs to repair itself (unless you have an auto-immune disease). In my case I had a delayed allergic reaction (after 48h) to 'fragrance' and other ingredients in some creams. So when I tried X cream that I read online I had an immediate relief (mostly due to the barrier/moisturizing properties), but gave myself chronic contact dermatitis without even knowing it. This went on for months after my fissure had healed.

4. Avoid being sedentary. I know firsthand the depression that comes from having anal discomfort. You don't feel like doing anything and some people might develop some agoraphobia. You'll end up sitting on your butt most of the day, Googling about your symptoms and possible treatments. Stop this vicious cycle! What you don't realize is that you're making things worse: you're applying pressure and blocking blood/nutrients from reaching your perianal area (think bed sores). You're also damaging your skin from clothing friction: the sweat glands in the anal area are triggered by stress and anxiety, this leads to excess moisture and chafing. Go on morning walks, keep working out (important to keep your stress in check), switch to a standing desk, get regular sunshine.

5. Rule out skin allergies. See a dermatologist and have them look at your perianal area (the outside). If it feels like skin irritation (rather than throbbing/spiking pain) and they can visually confirm it, try to get a skin biopsy. Ask them to give you a skin patch test (5 days total). This is very important because you might discover skin irritants that you never knew you had. I learned that allergic reactions can manifest themselves up to 48h from initial contact. In my case I had delayed reactions to fragrance and blue dye so I never correlated my discomfort to using them. Then it clicked for me: I've had been using products with fragrance that came in contact with my skin -- Balneol, laundry detergent, creams and also wearing blue underwear (my favorite color) all this time. This will be an eye opener for most people and also help your skin health in the long run. This is also why using less products is better.

6. Rule out food allergies. Go on a elimination diet for 2 weeks. Avoid common anal irritants: caffeine, chocolate, nuts, citrus, dairy, tomatoes. Keep your fiber intake high. Keep a log of what you've eaten. I found that doing this reduced irritation and made my bowel movements more predictable. If you still have irritation after 2 weeks of a strict diet, see an allergist and have them test for allergies to the foods in your 2 week food log.

7. Avoid overzealous cleaning. Avoid TP, wet wipes, and other cleaning products. You are probably making things worse by trying to be too clean. The human body has evolved to withstand some fecal residue in that area. Either you're giving yourself contact dermatitis or micro abrasions from wiping too much. My advice is to buy this bottle bidet from Amazon: http://www.amazon.com/Brondell-GS-70-Go ... hand+bidet
Squirt gently after a BM and if you can sit in a warm bath (avoid hot) for less than 20m. Then use a hair dryer to dry the anal area. That's all you need to do.

8. Stop obsessing over it! I used to take pictures every morning of my anal area to see its progress. What I didn't realize is that when I stretched my skin to get a good shot, I was tearing it again and again. I also kept fiddling with my anal area and giving myself contact dermatitis from whatever I touched that day. Constantly thinking about my health problems caused me stress and anxiety, which triggered my perianal apocrine sweat glads and made the area moist and prone to chafing. Distract your mind with other activities, like exercise, hobbies, video games, reading, socializing. If you can't seem to break the vicious cycle it wound't hurt to see a therapist and maybe get some pharmaceutical help.

So there you have it. I learned all of this the hard way after dealing with anal discomfort for over year. The internet can be a fantastic resource but it sometimes can make things worse. Remember that less is better and be patient -- your body knows how to heal itself but it takes time.
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Re: Guide to coping with anal discomfort

Postby cuzco » 30 Mar 2015, 00:28

More on delayed allergic reactions: http://www.wisegeek.com/what-is-a-delay ... action.htm
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Re: Guide to coping with anal discomfort

Postby Scientist2516 » 30 Mar 2015, 13:54

Cuzco, this is great. Thank you so much for your thoughtful post and good ideas.
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: Guide to coping with anal discomfort

Postby Deleted User 4175 » 30 Mar 2015, 14:52

Just a note on Diltiazem. I developed a MAJOR rash using this which was not effective anyway. My doctor said if it hadn't been for where the rash was she would have taken a photograph. I was told by my colorectal surgeon (UK) that in 15 years he had NEVER known of anybody who had reacted to this cream! I must be the only one then.
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Re: Guide to coping with anal discomfort

Postby Scientist2516 » 30 Mar 2015, 21:37

Hi copycats, no, you are not the only one! See my signature, the second line. In my case the rash spread all the way up my stomach and down my thighs. The itching between my legs was unbearable.........
It is rare, but not as rare as doctors seem to think.
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!
User avatar
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Re: Guide to coping with anal discomfort

Postby cuzco » 30 Mar 2015, 23:29

copycats, I also got a bad rash from Diltiazem :)
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Re: Guide to coping with anal discomfort

Postby owmybum » 13 Apr 2015, 09:01

I too developed a nasty rash from the diltiazem. It's way more common than Drs lead us to believe.

Thanks for the great post Cuzco
fissure after hem banding and tag removal feb 11
Pelvic floor therapy
Diltiazem
Botox June 13
Nitro
Internal flap July 14
EUA and polyps removed Nov 14
Diagnosed with neuropathy Jan 15
Diagnosed with HS EDS type 3 (causes poor wound healing )
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Re: Guide to coping with anal discomfort

Postby Wiltsman » 30 Apr 2015, 10:26

Thankfully no rash with cream - will this pain ever end :-(
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Re: Guide to coping with anal discomfort

Postby shams1000 » 02 May 2015, 13:22

I have been dealing with AF since November 2014 [around 6 months]. DILT never worked for me but I switched to NITOBID 2% cream in January 2015 and despite some headache, it's taken my pain from a 7-10 down to 1-2. I still experience burning but it is bearable and at least right now I am just sticking with a high fiber diet (I try fiber one cereal in the morning), Flax seed (1-2 spoons a day), lots of fruit and vegetables, good amount of water, but otherwise eat everything. I also don't
use cleaning products, but wash thoroughly with a warm water after every BM. I was on miralax initially, but that almost killed me - it gave me bad diarrhea. I also went on benefiber but I think it bulked up my stool too much. Also I warn others about LIS - I think some of the docs are after increasing their bottom line frankly (like my doctor)
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Re: Guide to coping with anal discomfort

Postby Suzanne » 20 May 2015, 00:21

Soooo appreciate you taking the time to type all that amazing information! MANY, MANY THANKS.

Don't be too quick to blame online research though! If it were not for the internet, I would not have discovered I had a fissure and then, got a confirmation from a lovely dr ( he was amazingly tender with me). If it were not for the internet, I would probably be in serious health troubles, due to liver issues. I was the one who discovered that it was the acid medication I was taking, that had caused my liver to malfunction. It was I who did cold turkey on anti depressants, otherwise, I would be still taking prozac and getting worse and worse and worse.

It is most interesting what you say about healing and this is probably been my undoing. I guess I must be healing because there is very little pain on going to the toilet; it is just awfully sore AFTER.

I did become obsessed with trying to find out as much information, but not about looking at myself; that is just too shameful to me; I would rather forget things like that lol
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