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Hi from postpartum fissure/pelvic floor struggler

Postby NancyAF » 06 Mar 2019, 10:09

I'm a woman in my early 30s who's been struggling with rectal bleeding on and off for more than a year. Would love to hear from others who've experienced something similar in the pregnancy/postpartum period.

The fissure first appeared around the third trimester of my first and only pregnancy, in November 2017. I had a wild night where I ate waaaaay too much cheese (who hasn't been there, amirite?) and the next day, wow. Terrible pain and bleeding during my morning BM. I went to my doctor, who diagnosed a fissure, and was basically told to do sitz baths and hope for the best. I was told there wasn't much they could prescribe given that I was pregnant. I suffered from continued bleeding and problems with large, infrequent BMs for the rest of my pregnancy.

I gave birth in February and continued to suffer with the fissure. Once my stitches had healed (second-degree tear), I went to a proper butt doctor and was prescribed nifedipine. I would heal for a short amount of time (days, maybe weeks), and then it would reappear.

At the same time, I was seeing a pelvic floor physical therapist to try to heal from childbirth so I could safely run long distances again. I found that, when I was diligent about doing my kegel exercises, the fissure would return. When I'd slack on the kegel exercises, it would heal. Neither the pelvic floor PT nor the butt doctor thought there should be a connection, but there seemed to be one. I more or less stopped with the kegels, and I was healed more of the time.

I didn't bleed the whole month of August, and I thought I was in the clear. September, bleeding resumed. The butt doctor said this *wasn't* a fissure. He said it looked like a scrape on the surface of the skin, and prescribed hydrocortizone cream. That helped. I was still taking a full dose of Colace daily, because when I'd try to stop, I'd get some minor bleeding again.

I went off the progesterone-only minipill I'd been on since shortly after birth in December, and that *really* seemed to help. I was able to stop taking the Colace. I was able to eat (some) cheese again. Life was good!

A couple months passed. I was training for a marathon and doing almost no kegels/pelvic floor work. And then, after a 16 mile run, I noticed a bulge near my vaginal opening that I could push up into the canal. So, I went back to the pelvic floor PT, and the bulge is my bladder! I have a very mild cystocele (only visible when standing), and she had me start kegel exercises again. I can't run more than a few miles until I shore up my pelvic floor, she says.

Three weeks after resuming daily kegels (and just a few days into the Femfusion Lift program my PT recommended), my butt's bleeding again! Kind of a lot! It's not as severe as it was when it first started, but the pain lingers after a BM, and the bleeding continues.

I also weaned my child about a week before the bleeding began again, and I'm wondering if hormonal changes are contributing as well. My period might be on its way back.

I feel like I'm damned if I do, damned if I don't. If I don't strengthen my pelvic floor, my fissure might heal for longer, but my bladder also might fall out of my body. (Seriously, this can happen.) If I *do* strengthen my pelvic floor, it seems to create tension in my sphincter that causes my butt to start bleeding again.

I would love to hear from other folks who might have some experience with either hormonal issues contributing to their fissures or with balancing pelvic floor issues and a fissure. This really sucks, doesn't it?
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Re: Hi from postpartum fissure/pelvic floor struggler

Postby Okaybum » 07 Mar 2019, 16:39

Omg yes. I can't do kegels either. Kegels exercise the already tight muscles.

So you found going off the mini pill to help? I'm on the depo shot and this is my last dose.
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Re: Hi from postpartum fissure/pelvic floor struggler

Postby NancyAF » 07 Mar 2019, 16:54

@Okaybum: I think going off the minipill helped, yes! My whole undercarriage seemed less dry once I stopped with the pill, and the tight areas of scar tissue remaining after giving birth seemed a lot less sensitive/painful. I mentioned this to my pelvic floor PT -- that I thought going off the pill helped the fissure -- and she said that it could have, and that, based on her research, she's most supportive of non-hormonal methods of birth control for the health of the whole pelvic floor. (Whenever I've brought up hormonal stuff with the butt doctor, a man, he hasn't known much about it.)

This article is what made me think hormonal stuff might be contributing to the fissure: https://www.thestranger.com/slog/archiv ... l-fissures

The author is a well-respected/well-known sexuality researcher, so this seems legit to me. More on her: https://info.publichealth.indiana.edu/f ... ebra.shtml

I'm not sure if this is helpful to you, since I had the double-hormone-whammy of breastfeeding (low estrogen) AND being on the minipill (progesterone only), but it couldn't hurt to try a nonhormonal form of BC to see if it helps. Good luck!
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Re: Hi from postpartum fissure/pelvic floor struggler

Postby Okaybum » 08 Mar 2019, 16:02

Very interesting. I went on birth control in an attempt to regulate things so I stopped tearing every 2:weeks and to get rid of the period as I seemed constipated before it.

I eventually did stop retearing but after 4 months, the doctor said the fissure site still looked raw to her. It was closed, but it's not healing entirely.

I've blamed IBS issues as the depo shot causes that. All the excess gas pressure hurts my fissure. Explosive BM make it sting too. I have blamed everything from my excessive stool softeners to gluten to veggies like onions.

While I get that sorted (dietitian advised I can't eliminate anything until I have my colonoscopy in July which sucks) it's interesting to note that maybe the depo is causing my fissure not to heal entirely by keeping low estrogen levels. I know I'm suffering from that as I had a 4 week long very light period which the excess moisture did not do any favours for my bum.

I strongly suspect at 39 I entered perimenopause because it was like a light switch was flipped on my digestive track and on my periods. Constipation and shorter, painful cycles. I will leave it there.

I've had fissures come and go all my life and usually I do nothing for them. They heal in a day or 2. The last 2 I had have required massive assistance. One healed in 2017 with just some movicol. This one I got last year is my first ever chronic one. It's not even very big.

Anyway, thank you so much for the insight. Very helpful
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