Hello friends,

I am 30 yrs old and developed AF 4 months back when I had forceps delivery with my DS. His head is big, so more trauma to the area.

First doctors diagnosed it as hemmies, then two months back daignosed as fissure. On Nifedipine 1, Lidocaine 2 combo ointment. Hign fiber diet, tons of water, fruits n veggies.

Was in horrible pain but after one week of applying ointment, felt really manageable. Total 5 weeks of treatment and felt much better, but constipated lil bit in 6th week and back to zero. It's been a week n half of that bad day and feeling little better now with the same medication.

My general surgeon (GS) asked me to apply internally and outside as the fissure is mostly internal. But it really hurts to put inside even with applicator or finger. So I asked if she could prescribe me suppositories. She called compounding pharmacy and discussed with pharmacist. Finally with the same combination as ointment, they will give me suppositories (1 every night for 12 days), then I will have my appointment with GS.

Anybody has any idea if suppositories are more effective? And please please help me with the pain management. I am doig sitz bath (5 times x 10-12 min each).

One more thing: I used vasaline to tuck little bit inside and outside, also KY Jelly (6-8 ml) inside with a syringe before bowel movement. Helped a lot. Hope it helps others as well.

I'm not certain if suppositories would be more effective. In my case they only irritate the region more because of pushing past all the irritated tissue, so I prefer ointment. You really don't have to put your finger up far to apply it, and if it's too bad you can use a q tip instead.

Your doctor would be the best person to ask about pain management. I've heard of people using ibuprofen for it.

Are you taking any stool softeners? Those can produce more predictable results than a high fiber diet. Also don't overdo the fiber as it can cause large bowel movements that retear the fissure. You want to avoid diarrhea and too hard stools to get the good in between consistency that doesn't stick to the fissure and irritate it.

Thank you patience_and_healing for your reply. I am starting to use suppositories from Saturday. I will look into the irritation if t happens as you said. I will discontinue if it irritates, else will continue.

I am taking some pain killers that doctor prescribed, it's helping but feels too dizzy. I do nurse my 4 month old DS. He also sleeps coz of that tablet. My GS said that no other side effect to the baby with that.

I actually had my re tear last week coz of lil constipation. I got panicked and ate lots of prunes and ended up with multiple BM's and bulky BM's in a day which worsened the situation. Now feeling lil better. I am taking Lactulose stool softner. 20 ml two times a day.

From what I've read on this forum, breastfeeding increases the chances of constipation so you need to be extra careful that you keep your stools soft and regular.
If you don't like the painkiller do ask the doctor for another one. There are many kinds to try. I would also recommend going to a colorectal specialist instead of a general surgeon. But if you like your doctor and trust her then it's great.

I actually have no experience with any surgeon till now. Nifedipine seems to be working, so I will continue and wait for my next appointment on May 03, 2017 with GS. If she suggests any office procedure then will get referral to CRS.

I actually myself asked GS for suppositories as I read this atricle and also keeping nifedipine against the fissure all night is more effective I thought.

http://www.iscrs.org/cd/Rosen%20Ada%200011.doc

Don't know how it's gonna work. But thank you so much for your advice though. I will watch for any kind of discomfort or irritation.

That's an interesting study on the suppositories. Thanks for the link. I hope the ointment works for you and you don't need any referrals. :)

Thank you :)

Aren't qtip's are cotton buds?? I am scared if I use them, cotton strands should not get stuck in the wound and create more damage. Please let me know your opnion.

It's possible they could get stuck to the wound, but if the q tip is covered with ointment that would be less likely I think. Go with whatever you feel is best.