Introducing myself and my fissure

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Introducing myself and my fissure

Postby Sakura1 » 10 Mar 2014, 14:13

Good evening all

I have spent quite a while now looking over these threads and the fantastic information you all provide. I wanted to share my experience and hope to get a bit of feedback.

In June 2013 I was diagnosed with breast cancer. I was to be given chemotherapy followed by surgery and finally radiotherapy. The chemotherapy and/or anti sickness meds gave me terrible constipation. I got in such a state that the out of hours doc gave me a strong laxative which then gave me the worlds biggest poop and hello to anal fissure and piles. I had internal piles and a prolapsed pile which hung out of my backside for a few weeks.

I was put on lactulose and started taking 45 mils per day. I wasn't eating well as the chemo affected my tastebuds badly and gave me mouth ulcers and a sore throat. Every time I progressed in my healing, I would have the next round of chemo and would get in a mess again.

I should point out I am vegetarian and my diet used to consist of loads of fruit, veg, quorn, small amounts of cheese and eggs etc.

Once I got the fissure and piles the pain when I went to loo was pretty much indescribable - but you understand :)

In November I wasn't too bad but went for my final session of chemo and had a couple of days where my backside was extremely itchy and sort of dry feeling. I then got another tear with plenty of blood. This time I found that there was a permanent feeling of something being stuck in my bum, high up on the left hand side. I had awful spasms which were really only relieved by lots of paracetamol and sitting in the bath. It hurt to sit down and this continued right up to current date.

In December I went in for my operation and the general anaesthetic gave me constipation. After three days of lactulose and laxido failing to produce a bm the nurses gave me milk of magnesia, laxido, lactulose and a senna tablet. This gave me awful green diarrohea for 4 days which aggravated everything badly. My surgeon gave me glycerine trinitrate ointment as she said the spasming was probably stopping the fissure from healing. She also offered to refer me to a specialist which I gladly accepted.

The specialist couldn't feel anything nasty in there and asked me to carry on the GTN cream for a further 8 weeks before he would consider botox. He thought the feeling of something permanently stuck there was my Lavator ani muscle spasming and we discussed biofeedback and relaxing.

Over the last few months I had seemed to slowly be getting better with most bms being odd but not exactly painful - it's kind of on the verge of pain but nothing like it was when I had the main tear (I still cannot sit down for more than a few minutes at a time though as the pain builds and builds the longer I sit).

Today I felt another tear with a little bit of blood.

My poop varies on the Bristol scale from 4 to 6 which is quite frustrating because I still take 40 to 45 mils of lactulose a day and all I eat is:

Breakfast - activia bio yoghurt
Lunch - one slice of wholemeal bread with salad and a small amount of cheese or egg mayonnaise
Dinner - bowl of soup
Snack - pear or half a dozen grapes
Drinks - minimum 4 pints of water/squash per day with an occasional cup of coffee made with skimmed milk

If I try to increase my eating then my bm's get too big and I get pain. Even if they are soft, too big causes problems. Fibre causes me problems as well.

I have lost half my bodyweight since this began and am booked to see a dietician tomorrow as my oncologist is very concerned.

The bowel specialist wants me to change to milk of magnesia and start eating more
My oncologist wants me to start taking Docusate Sodium
My GP has me on Lactulose plus 1 Senna tablet a day (so I am not straining)

I am terrified of changing anything as the milk of magnesia can cause the runs which then just aggravates the fissure plus bring the piles up. Sometimes the Lactulose doesn't seem to do enough, some time it works too well and I get the runs.

I am now starting radiotherapy and have been told the latest scans show something suspicious on my liver so it is possible the cancer has spread. I need to be getting strong to fight this disease but I am just not able to eat and continuing to lose weight.

Thank you for reading and thanks for any guidance you can offer.
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Re: Introducing myself and my fissure

Postby Scientist2516 » 10 Mar 2014, 22:24

Hi Sakura,
Welcome to the forum, and thanks for telling us your story.
You've been through so much! I'm in awe of your strength and determination.
I wish I had some guidance for you, but it sounds as though you are in good hands, and if you follow their advice, that's far better than anything I could say.

I would like to know more about the biofeedback and relaxing. When my fissure was bad I asked my colorectal nurse if there was anything like that I could do, but she didn't know of anything. It seemed impossible that nobody had thought of trying to control spasming via biofeedback. If you can control your heartrate using biofeedback, why not anal muscles?

Anyway, the only thing I can think of that you haven't mentioned is using baths/a heat pad/a hot water bottle to relax the anal muscles. I read a scientific paper where they applied moderate heat to the buttocks and measured a reduction in anal pressure. When my fissure was bad, I used a hot water bottle - sat on it at work, sat on it at home, put it under my bum at night. A medium warm hot water bottle can really soothe pain and relax the area, so try it, if you haven't already. A warm bath can do the same thing, or even a sitz bath over the toilet. A lot of colorectal doctors and nurses recommend the sitz bath.

I think the hot water bottle contributed to my healing, and I hope it helps you.
In any case, welcome, and good luck, and please let us know how you get on.
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: Introducing myself and my fissure

Postby Sakura1 » 11 Mar 2014, 03:41

Thanks for your comments Scientist :)

I used to have lots of baths for the hemmies and fissure but had to ease back when the spasms and feeling of something stuck up my butt got really bad as the hot water seemed to rev it up.

Back in the bath now though to help ease latest tear.

Not tried hot water bottle but will give it a go thanks.

The biofeedback involves doing a whole body relaxation (I've done a course in clinical hypnotherapy and they teach you how to do this but you can pick up relaxation cd's that talk you through it). You then visualise the spasming muscle and picture yourself massaging it and relaxing it. If that doesn't work then I visualise my big toe (which obviously isn't spasming) and focus on that and how relaxed it is. This seems to take focus off bum and does help. I know that you can certainly intensify your bum pain by focussing in it so it makes sense that you can also reduce that pain. This works for most types of pain.

What I don't seem to be able to resolve is managing to eat any more than the pathetic amount shown in my post above. I see that many people in here eat quite a lot. Is that because they are just putting up with the pain of it coming back out? I couldn't deal with that so reduced food intake so that I still poop once a day but mostly without a great deal if pain.
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Re: Introducing myself and my fissure

Postby Sakura1 » 11 Mar 2014, 12:52

Quick update after seeing the dietician today.

After I explained the situation to her she recommended I go on a low residue diet - so no wholemeal bread, brown rice, fruit with skin, or various veggies.

She told me to try cornflakes, white bread, white rice, fruit with the skin removed, cooked cauliflower, Jaffa cakes, lacto free milk, small amounts of butter added to mashed potato and to carry on with lots of water.

That is totally opposite to anything else I have read for fissure, but to be honest, I am getting ridiculous amount of poop from a very small amount of food that is considered fissure friendly so maybe she is right in my case?
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Re: Introducing myself and my fissure

Postby owmybum » 11 Mar 2014, 14:30

Hi sakura1'

:wel:

You have been through so much already, I'm so sorry you have now been inflicted with a fissure and hems!!

Scientist has given some great advice there.... Heat can be very pain relieving.

One thing I would suggest is to switch from lactulose to movicol. I have found it to be so much more reliable in maintaining soft easily passed stools.

When my fissure was at its worse I ate much less than you have put on your list. It's ok to eat what you feel safe eating.... Who can blame you for loosing your appetite with all you are going through.
Maybe add some glug s of olive oil to your soup.... Boosts the calories, and can aid in stool lubrication. Peanut butter on toast?? (The smooth sort!!!)

I really hope things start to settle soon

:smilyhug:

OMB x
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: Introducing myself and my fissure

Postby Sakura1 » 14 Mar 2014, 07:21

Thanks OMB

I will have a chat to my GP about Movicol. Can I just check that it doesn't work like Fybogel and make your poop soft but large as Fybogel gave me huge problems.

I have eaten a Jaffa cake for my mid evening treat the last two days - heaven to eat something a bit different :)
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Re: Introducing myself and my fissure

Postby Scientist2516 » 14 Mar 2014, 11:30

Hi Sakura,
I've been thinking a bit about your situation, and it looks as though your dietician is trying to up your calories without overloading the fibre. The fibre is obviously causing you problems. Different people cope with fibre in very different ways, and it sounds as though you can tolerate smaller amounts.

It also sounds as if getting enough protein is a problem for you because of being a vegetarian, and high-protein vegetable foods (like pulses) are high in fibre. Did your dietician talk about that at all? Eggs are good, though you have to be careful since they are quite binding. Cottage cheese? tofu?

Oh I miss Jaffa cakes! When I go home to England once a year, I gorge on Jaffa cakes, Mc Vities chocolate biscuits, crumpets.......drool.
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: Introducing myself and my fissure

Postby Sakura1 » 15 Mar 2014, 05:11

Thanks for your comments Scientist.

Yes the dietician is really trying to get some calories in as I am now down to 7st 3lbs and still losing weight. She told me to try eating Quorn (I do sometimes have Quorn slices in a sandwich). She also asked me to consider eating fish, but that is a no no for me. Never eaten cottage cheese as I always found it looks a bit odd - will have to give it a go :)

As I am having a senna tablet every day at the moment I hope I will be ok with the eggs. I'm not eating lots of them, enough to have half an egg mayonnaise sandwich. Just changed to Alpro yoghurt and milk as well as I do get the runs and she said that people often become lactose intolerant after having chemotherapy.

I agree, Jaffa cakes and crumpets are awesome :)
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Re: Introducing myself and my fissure

Postby owmybum » 15 Mar 2014, 08:47

I would try movicol. It doesn't bulk the stool, just makes it soft. You can just get it from any chemist... Or on prescription. Start with one sachet, and see how you go. It took 3 days to work properly on me when I switched from lactulose. Haven't looked back since!

OMB x
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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