Have you tried Miralax at all? You say you alrrady have soft stools, but this has been the only thing that consistently allows me to have pain free bowel movements. My doctor said it's safe to take everyday, but after my own research I noticed that there aren't really any studies done on it so I try not to use it more than necessary. That being said, I do use it when things become unbearable. Since you are so close to delivery, maybe you could just use it for a short time to try and heal up before delivery? I've tried so many other things and this honestly worked like a miracle for me.

I thought about trying the dilation for a while but never really ended up trying it. If things are tight at first, I'd try a hot bath and then lying on your side in bed (if you already don't do that).

Do you have spasms too or is most of your pain during a bowel movement? While I was breastfeeding, I'd be in pain for most of the day but I'm not sure if I was having spasms or just general pain from it being torn open. Currently, if I'm careful, my pain is mostly limited to bowel movements. Definitely not looking forward to breastfeeding again :/

Oh man I replied yesterday but see it didn't post.

I laughed out loud by the traumatized husband close to Valentine's day, my hubby is the same way!

I spent some time on our foundation's medical site looking at the clinical information available for anal fissures. I encourage every one to ask your doctor for the print out of their clinical information - not the patient information! I think you will find the information on meds and pregnancy and lactation studies very interesting. We use Lexicomp.

I also have a chance of having about 10 obs deliver my babe - oh how times have changed. Luckily my ob has come in for my last two when not on call, praying it happens again! You can ask your dr to take your case to their committee, in which they discuss your case with a panel of doctors and decide on best care. You can take that information or not and make a birth plan. Whoever delivers you will follow the birth plan. We have lots of patient rights, and even moreso being in CA. I hope that that helps a bit.

I know it's absolutely frustrating - hang in there momma!

Allthepain, my stools have been pretty soft but maybe I'll give the Miralax a try. My only concern is that it will make me have more frequent BMs and I'm trying so hard to keep it to one a day so it can heal and also because I get bad pain afterwards for hours. I'm not really in much pain when I actually go to the bathroom. I would say that it's a 2 or 3 on the scale from 1-10. It's mostly just about an hour afterwards that I have issues. Do you find that the Miralax makes you have more than one BM a day?

PregnantandinPain, thanks for the advice and I'll have my OB consult with her partner to see what he thinks. I go to a practice with only two OBs, but my OB is not the senior of the two so maybe the other doc will be able to offer some good insight.

Guys, I'm kind of freaked out right now. I thought I had identified my fissure as this area that was sore and bleeding on the underside of my hemorrhoid. Recently it's started to not hurt to touch it at all and looking pretty healed, even though it still bleeds a little bit. Today, I examined myself a little further and found that what I'm seeing is only the tip of the iceberg, so to speak. It extends much further inside me and I can't even see an ending to it. It gets deeper as it goes inside. That would explain all the blood in my BMs. I'm so sad right now :-( I'm realizing that the hemorrhoid is probably a sentinel pile and that this thing is chronic because of how deep it is. I was really hoping to heal it before birth but I don't see how I'll be able to heal it without more drastic measures like surgery. UGH, so sad :-(

Oh no AF, I'm so sorry to hear that. Is it possible you maybe didn't see all of it last time you looked? Have you been examined by a dr - what did they say? Sorry I get confused with multiple postings. Gosh what heart-break. With the reduction in pain I would think that's good news.

I would say my pain sounds like yours. I have soft bm's, one or more a day. Not too painful but it's the aftermath. I assume it's the spasming. I've been more diligent with the Dilitazem and the last few days have been better.

Gosh I feel for you girl.

Thanks, I'm trying to be brave about this but I'm still pretty sad about the state of affairs. Yes, I kind of examined myself a little more thoroughly today and noticed the larger fissure further to the inside. I think I've been so focused at looking at this small fissure, I totally missed the one beyond it that's further inside me. It's kind of hard to see because it's sort of hidden by the hemorrhoid or sentinel pile or whatever it is. Pretty sure it's a sentinel pile now. My CRS was on the fence about whether it was a hem or sentinel pile last time I saw her. She identified the smaller fissure, but I'm realizing that we missed this one further inside. At the time, she was surprised that such a superficial fissure was giving me so much trouble, but I guess it's because there was an additional larger, deeper one further inside. I've had big streaks of blood in my BMs for weeks and I think this explains the issue.

Is your fissure anterior, too? I've been reading about how they're common in younger women with normal resting anal pressure. https://www.researchgate.net/publicatio ... r_function

Oh man that stinks.

I was told after examine mine was posterior but after reading his report he said it was anterior.. so who knows!

Mine is definitely anterior with a decent sized sentinel pile. I don't think I have hemorrhoids. Most of my pain is during bowel movements unless it's a bad retear and then it's pain for hours. I can't really see mine on the outside, but it's a really hard area to see anything obviously. Mine can definitely bleed a lot, but I'm really not sure how deep it is. The CRS said possibly superficial but if it were, I'd think it would have healed in the last 9 months...? He just did a manual exam so I'm not sure how well they can tell from that.

I think the Miralax might still be worth a shot. I would still have pain with my "soft" poos, but none at all with Miralax. I took it every other day and had one bowel movement a day. I was suffering from bad constipation though so maybe you could try a half dose. It typically takes a day or so to work so it's not like you will have to go instantly or anything. I've read other people on here have had a lot of good luck with it too so maybe it'd be worth a try. I think anything might be worth a try to not have it "active" at delivery.

These things are so awful. I hope you get healed enough in the next few weeks!

That article you added is interesting too. I did have a small tear from birth both times, but I didn't develop the fissure until later with the severe constipation. If the pressure is normal for us, I wonder what treatments are supposed to work?

Allthepain, I’ve decided to pick up some Miralax this week and give it a try. I haven’t tried it yet and maybe it’ll help me. I’ll let you know! I have a large sentinel pile too and it came up rather quickly, it’s crazy. Does your AF only bleed when it’s active and there’s pain? I don’t have a ton of pain during BMs but always a good amount of blood with pain in the hours afterward. It’s weird.

Also, yeah if anterior fissure people don’t have high resting pressures it makes me think that we’re at a disadvantage since most fissure treatments are aimed at reducing resting pressure, right? Like if our resting pressure is already normal why aren’t we healing? Ive read elsewhere that advancement flap surgery and fissurectomy are possibly better approaches for anterior AFs

I hope the Miralax will help you too! If the Diltiazem seems to be healing you though maybe wait, but otherwise I think it's worth a shot. I think our fissures sound a little bit different because I do typically only have bleeding and severe pain with bowel movements. If it's a bad one, I will also get bleeding when I sit down at the toilet again but it doesn't bleed outside of that. I do get a lot of blood at times though which freaks me out. It will actually drip out which makes me feel panicky while pregnant of course. Do you think you are having lots of spasming after bowel movements?

I'm currently in kind of a manageable state at the moment. If I can keep everything really soft, I won't have much pain or bleeding. It's still not healing at all though. If I alter at all from my diet, it will be extreme pain and tearing again. I've been like this for 9 months now so I know I will need further treatment to heal. I hope we both find a good way to heal. I'm terrified of surgery, but I absolutely don't want to live like this forever either. My doctor said he very rarely does surgery on females though so I really hope the creams will help me.

Keep us updated on your progress and what you decide to do birth wise :)