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Re: make it easier!

Postby whoknew » 06 Dec 2013, 12:45

So, last night wasn't as bad as I was fearing. I did not end up going again, and I had relatively few spasms that were manageable with the ointment. I ate raw red pepper and cucumber with some chicken breast for dinner, and had some coconut milk with honey and cinnamon. I wasn't hungry for the milk - or anything really - but I wanted to get some fat into the meal.

Woke up last night at about 4am and noticed that I didn't feel any spasms, but I could feel a part of the fissure was stinging a little bit. Applied some ointment and it did nothing. Thought to myself, maybe I didn't apply it deep enough and gently pushed more in as far as I could (which wasn't very far, but still) and I still couldn't get rid of that burning feeling. On the plus side, it wasn't a spasm, but it reminds me of the way an ulcer in the mouth feels. Only instead of my mouth it's in my butt. I don't want to be "that guy" who calls the doctor every day but I'm wondering shouldn't the lidocaine be taking care of the pain of the fissure?

This morning I slept in until after 9am, which is a huge improvement over waking up at 5am. Had oatmeal, smoked salmon, and half an apple for breakfast (and of course, water, water, water!) and took a colace. My plan is to try once in the morning and once in the evening. Adding it to lunch was really unnecessary and made me have to go twice in the same day: no thanks!!

After breakfast I felt like I kind of had to go, and I did. It was mostly undigested kale, not too hard to pass, BM was uncomfortable but not super painful. By the time I was done the shower was nice and warm, so I jumped in and had no immediate spasm or pain. Was able to stay standing long enough to wash and condition my hair, dry off, wash my face, apply ointment, and cry on AJ's shoulder for a minute.

I really need to find a way to deal with this pain better. It's not as bad as yesterday, but it's definitely distracting and difficult to ignore.

Hope you're all having a good day out there!
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Re: make it easier!

Postby rio » 06 Dec 2013, 14:16

Hi, Whoknew! I enjoy reading your posts, but feel sorry for the pain you are in. It seems nifedipine starts to work as you say you had less pain today. I think you will come out from the worst soon. You have a strong will, lovely imagination and sense of humor that helps you to overcome this.
Disabling burning, drilling pain in anal area for almost a year, started after UT infection. Small anal fissure diagnosed, turned out it is probably not the cause of pain, MRI shows no inflammation or fistula. Grateful to forum members for support.
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Re: make it easier!

Postby whoknew » 07 Dec 2013, 10:55

Thanks Rio. When I'm not in pain, I feel a little bit better about this whole process. I'm not entirely sure how long this is supposed to take - how long before I will feel up to going back to work? and do other normal stuff? How long do I use the ointment without it returning me to normal activity levels, before giving up and going the surgical route? These are questions I need to ask my CRS when I talk with him, hopefully on Monday.

I just had to send an email to the people at work and tell them that I don't know when I'm coming back. They know that I've been suffering, and that I went to the doctor last week and was sent to see a surgeon; they know that surgery has been recommended but that medicine was given first. They don't know I have an AF - but they know I have something that is not fatal. Because I waited as long as I did to see a doctor, this whole experience is a lot more dramatic than I think it needs to be. I'm a bit mad at myself for waiting as long as I did to get help. If it hadn't gotten worse, I would have let it go on forever.

For the first time in weeks I've woken up and started the day without having a BM. I'm a bit anxious about what is going to happen when the time comes - am I constipated? Is it going to be hard? But I'm trying to relax and just see what happens.

My meals yesterday:
Breakfast: oatmeal, smoked salmon, half an apple
Lunch: mashed sweet potato, turkey breast, banana
Dinner: chicken, mashed sweet potato, grapes, Ensure

I've been eating more protein, as recommended by the nice lady at the CRS office, and smaller meals just so I can try to avoid having any monster BM. I've been drinking water like crazy (seriously, I lose count, I just keep drinking) and took colace with breakfast and dinner. I had a weird gurgly feeling yesterday with some gas, which I was actually able to pass on the toilet. I also started taking Horse Chestnut herb capsules from Whole Foods - they are supposed to support healthy circulation, especially in the lower extremities.

So now, since I'm not having to use the bathroom, I'm wondering - am I eating too little? Do I need even more fiber? Is the Horse Chestnut making me constipated? Maybe it was the ensure? Maybe something I ate the day before yesterday? Ahhhhhhhhh I am going to make myself crazy. This is a puzzle that can't be solved!

Today's meals
Breakfast: oatmeal with flax and chia seeds, banana, smoked salmon (colace and horse chestnut)
Lunch and Dinner: I don't know yet

I hope everyone's having a good day today!
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Re: make it easier!

Postby whoknew » 07 Dec 2013, 17:51

It's about 5:30pm and I finally had the first BM of the day at 4pm. It was fully formed, not super-harsh, but I had to push a bit to get it out. It kept feeling like it was "stuck" in there and I eventually got up and jumped in the shower to wash off and see if the water would relax the muscles. It did an OK job and I got cleaned off and stood in the water for a bit, breathing exercises, etc. One new thing, I tried petroleum jelly before the BM to make it easier to pass - which it did - but afterward I felt like a mess, like I would never get clean again. I used just a bit of witch hazel on TP to try to get the anus free of petroleum jelly but I didn't want to stress the skin with multiple rubbing/wiping/product application. So I just did the best i could, dried off after the shower, and applied the ointment. I didn't have a lot of spasms, but I do have a dull ache inside. Maybe more stool waiting to come through? But anyway, *knock wood* the post-BM pain wasn't near as bad as I was expecting, given that it came almost 12 hours later than usual.

I had several visitors today, which lifted my spirits. I told my best friend exactly what was going on, explained what an AF is, and she is nothing but sympathetic. She wants to know what she can do - hmmm, how about trade bodies for a few weeks while we deal with this mess in my butt? No? She brought me a beautiful vase of roses, which I put - where else? - in the bathroom. It's the only place safe from the kitten, and since I'm intimately connected with the bathroom right now, it seemed an appropriate place for the flowers.

I was concerned that I wasn't eating enough. Yesterday I definitely skimped on food, and I'm having a hard time regulating the portion sizes. I was at first eating more than I needed, and now less. So between breakfast and lunch I ate an apple. For lunch I had a sweet potato, some garlic broth with turkey and kale, and some grapes. Then after lunch I had some yogurt. After an hour or so of gurgling, sloshing in my gut, things started to move. Too much? Not enough? I will find out later.
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Re: make it easier!

Postby jr2 » 07 Dec 2013, 19:10

The fissure journey is a very long, at times very dark, anxious path with a lot of setbacks, road blocks, detours and potholes. It takes so much experimenting to find what works for your body in terms of diet, etc., to achieve proper nutrition as well as BMs that don't do more damage.

Fiber is one of those things that is very tricky to get just right. Too much of it and the bulky BMs open the fissure wound even further. This, despite the recommendations of most doctors to just keep adding more fiber. Most people come to realize that going overboard on the fiber just makes things worse.

I don't know how much fat you have in your diet, but it sounds pretty low. You may want to consider increasing your healthy fats, as fat is actually more of a stool softener than fiber without adding bulk to the BM.

If you are still finding BMs to be too solid or painful, you may also want to consider adding Miralax. Though considered a laxative, it isn't a stimulant laxative and isn't habit forming, but much like the Colace draws more water into the stool. Most people with fissures find it to be a godsend. You don't have to start with a full dose. You could keep everything you're doing exactly the same as you are now, including the Colace, and just add a teaspoon or so of Miralax. If you see no effect from that, you can slowly titrate up from there. What every fissure sufferer agrees on is that stool consistency is the number one factor in making progress in their healing.

Some people also find adding a magnesium supplement to be helpful both for stool consistency as well as an aid to muscle relaxation.

It's great that you have had a visit from a friend. I would suggest taking her offer to heart. Many times when we are ill we tend to feel like we are a burden on others and hesitate to ask for the help we need. If you need extra help with the practical things of daily living right now, let her help you. Fissures, as you've already discovered, are serious business. It's strange to me that we wouldn't think twice about needing to be diligent with our self care for an injury like a broken leg or an illness like the flu, but somehow with this affliction we're supposed to just soldier on. Which is so counter productive to our own healing.

Wishing you the best of healing success and hoping that you turn the corner very soon.
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Re: make it easier!

Postby whoknew » 09 Dec 2013, 14:39

jr2, thank you so much for your message. This really is a roller coaster; one minute I'm thinking "I got this" and the next I am crying over poop. I am adding more fats to my diet, which was definitely lacking in that department. I also started miralax last night, and will keep the other information on magnesium handy. And, my mood is a bit better today as well. Your words were helpful and comforting, and I really appreciate them :Rock:


Yesterday I did not log anything. The BM came in the morning, was difficult to pass, not terribly painful, and incomplete. I had round 2 yesterday evening and it was uncomfortable and the spasms were unpleasant. HOWEVER - I was able to sit in a chair on a heating pad for several hours and spend time with friends and our dogs; I actually cooked dinner without feeling like I was being stabbed in the butt by a hot poker made of glass. These are enormous improvements over the last week, when I wasn't able to sit on my bottom or stand for more than a few minutes at a time without feeling that burning stabbing.


Food yesterday, 12/8/13
Breakfast: oatmeal, with 1 tb almond butter, 1 tb coconut oil, 2 tsp honey; a banana; 2 oz smoked salmon
Lunch: garlic/kale soup; 3/4 cups of brown rice with 1 tsp coconut oil; an apple
Dinner: fish; sweet potato/bell pepper hash; grapes; 1/3 oz goat cheese with blueberries

Yesterday started out bad but ended up pretty good. I had WICKED gas last night. A few times it felt like a family of porcupines was in there setting up the christmas tree and playing pin the tail on the fissure!

Today I woke up anxious because I had to call the CRS and then update people at work. I don't know why I felt so anxious, because everyone is very nice and caring and supportive. I think being the center of attention makes me feel a bit uncomfortable but that is what this situation calls for. Anyway. I talked with Yolanda at the CRS office - same nice lady I talked with last week - and got some more information that is actually very useful and totally alleviated my anxiety.

It turns out that the nifedipine ointment takes 2 weeks to really start doing it's thing! I've been here thinking my ass is super-broken and that I must certainly need surgery, when in reality it's too soon to know if this course of treatment is really going to work. And the fact that I have had some improvement in the 5 days I've been taking it has me convinced that I might not need surgery after all. I actually liked the idea of surgery, simply because I want a quick fix... but as you all know, this is not a condition that comes with a quick fix. Even if I do get surgery I still have to take the time to heal the fissure.

Yolanda also told me that the insurance company would want to see that more conservative options were not working, before they would approve surgery anyway. So. There is that.

Basically what this means is, another 10 days or so of laying on bed, sitting on a heating pad, alternating between drinking water and peeing it out, forcing myself to eat fiber-filled foods, and boring you all with my random thoughts about poop and obsession over fiber. By then maybe I will be feeling better and can go back to work. Or if not then I will know that I need surgery and can pursue that.

I feel so much better having a plan. Something to cling to when the pain is getting too crazy.

Today's BM felt huge, seemed ready to come out, but when I sat down it felt stuck. I had to push a little bit again to make it come out, like yesterday. Pushing didn't hurt, but passing the stool did. After about 3 minutes, it felt like stool was stuck so I gloved up and tried to see if I could pull the stool the rest of the way out. Like a poop midwife. (HA, don't tell my doula friend I said that :) The stool was actually very soft, that "toothpaste" consistency (SCORE!!!) but there was a rather round grain of rice from yesterday's lunch that did not get digested. It still felt like something was there, I don't know. I wish I could look and see. I don't know the terrain back there, maybe there was just a tiny bit stuck on a stalactite. I don't know. I could spend all day analyzing stool, apparently... it took an AF to learn this about myself.

Anyway there were some very uncomfortable spasms later, but they did not last the usual 8 hours. It's 2pm, approximately 5 hours after that BM and I'm sitting up on a heating pad with minimal pain, just some discomfort. Hallelujah!!

I'm so emotional right now. I want to cry over beautiful music, happy memories, random acts of kindness. I think it's relief that I'm not having surgery this week. But I'm also feeling that "edge of reality" feeling that comes with being sick, or when someone dies, or sometimes even just going on vacation. There's not the normal life stuff available to fall back on thinking about, and all kinds of things appear and you just have to deal with them. There's also the knowledge that every day for I-don't-know-how-long, I'm going to spend at least some time in pain - every day. It can't be avoided, and I don't know when it's going to end.

But it's not bad emotions, not all of them. I'm filled with gratitude for the kindness of the strangers I've met along this journey and for the love and comfort of those people who are close to me. There's also pride - that I dealt with the pain for so long, and that I stopped and asked for help, and that I'm actually seeing improvement with my efforts. And, a little bit? - relief. I've been working so hard for the last several years with very little rest or opportunity for true relaxation. Even though I am trapped in my bed for several hours each day, dealing with pain, I feel free. I found myself in the position of having to test the safety nets in my life, and guess what? They work. *Tears* I don't even have a word for this emotion.

Did I mention my period is hovering? It was due last week, but I think the stress of the fissure might have freaked out my body. I have no idea, really. Just a guess.

I had a moment this morning of missing being able to just poop and fart like normal. Sorry, this paragraph is gross, which is why it's at the end of the post. Skip it if you like. But I used to find so much satisfaction in having a good poo. Physically, it made my body feel good. I've always been regular, and would spend as much time as it took on the john to get it all out. Maybe one day I will again be able to enjoy pooping again. I hope!
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Re: make it easier!

Postby Scientist2516 » 09 Dec 2013, 15:00

Aww, Whoknew? So many thoughts in your post that resonate.
I think you'll get to enjoy pooping again.
There could be a lot of anxiety for a long time too, but one day, down the road..........when it stops hurting, you'll have not just the old satisfaction, but also some relief and joy that you can poo without pain.

I'm so glad you have a good support system. You have a way of finding the positive things in this situation; good for you!
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: make it easier!

Postby jr2 » 09 Dec 2013, 15:57

With your period due, just keep in mind that most fissure sufferers find their pain flares up more during their period. Probably a combination of emotions, increased water retention and pelvic congestion. But it doesn't necessarily mean the fissure itself has gotten worse or that it isn't healing. Just keep holding those healing thoughts especially close and be extra gentle both with yourself and your diet, and your surroundings. (music, quiet time, favorite movies or books, etc.)

and a big hug from your fissure friends here in the computer too : )
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Re: make it easier!

Postby whoknew » 11 Dec 2013, 09:54

Scientist and jr2, thanks for your responses. The roller coaster just goes on and on!

Yesterday was a pretty good day: it snowed again, and AJ only had to work for a few hours in the morning. Later on she came home and I fixed lunch, then we watched Battlestar Galactica and took a nap. We planned to have our friends who live nearby come over for a potluck dinner at 6pm - I roasted a whole chicken, and a tray of sweet potato cubes; a friend brought some more sweet potato (we coordinated it that way, because both of us had a small amount of potatoes!), and the other couple brought a pesto pasta thing that smelled so good, I actually ate two pieces of pasta. It wasn't the pasta that attracted me - it was the pesto, which had been homemade. So good!

About half an hour before they showed up, as I was chopping the sweet potatoes, I felt the sudden urge and went to the bathroom. I could feel a lot waiting inside trying to come out, and some gas moving around in there too. It was almost like "contents under pressure" - nothing would move, and after about 15 minutes of just sitting there (had to get AJ to finish the potatoes!) I gave a little push and WHOOSH it all came out at once - solid, liquid, gas - and when I went to wipe I found a few spots of blood. So great, it looks like I have a tear in the fissure. I was able to clean up quickly before the company arrived, sat on the heating pad and ate dinner, watched 2 episodes of Dr Who before the pain was too bad and I had to lay down on the bed. That 3-4 hour mark after the BM is the worst, and it's what is keeping me from going back to work. I'm blaming the episode on too many dried apples.

Yesterday's food
Breakfast: oatmeal, 1tb coconut oil, 1tb almond butter, 1tsp honey; 1.5 oz smoked salmon, 1 banana
Lunch: Sweet potato soup from a box with bell peppers; dried apples; .5 oz goat cheese with blueberries; 1.5 oz smoked salmon
Dinner: 2 oz chicken, .5 c sweet potato, 2 pieces of pasta with pesto
Snack later: a banana

After that huge BM right before dinner, I wasn't very hungry, but since there was company and it was dinner and I needed to eat, I choked a bit down. Later on I started feeling actually hungry, so just had a banana. I don't normally snack, especially after dinner, but I'm trying to give my body what she wants (within reason).

Right before bed I took some miralax. The previous night, at the recommendation of my CRS office, I tried taking the Konsyl they'd given me a few samples of. Yolanda said "it gives the stool a silk-like coating" which sounded like heaven. I'm not entirely sure that was an accurate description of what happened with the Konsyl, and I've been switching stool softeners/fiber supplements so much in the last week, my body really needs some consistency. I've decided to just go with the miralax for now.


Today I woke up after a bad dream and my butt hurt. I got up and had some water, then had some more water. Right now breakfast is cooking and once it's finished I'll eat it. No morning BM so far, but I'm not surprised after what happened last night.

I was thinking last night that maybe I was eating too much at meals. That second BM was large and very loose, similar to the one I'd had in the morning, and I thought maybe too much food was the problem. But this morning I used one of those online calculator thingies to get an idea of what my actual intake is, and I'm not even getting 1200 calories as it is. I can't justify starving myself, but eating produces such unpleasant results. Just when I think I've figured the diet portion of this out, I've got to go back to the drawing board. For now I'm keeping the breakfast the same, and thinking about replacing a second meal with a fruit and veggie smoothie. I have no idea.

And? I think "Aunt Flo" is about to arrive any minute now.
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Re: make it easier!

Postby jr2 » 11 Dec 2013, 12:44

Yeah, the thing to keep in mind with BMs is that you want them to be very regular, at least once, or twice a day, so that you aren't building up a lot of waste to be expelled at once. In the beginning, the thought of going twice a day can sound awful, but as the stools become easier to pass with less bulk to them, it actually helps the fissure more. You'll have to be the judge on the Konsyl, but all psyllium does for me is give me bigger stools that rip my fissures open. Your diet sounds like it's got enough fiber in it, but if you wanted to try adding a fiber supplement for more silky stools, I use 100% organic acacia powder. No bulking, it just helps with stool moisture and that kind of silky texture we hope for.

It's really about just continuing to experiment with the dosages of things like Miralax and diet to find a way toward more consistent results. So, for me, for example, I found I couldn't use Miralax or Colace alone because since I have problems with diarrhea normally, to take an amount of either of those alone to soften stool enough was also causing me more diarrhea through the day. So, one Colace plus either a half teaspoon or a teaspoon of Miralax with the acacia fiber ives me the most consistent results. I actually backed off the amount of fiber I was eating and found it really helpful. But again, everyone has to find the balance that works for them.

I don't know if surgery is something on the radar for you yet or not, but these efforts to get stool consistency working better will pay off too if you do ever decide to go the surgery route. To get a routine that works well for you, even if it isn't quite enough to get your fissure healed on its own, will serve you really well for a surgical recovery.
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