I've had hemmorhoids pretty much since my son was born 12 years ago. Diagnosed with IBS-C even though I have none of the symptoms other than the actual constipation. My hemmorhoids bleed a lot especially during my period. A few weeks ago I had a really heavy flow period and my hemmorhoids flared up really badly as well. By the time it was all over I had somehow developed a mild fissure as well. Went to the gynecologist and she did a rectal as well as a pap. Somehow I think she must have aggravated the fissure because it was over 2 weeks ago and it's just gotten worse and worse. Having a BM takes forever and is so painful I want to scream. I'm spending far too much time on the toilet especially considering we are a household of 5 with only one bathroom. I have to sit on a throw pillow at work and when I drive or the pain is unbearable. I've been taking ibuprofen but it only helps a little. I've increased water and fiber intake using Benefiber and dried prunes. For 2 whole days I ended up with diarrhea and then it was right back to constipation. I have a Drs appt but they are a small local clinic and can't get me in until March 19! I don't know if I can deal with this until then. Please help I need some ideas about what meds or diet changes might relieve this! I don't want to end up needing surgery because I have a history of bad reactions to both local and general anesthesia.

Hey Cusegal....sorry to hear you are battling a fissure....welcome to a great place to discuss and get advice.

The good thing for you is that it sounds like you are in the acute phase and have a really good chance of getting rid of the fissure without needing surgery.

Here are some suggestions:

1. Get your Dr. to prescribe some fissure cream and apply 2x-3x daily for 6-8 weeks. Personally Nifedipine was best for me...there is also diltiazem and nitroglycerin ointment.

The whole idea behind the creams is to help reduce the resting pressure of the internal anal sphincter -- allowing for more blood flow to the area...which allows for healing of the fissure. Other ways to stimulate blood flow that I use(d):

2. Take a bath / sitz bath after each bm.
3. Sit on a heating pad during the day as much as possible
4. Eat a healthy diet with lots of liquids, fibre (but not too much, it can bulk up the stool and cause more pain)
5. Swim if you can get to a pool.....again, warm water helps
6. If you are constipated....may want to introduce some magnesium citrate in to the diet...you will have to play around with dosage...perhaps start with 100mg and see how it works and go up from there if needed...i am not a dr but i wouldnt take more than 400mg-450mg a day.
7. At work if you can get a stand up desk (if you sit all day) then do so...
8. ibuprofen before the bm is good if you can time it.
9. when you go to do a bm use a step stool for proper potty positioning (check out squatty potty for the idea...you can use anything to prop your knees up, books etc)
10. Time....this is the worst and the best. It takes time for the pain to subside....take it one day at a time and think positive.

Good luck and let us know how you are doing

Canadabum

Swimming ... that's one I hadn't thought of. The chlorine won't aggravate it?

Unfortunately we don't have a bathtub our bathroom is TINY. Right now I really wish we did but we have a well which gets low easily so we don't have the water supply to support a tub anyway.

I'm taking 400 mg of magnesium daily and have been for over a decade now because I have magnesium deficiency disorder which means my body doesn't absorb it properly. I need higher intake than most people just to have a normal level in my system at any given time. If I don't take it for a few days I get really bad heart palpitations. I wonder if my body has gotten so used to the high doses that maybe it's not working the way it does for others.

Is the nitro safe if you're already using nitro patches for angina?

What are my best options for stool softeners? I can't use laxatives that contain muscle relaxants because of my heart condition. I've been told muscle relaxants can be extremely dangerous when your heart muscle is already weak. But I'd like to pick something up when I go into town tomorrow morning.

What does it mean to be in the acute phase? I know the pain is very localized right now right around the actual anus and just inside it although it's starting to hurt when I pee as well like the urine is burning the tender skin of the damaged area. It REALLY hurts to wipe and I can feel a lump sometimes but not all of the time when I wipe after a BM.

Today I had my first BM in 2 days and it was huge. Probably 8 inches long by 2 inches wide all one big chunk. Thought I was going to die passing it. I'm really hoping it mostly cleaned me out so that the benefiber and prunes can start working.

Is heat better than cold for stopping the pain? Because I'm half tempted to go outside and sit in the snow for 5 minutes every time the spasms hit!

Cusegal- first off, I am not a Dr so I can't offer proper medical advice. I would highly recommend you go to your doc tomorrow and ask these same questions.

Can you buy a sitz bath and use...fill it with warm water after each bm and sit in it for 5-10 mins.

Chlorine did not aggravate my fissure.

As for magnesium...what kind do you take. Magnesium Citrate seems to be the variety of choice on his forum - it helps with peristalsis and with bringing water in to your colon to help make things softer in there.

I am not able to comment on doubling up on nitro...ask your doc. The other creams are basically muscle relaxants...applied to the anus. You should consult your doc about what is safe for you to use.

As for stool softeners...there are some great posts you should consult. Most on this board swear by Miralax/movicol/restralax. It works by drawing water in to the colon. Again, ask your doc about this one.

Being in the acute phase simply means you have been dealing with this for less than 8-12 weeks. Most people heal in that time frame -- those (like me) who do not heal up in that time are dealing with a chronic fissure.

When taking more fibre make sure you increase your water intake.

As for heat and cold...do whatever makes you feel good!!!

Just had my first BM in 3 days. It was huge and when it finally passed it hurt so bad I screamed out loud. My son came running and actually asked me if I wanted him to call an ambulance. Scary thing is I was tempted to say yes!
I can still feel more stool pressing on my rectum and I'm getting almost non stop spasms. The only thing helping at all is ibuprofen and I know you're not supposed to use NSAIDS for long periods of time. The last thing I need is an ulcer on top of this.
I have been drinking Miralax and eating prunes for a week now and it just doesn't seem to be working. My stool is hard as rock and feels like it has razors poking out the sides. This one was so bad I thought for a moment I was going to have a heart attack from the straining. My heart is still racing 15 minutes later.
And my Drs office can't get me in until March 19th! I don't think I can take it that long. Is it worth going to the ER, or are they most likely just going to charge me an outrageous sum of money to do nothing and tell me to follow up with my PCP who can't get me in for a month? Unfortunately my insurance doesn't allow me to see a specialist like a gastro without a referral from my PCP

This morning's BM was better. I'm finding that if I pull my knees up and don't strain, after a while it happens on its own. Think that might be the miralax talking because I've had to strain to pass stool pretty much since my son was born 12 years ago. Which has always seemed kind of strange since for years before my pregnancy my problem had been diarrhea - ever since my gall bladder was removed. Right now I think I'd happily go back to those days.
But at least this morning wasn't so painful and I'm feeling mostly empty for the first time in days. Hoping I can keep it like this and maybe start healing. I do not like the thought of possibly needing a surgical procedure.

Glad to hear that this morning was easier than yesterday...sounds like it was a harrowing experience.

Squatting when going is really helpful...you can buy a squatty potty (check out on line) or simply use cheap step stools or stacks of books...whatever you have to help lift those knees up.

Here is another strategy for going to the loo....drink a glass or two of water or your favourite tea to help things along as soon as you feel the urge...heck, take a glass of water in with you and drink while you are sitting...it can help move the gut to act. Also...walk around a bit and generally get your body moving...also helps activate things.

Can I ask what sort of magnesium you are taking -- this may be a factor in your straining.

Are you drinking 8 glasses of water a day?

All best - CB

I take magnesium oxide 400 mg per day. Prescription only, prescribed by my cardiologist to regulate my heart rate. I also take Altace and Coreg. I've been on all 3 since 2003.

Cusegal...the magnesium you are taking should not have an impact on your movements...had it been combined with calcium then it may have been an issue. I am not familiar with the other two drugs (though understand what they are form a quick search) and how they may or may not impact bowel function.

So going on a month of this misery. Now, I seem to be alternating between extremely painful BM with no blood, or else heavy bleeding but no pain. This morning it was the blood - took almost half an hour to get it to stop which let me tell you is pretty scary. On top of that I also have terrible gas and bloating and I'm nauseous as well. I'm starting to get really afraid that this is something serious, and yet I still have to wait 3 more weeks to see the GI doc and even then I'm sure he won't be able to do a scope on initial visit. Can anybody give me any idea what is going on here?