Some fissure questions I have for everyone..I was told I may have one by my doc, he has me on Nifedipine/Lidocaine. Have been using it externally for a week now. Pain is still there when going, stinging, it seems to be based on how big the stool is. My stools seem to sometimes be hard at tip, but soft behind, why is this? My diet of late has been:

Morning: Orange Juice, bowl Raisin Bran, 1-3 cups coffee, or whole grain toast, or occasional small piece sausage. Banana, apple, or pear, sometimes oatmeal. Sometimes a bit of prune juice.

Lunch: Salad, with apple or steamed veggies with whole grain pasta. Water or Juice or soda.

Dinner: Steamed veggies, fish, chicken, soup, water, yogurt, apple, box raisins, fiber one bar.

People say you need 18g of fiber per day. I'm also taking one stool softener, but maybe I should take two per day for a bit, and see if that helps? Will fiber make stools larger & more painful?

I've heard that what goes in soft comes out soft..So, ice cream, would that be ok? As long as I keep my fiber up & drink enough water? I refuse to give up my coffee, I can't function without it. And it seems to stimulate my bowels too.

So, can I eat things I like (within reason) as long as I have plenty of fiber and take the stool softeners?

Lastly, another fiber question..I got some fiber supplement pills awhile back, they are Equate Fiber Therapy pills, 100% natural psyllium. It says "fiber laxative" "fiber supplement". But I don't want a laxative, I just need a natural supplement that is safe to take, and is NOT a laxative, is there such a thing? Because I still don't think I get enough fiber per day..So what are some options? Metamucil? My doc told me just make sure my stools are soft.


Going back to see my doc next week for follow-up. Going to keep using the cream, hope it helps, there is still a lot of soreness down there. Nothing looks obvious in the mirror to me, but I guess an AF (if that's what it is) is so small yet can cause a lot of irritation/discomfort like a paper cut on the ass basically.


I have two skin tags, but my CRS told me earlier this month that they would be more trouble to remove than leaving them on. But I know one of them is contributing to my discomfort. Maybe I could try nitro or a steroid cream if the Nifed/Lido doesn't kick in soon.

Alex,

Yes, increasing fiber will increase stool bulk. For some people with fissures they can find that this causes too much stretching of the sphincter. There are also two different kinds of fiber, soluble and insoluble. There are charts you can find online that describe the difference. But generally, too much insoluble fiber can lead to those bulkier stools. Everyone is so different when it comes to how much fiber, and what ratio of soluble to insoluble works best for them, and it takes a lot of experimenting to find what works best for you. You might be finding, in particular, that the amount of grains you're eating are causing bulkier, drier stools.

The harder portion of stool at the front is just because that part has been in the rectum the longest and has had more water extracted from it. You could try adding another stool softener to see if it helps, and taking it at a different time of day than you take the first one. Also, make sure you're drinking plenty of water. Both fiber and stool softeners require generous water intake to keep stools soft.

As far as coffee, it's mostly advised to avoid it because of the vasoconstrictor effects of caffeine, but a lot of fissure sufferers continue to drink it and many of them say they don't notice any difference between drinking it or not drinking it in terms of healing, etc. So, that's just up to you to decide whether you want to experiment with stopping.

Don't be concerned about the designation of "laxative" attached to fiber supplements. They are not stimulant laxatives. They are just required to be labeled that way. But the fiber in a supplement isn't any different from the fiber found in foods you eat. Fiber is fiber.

Thanks a lot! This was very helpful for me. I had tried eating almonds for awhile, but to me it seemed counter-intuitive, because nuts are hard, and I was afraid they would scrape me more down there. But the chart I found said nuts are good soluble fibers..So maybe I should eat almonds after all. I've been eating veggies, because I thought they were softer, and would make my stools softer..But right now, what I need is to keep my stools soft and smaller..Rather than bulky.

Maybe I'll try a fiber supplement. I'd prefer to go the natural route. I think for now, until I heal more, I'll go with more soluble fiber. I love nuts, so are those ok? Will my body break them down enough?

I've been eating a lot of apples skin and all. Maybe I should peel them..Going to add another stool softener.

I am going to ask my doctor next week if there's a chance I might have herpes, or another std, because the guy I dated previously told me he thought he might have been exposed to an std after we broke up. So it makes me wonder..And today I have felt a little feverish too..My doc told me last time he examined me, that he thought it was a basic fissure, and didn't see the need to culture it, but I would feel better if I could be tested for stds when I see him next week just to be sure. Thanks again for your answers.

Funny thing about nuts is that a lot of fissure sufferers avoid them for fear of any potential sharp pieces causing damage on the way out. But lots of fissure sufferers include nuts in their diet and don't find this to be true. If you do try adding them back to your diet, just make sure you chew them really thoroughly before swallowing to mitigate any risk.

Veggies and fruits are good for keeping stools soft, but yes, it can be beneficial to emphasize ones that have less insoluble fiber. I always peel apples before eating, for example. Strawberries and kiwis (with no skin) work well. If you like sweet potatoes, those are good for softening without bulking. Spinach is also good for softening without bulking. Some people find onions and garlic to have a natural laxative effect and since they don't bulk, you can experiment to see how that works. Also, in general, cooking veggies helps to break down the fibers in them, so you get the benefit of the stool softening effect without as much bulking up. Also, fat is pretty much the strongest natural laxative there is. So, incorporating extra healthy fats during this healing time can really help. Olive oil, flax oil, coconut oil, etc.

If you have any suspicion of an STD, definitely insist on getting tested. There's no reason to guess or speculate if there is any possibility there.

I definately noticed when I ate a serving of almonds per day, my stools actually seemed looser than they do now! I only stopped eating them because someone told me they could cut it down there, but like you said, I think if chewed enough, they'd be ok. And they're a good soluble fiber source. I seemed to have easier stools when I ate almonds especially in tandem with other fiber sources. I think I'll add them again. Does it have to be almonds, or will any nut be ok? because I LOVE nuts as a snack and they're rich in protein too. I'd try peanut butter, but I'm afraid it would clog me up too much.

Love sweet potatoes too. Just anything that will keep them soft & not too big in diameter, which I want to avoid! As far as apples & pears, which I eat a ton of, so it's probably best to peel them? I'll do that from now on.

Funny enough, I noticed that when I used to eat 2-3 bananas per day, I seemed to have softer stools too! And yet many people claim they constipate..I don't think a couple bananas per day should be too bad. For me, I used to have gas which helped pass my stools, and maybe bananas played a role in that. I'm going to take your suggestions! Bottom line, I'm going to up my soluble fiber to try & achieve looser stools.

Oh and I'll definately push hard for my doc to test me for stds, just to be sure. Want to make sure I'm 100% healthy!

I have been eating almonds without problems, just chew them well, although even when I was sloppy and they came out in larger pieces I had no issues. I doubt they can hurt a fissure no matter how they come out...

You should be careful with bananas. Even one a day gave me problems, but everyone is different.

Regarding the plug effect, where the tip is harder, then it took me many months to find a diet that eliminated them. It can be done with a lot of trial and error, so don't just accept them. The plugs was what caused me many retears during the worst months.

Good luck on finding the right diet that works for you.

JHh

What I'm wondering is, if you eat one or two foods like a banana or pasta that might cause stiffer stool, will compensating by drinking a lot of water, taking stool softener, eating enough fiber that day, be enough to mitigate against a hard stool the next day?

What saved me and healed the fissure was Miralax, lots of water, a god diet fruits ,veggies, etc. warm baths of at least 20 minutes after a BM and Rectogecic to avoid anal spasms so my fissure could heal. The key my doctor told me was to keep the BM soft and avoid the anal spams. My fissure was cured in 2 weeks. That was one year ago. Nuts are a no, no for me they caused me a relapse once. I am Sorry for my English it is not my first language. I hope it was of some help for you.

I guess everyone is different. I don't seem to have spasms so much. Do fissures typically cause pain constantly, or just during BM? For me, it's always a brief sharp pain when passing stool, then a bit of irritation here and there, but the pain is brief and only when passing stool. I'm going to get another opinion, because I wonder if it's an anal fissure or just an irritated skin tag. Maybe that's why, after one week, the Nifedipine/Lidocaine hasn't improved the pain at all with BMs for me.

Metamucil will help you with fiber intake. I take 1 table spoon in the morning and 1 teaspoon with dinner, but you need increase it gradually. Re nuts-it is better avoid any hard foods. I eat nut smooth butters instead and avoid crackers hard, cereals, etc
Good luck!