Hello all,

Life is weird.

I just wanted to follow up on my progress since my last major post. For reference, this was my last major post: a-belated-intro-my-story-t8275.html.

I went to another CRS, and she told me that it is a pelvic floor issue. It was difficult for her to get a finger in there (also not pleasant—mild blood and pain for the proceeding week. Everything just seems locked up down there—skeletal muscles as well as the sphincter. I have a feeling that she is right about this one. This is effectively functional stenosis, or, muscularly-induced constipation. Any stool larger than a pinky finger is uncomfortable (but I’ve figured out a diet that guarantees small stools).

So, she suggested I go see a physical therapist, meaning they will probably suggest biofeedback among a number of other things. Ugh.

Here’s the good news. 1. As far as we can tell, there is no anatomical stricture down there. I haven’t had any hemmorhoidectomies or excessive scar tissue build up to cause such a problem, so it is probably just a muscular issue, which I can work on. 2. No LIS. In some ways I am disappointed that there seems to be no ‘simple solution’ for me, but I am glad to not have to deal with surgery. 3. I have found a diet that works for me. I can wake up every morning relatively self-assured that I will not retear.

I don’t really want to go in for biofeedback right now, because I fear they will reinjure me, as so many doctors have, so I am trying to just relax everything through proper stretching and deep breathing. I haven’t felt pain in weeks, and after some consistency and more time to heal, maybe I will be ready.

If I can a) get off some of the pharmaceuticals I am taking and b) make sure that my pelvic floor issues don’t worsen, I suppose I have arrived at a long-term solution. Not the most ideal solution in the world, but I can be fully active again. I haven’t felt pain in several weeks, and more importantly, anal fissures and rectal pain are not at the center of my life (though management and prevention still require considerable work). Despite the fact that it is pretty much the same food every day, I actually really like what I am eating. I can keep this up the rest of my life if I have to. I am grateful that my daily diet includes oats (like), beans and rice (love), coffee (really like), and dark beer (love). *See explanation below if this seems like a strange diet to you.

For anyone that has gone through biofeedback and/or physical therapy, I would greatly, greatly appreciate recommendations for exercises, stretches, and the next steps in the healing process

Best wishes to all
(I’ve made some notes about my diet below. I hope it of use to some of you.)

MY DIET

My diet revolves around oats in the morning and beans and rice in the evening, with a number of supplements, including coffee and beer. All of my stools are smooth, soft ‘cow pies’, and I produce two to three per day—one when I wake up, one after food/coffee, and sometimes another shortly after or later in the day. I think the beans and rice have made the biggest positive improvement in stool consistency.

I want to say a quick thing about coffee and alcohol before I continue, because I know they are controversial.

a) I have one cup of coffee every day. It induces a second (or third stool), and I don’t think it dehydrates me excessively. The benefits outweigh the costs for me.
b) I have at least one dark beer a day. I know it is widely accepted that alcohol dehydrates the stool, but this just has not been true in my experience. The inverse seems to be true for me. The stools seem more watery with beer, in fact. If I drink in excess, it even causes diarrhea. And I know I’m not alone on this one.—ever heard the term the ‘whiskey sh•ts’? I should note that I am very good at staying hydrated, and I drink lots of water whenever I drink alcohol. But the dark beer, for whatever reason, has been important—it seems to move my bowels faster, and hydrate the stools. I also think, culturally and psychologically, reintroducing alcohol has been very important. I am young and outdoorsy—going completely sober was stressful because of the social implications. It just made it hard to ‘hang out’ and meet new people. It’s important to find a healthy diet and healing plan, but it is also important to make the plan psychologically sustainable. I am so much happier now since reintroducing a little alcohol. I don’t know if this works for anyone else, but I just wanted to mention it. Listen to your body.

Breakfast:
- Breakfast drink:
o 1 teaspoons berry powder (Synergy)
o 1 ½ teaspoons wheatgrass powder (Synergy)
o 400mg magnesium glycinate
o 1 emergen-C packet
o 1 cap of Miralax
o 12-16oz water
- Oats:
o 2 tablespoons brown rice, 2 tablespoons steel cut oats, a handful of goji berries slow cooked overnight in a crockpot with 2 ½ cups of water
o After cooking, I add a banana and two tablespoons of rice protein (20 grams of protein) with a banana and honey.

Lunch:
- Varied, but generally includes eggs, half a wheat tortilla, a small amount of meat, vegetables, yogurt, hummus, berries, etc, etc., avocadoes

Dinner (around 5:30 pm)
- 16 oz water with 400mg magnesium oxide, and 1 emergen-C packet
- Refried beans and rice (about 16oz) with a variety of vegetables.

Before bed:
- 1 triphala tablet with several swigs of prune juice
- Nitroglycerine ointment

Explanations:
- I eat oats and beans and rice because they naturally retain moisture. I try to eat foods that I think will retain moisture as they go through my gut. This isn’t exclusively about ‘soluble fiber’ or ‘insoluble fiber’, though it certainly involves them. Just imagine how water might be added/extracted from the foods you choose to eat.
- One of my goals with my diet is to have a fast bowel transit time. Food that stays in too long gets compacted. Coffee in the morning, eating an early dinner (around 5:30pm), one beer after dinner, and prune juice/triphala induce a transit time of 12-24 hours (since my stools come out every morning) . The beer also helps me not eat after dinner, which could produce a stool too ‘freshly formed’ to come out the next morning (thus staying in there for 36 hours).
- Magnesium glycinate helps relax musculature
- Vitamin c hydrates stools
- Magnesium oxide/miralax hydrate stools
- Avocadoes and honey are both supposedly very good for your gut
- I take miralax/emergen-c with breakfast and magnesium oxide/emergen-c with dinner because I want to make sure that my highly fibrous foods retain their moisture. While ‘wet fiber’ is fantastic for rectal problems, ‘dry fiber’ can be your worst nightmare if it compacts. Also, if I don’t expel dinner the next morning, I want to make sure it stays nice and hydrated because it might be sitting there for around 36 hours (till the following morning).

So, I’ll just keep doing that as long as I need to, I guess, while slowly tapering off the Miralax. Wish me luck!

I couldn't agree more about the alcohol. I became an ascetic during my fissure times and wouldn't touch my usual 2-3 glasses of red wine. On top of not eating meat, dairy, bread, sugar, etc... It became pointless to try to hang out with friends when our usual activity was apps and wine for happy hour. So on top of debilitating butt pain I was lonely and starving. I think the drastic diet change, including no alcohol, was a huge mistake in hindsight. It messed with my psyche and made me so depressed which probably didn't help my fissure. I didn't realize this till after surgery but I think you have the right idea. Btw booze also gave me looser bms, not the other way around.

Great post UT, Totally agree on the coffee and alcohol. To much alcohol can constipate some but many get diarrhea, neither are good for a fissure. My CRS looked at me like I was crazy for giving up my one cup of coffee in the morning and a glass of wine at night. For me a cup of coffee in the morning helps me go to the bathroom and the wine at night well, I just like it. The key is my intake of water is way up, that helps keep me hydrated. Small amounts of coffee and alcohol are not that dehydrating. Also, love the rice beans, the funny thing is through this all I found a chicken burrito with rice and beans helped my BMS stay soft and long, lucky me. The truth is what works for one is not right for everyone. You need to find your balance and what works for you mentally.

Hi UT,
Also agree with the alcohol! In moderation and followed with water, I have no issues either......if I overdo it however, it gives me a bad tum and the runs!!
Your diet is full of the things I also eat, especially avocados - I love them. The one thing I realised is that if the food product is "soft" (bananas/ oats/ beans/ avocados etc..) combined with the whole wheats (pasta/ bread/ rice/ cereals) - I generally have the perfect combination for soft stools......You just know that eating tougher things (red meats/ pastries/ pizza dough) are going to be more difficult to pass so easily.
I hope you are able to figure out your pelvic floor issues but you are right in that relaxation of that area and in general, is key. Wishing you all the very best in your full recovery :)

How can we permanently relax that area when we really don't have much control over it?

Thanks for your posts, all. I appreciate your support.

Alyssa, I wish I could tell you... I know that you have been working with physical therapists, so I'm sure that you know much better than I. Your symptoms are very different than mine, so I am not sure what knowledge I can contribute. I know you have been in much pain and I wish you nothing but the best.

What I have been doing lately to relax the area includes:
a) deep breathing-- I do an exercise where I breathe in and hold at a ratio of 2:1. That means inhale for 12 seconds, hold for 6, exhale for 12, hold for 6, repeat (could also be 14:7, 16:8, etc). Supposedly deep breathing helps. This exercise was not taught to me for relaxation purposes...it's just something I picked up a while ago.
b) yoga--focusing on upper leg stretches (pigeon pose, dragon pose, downward dog, etc)
c) nitro
d) aquaphor in the morning pre-BM (helps things slide out easier)
e) mild dilation. When I apply nitro in the evening or aquaphor in the morning, I just hold the pinky finger there for a few minutes. I think this promotes relaxation.

Does this stuff help? I don't know, honestly. I think it does.

Wishing you the best.

Thank you outdoorsman for your suggestions... My pt did mention that self dilation could be beneficial; I was looking at the dilators online but did not find something that I would consider comfortable to insert in that area.

yeah, right? Surprising there isn't a 'gentler' set. I haven't looked in a long time, but I think there were a few that looked ok.

The thing that I've been only doing for a few days now (but seems to actually be helping a lot) is just leaving that pinky finger there in the morning pre-BM. I leave it in there as the muscles contact and relax--it seems like this loosens everything up when I then do have the BM a few minutes later. This is also easy for me to anticipate and work into my schedule, because I wake up and have to go within 10-15 minutes of waking up, so it is predictable

It is also funny to consider that I start every day by sticking my finger up my butt.

Everything y'all posted in this topic is very helpful. Thank you! I may try the pinkie thing after I'm feeling a little more healed. I've tried using vaseline on a q-tip, but that seemed to make things worse.

Hi Alyssa. I too have pelvic floor dysfunction, for about 12 years now. I have received botox injections for the last 6 with varying success. The last couple of years though haven't been great and I got a fissure from getting a hemorrhoid banded (something I have had done before but the Doctor didn't take me seriously about how tight and vulnerable I was down there). Previously, I also avoided fissures by having 'cowpie' BMs. I really regret trusting a doctor up there but that's in the past now...have had the fissure for 8 hellish months now and it has done a number on my pelvic floor dysfuntion. I saw physios for quite some time before starting botox and to be honest it was the only thing that broke the pain cycle for me. A lot of people have great success with physio though. I think it depends on how long you have had it before you get treatment. I read a great book once on this disorder that you may want to check out. It is called 'A Headache in the Pelvis' by David Wise and Rodney Anderson:

http://www.amazon.ca/Headache-Pelvis-Ex ... 0972775552

Being female, you may be able to help your muscles quite a bit without going rectally but rather vaginally as most of the muscles can be accessed from both entrances.