Hi All,

So grateful to have found this forum. I've been reading for a while now, but feeling overwhelmed with trying to figure out what I should do, so I thought I would finally register and introduce myself.

I gave birth to my first child late December 2015. Labor went fairly smoothly, but I did have about two hours of very unproductive pushing before I changed positions and my son was born. I think this is what led to my fissure.

My first bathroom trip after labor was scary, but uneventful. I think it was the second time I went that I felt a slight stingy, pinchy feeling. Everything was so swollen and all the sensations so new, I didn't really give much thought to it.

Stingy feeling got worse and I began to experience what I know now are spasms. It took a really long time to get diagnosed because I thought I just had hemorrhoids and figured there wasn't much the doctor could do.

Was in extreme pain at my postpartum checkup, midwife said that my hemorrhoids weren't that bad and shouldn't be hurting that much. Not very helpful, since it didn't change the pain I felt. Turns out they were looking at my sentinel pile, but didn't recognize it as such.

Luckily, upon further complaining, I was finally referred to a CRS two months postpartum. He quickly diagnosed me with fissure, prescribed Nifedipine, told me to eat lots of fiber, said it would take two months to heal, and scheduled a follow up a month later.

It's now been almost four months since I finally got diagnosed, and I am still suffering.

I've never had issues with constipation, but find myself swinging wildly from painful loose stools to constipation. I've tried Benefiber, which seemed to help for a couple days, but seems to be contributing to the constipation.

I've cut out coffee, been trying to focus on eating vegetables. Have oatmeal every morning for breakfast as recommended by CRS. Been doing a site bath after every BM for about a month now.

I'm just at a loss. I can't enjoy and care for my son the way I want to because I can't sit/move without pain on some days. Add to this breastfeeding, which I think limits my treatment options.

Would love to hear some suggestions for what to try next. I'm thinking about asking the CRS about Botox next time I go in. Also, if there are any mamas out there, would love to hear your experiences. I really want my son to have siblings, but at this point, I'm terrified that this could happen again and I'm afraid he may be an only child. (Coming from an only child, I know this isn't a horrible thing, but as an adult, I've longed for siblings of my own.)

Thank you in advance for any advice/support you can send my way.

Hi Sadmama,

I'm so sorry that you are going through this right now. I know how hard and painful this is. If you've been using Diltiazem for more than two months now and your fissure is still not healed, you may have to do another course of it (or GTN or Diltiazem). Also have you tried Miralax? This has done wonders for me and many others on this board in the early stages of the fissure to keep stools soft daily, decreasing some of the pain.

I've never had Botox, but I have read mixed reviews about it. If you've been suffering for four months now, I think the fissure is chronic, which often requires surgery. LIS surgery would be your last resort, but I would try everything else beforehand. Although surgery sounds scary, the majority of people have a lot of success with it.

I know this is a lot of info to take in, especially when you're in pain. I wish I could do more to help, but i want you to know don't lose hope and hang in there! You will get through this.

Hello Sadmama,
I am sorry to hear you are in pain.
I typed out a whole long response to you and somehow managed to delete it so here is the brief version. I had the same thing happen some 13 years ago after the birth of my daughter. I had difficulty being an involved mom for atleast 4 or 5 months due to the pain. My mom mostly took care of her for 6 months. I had to reach out and ask for help as I realized I could not take care of me and her simultaneously. I never regret that I asked for help ( and hired a nanny who I trusted for several months) .

I suffered for months and I also sought the help of a good colorectal surgeon and at that time had an LIS from which I recovered very very quickly . I worked through most of this time !!! There were not many local therapy options offered to me.

The challenge was hydration while breast feeding. And working and managing diet .

I also knew a lot less about diet back then and now I am more careful about getting soluble fiber in.

I also have a relapse now and have opted for Botox. Feel free to see my newbie post and my diary. For me attitude is so key as the days I mentally let it get the me are the most miserable with physical and mental pain. I have my lows but somehow try to inspire myself to do simple yoga and meditation that seems to calm me a bit.

Stay positive it will end. I have to do the same :) . As for me ,my first LIS was when I was 18 and after the second LIS ( after the baby) I was 27 I stayed symptom free for 13 years before I just relapsed . Now my daughter often takes care of me too.

Please don't be a Sadmama come reach out to us all. We all feel your pain. Literally!

Thank you both for your replies! Seriously, just getting to talk to people who know my pain has lifted my spirits so much!

I have not tried Miralax. I'm a little reluctant to as from what I've read, it seems like a more extreme laxative? Also, I don't think it's recommended during breastfeeding? I already feel guilty about the daily Colace and Ibuprofen I've been taking, even though these are on the "approved" list. I'm typically not one for medication unless it's really bad, and as you know, this pain IS really bad.

Curious what the mixed reviews of Botox are. Just varying success, or further complications?

Healingthroughdiet, I think keeping up hydration while breastfeeding is definitely part of my problem. Have upped the liquids considerably in the last week or so. Hoping that prevents any further constipation. I've only had a few instances of this, but just terrifying with the fissure.

My larger problem it seems is loose stools, which come out so quickly they really irritate my injury. Like you, I am learning more about diet. I've opted for whole grains when possible for many years now (diabetes runs in my family), but am now learning that they contain insoluable fiber, and may be contributing to my loose stools? Think maybe I too need to focus on soluable fiber. It's a lot to take in when managing daily pain and caring for an infant.

One good thing is my husband and I agreed for me to stay home prior to this whole episode, so I am able to rest when it's really bad (assuming baby cooperates!). Speaking of, I've seen a lot about not sitting too much, but what is the thought on lots of rest? I figure sleep is the time for the body to heal itself, but don't know if I should push through and stay active? I will say I get lots of walking in with grocery store trips, laundry, unpacking (we just moved).

Thank you again!

Hi sadmama, i was also diagnosed with fissure a month ago, its cos of the unhealthy lifestyle i lead when i went home for vacation.. Altgough it took me a while to visit a GS because i thought i could reverse it by using pain meds and laxatives. i was anxious of whats causing the burning pain and bleeding which didnt stop. Upon return to work i met a laparoscopic surgeon here in dubai (best in keyhole surgeries) and gave me antibiotics prior to surgery as he said theres infection.

I just underwent stapled hemorrhoidopexy, open hemorrhoidectomy, and spinchterotomy this morning, was out the entire procedure and i woke pain was around 3/10. I am actually admitted now in recovery room for post op pain management.

So far the anesthesia wore off and im just feeling a dull pain which is manageable. Am anxious to have my 1st BM the next day after crossing fingers theres no blood or pain.

If you are thinking about surgery go for it in a heartbeat. Its better to get it done and agonize a few days, rather than prolong and have chronic pain and bleeding.. also It gets more complicated as we age.

I hope this helps. Be well!

I am not sure about use of meds during pregnancy but miralax is just an osmotic laxative - makes stool soft . Maybe checking with the OB will reassure you? I did take colace and ibuprofen during my lactating period I believe . But best is checking with the neonatal pediatrician .
I also have a Botox diary.
Yes diet changes have helped me over the years, soluble fiber helps me the most
Regarding Botox to me it seems to help , my diary logs my progress , LIS also worked in the past.
Take care
HTD

Hi there Sadmama hope you are feeling better take care