I've been lurking on this board for information and to post questions and thoughts from time to time, but I've never properly introduced myself.
I'm 38, fairly active, run 10 milers, half marathons, and go to the gym on a relatively regular basis. I do enjoy my food though - stay away from fried foods generally, but enjoy eating fatty foods like cheese, meats, and breads. During the week I generally eat whole healthy foods though - salads, fish, chicken, etc. Anyway, probably due to the weekend diet and allowing myself to get dehydrated during bouts of depression, I had my first fissure about three years ago, which seemed to miraculously heal with no special meds.
I was pain-free for three years, would have a little irritation now and again, but nothing major. Then this November I had back to back incidences of diarrhea, then constipation, then diarrhea again, which led to a major retear or new fissure at the 6 o'clock position. Didn't think much of it - I knew the drill - blood and pain during BM, take stool softeners, use coconut oil, and it would eventually go away. Well, guess I was being a little naive and optimistic. Fissure stuck around and seemed to get worse as the weeks went on with a pain level of about 7 out of 10 during BMs and pain sticking around 7-8 hours after - turned out, I made the fissure worse. Following all the advice I had read online, I was getting way too much fiber (40+ grams a day), and as a woman, I really should have been aiming to get 25 grams. All that fiber was making my stool huge and even with the stool softener, they were hard to pass. I figured this out after reading through posts on this board, etc. and seem to have a handle on the fiber, at least.
I was finally able to get an appointment with a CRS on December 16, who prescribed nifedipine and gave the regular spiel: fiber, water, etc. One week on nifedipine and my sphincter was finally able to relax and by the time Christmas rolled around, my pain decreased drastically to around 3 out of 10. The week of New Year's was even better with no pain at all, even during BMs, to the point that I felt I could stop taking the nifedipine.
Last week, I returned to the gym and lifted weights including squats and deadlifts, walked on the treadmill, etc. I had a heavenly week of living like a normal person, not stressing about my BMs, eating healthy, working out, etc. I even had the occasional glass of wine with dinner with no problem. Then Saturday rolls around, my husband and I went to a store to wax his snowboard, I didn't take water with me, and we ended up staying there around 1.5 waiting. Then we went to the gym, then dinner where they only had ice water and the restaurant was so busy, I couldn't get regular tap water without ice. Well, add this all up and it turns out I didn't get enough water, and bam, fissure comes back Sunday with a vengeance.
Now I'm back to applying nifedipine six times a day, making sure I get my fiber in, drinking one gallon of water a day, and jumping in a sitz bath after BM. Stool has stayed around Bristol 5/6 through water and diet alone. It appears to be soft enough, but the pain during BMs has been back up to around 7 out of 10. Sunday the pain lasted all day, I believe it was because my sentinel pile was irritated. The pain afterwards has been steadily decreasing this week, but the pain during BMs has stayed around 7/10. Sentinel pile seems to have calmed down as well.
I haven't taken stool softener this go around. My concern being that if stool is too soft, it will require straining to get out. I also don't take miralax, movicol, or anything else, as I'm scared it will cause diarrhea. I just started adding in 500mg of magnesium to make sure things are soft. Should I stick with what's working as far as diet and water to keep stools at Bristol 5/6?
I have a follow-up with the CRS scheduled for next Tuesday, but if things haven't calmed down, I'm tempted to push the appointment out because last time, she stuck her finger up my you know what, causing pain for hours. She mentioned that if fissure doesn't heal, next step is Botox, but I would like a few more weeks to see if I can get back to New Year's week level of comfort on my own without the Botox intervention.
Anyway, thank you for reading and I plan to keep this post updated for a while. Thanks for all your advice and support. This is a long and lonely road. I only recently told my husband what's been going on with me - he's support as can be, but I hate burdening him with this.