Hi, everyone. I've been waiting several days to post here but too much distracted by the pain, so I just search and scroll down through the valuable info, sometimes with tears and sometimes with laughter. This forum provides me a huge support in between screaming of pain. I'd like to thank you all from the deepest of my heart.

A little bit about my condition:

I'm 31 years old female, having irritable tummy since I was a kid, diagnosed with lactose and gluten intolerance in 2012. Having diarrhea and grumpy stomach is usual for me, been living with it for years. But in 2014, a few days after my marriage, I was constipated for days and finally got a pretty horrible bleeding when I had BM. I waited several days without medication and it seemed to heal by itself.

Only after that, whenever I travel, stay overnight at a new place, or under a lot of stress, I will get constipated and sometimes the bleeding comes. In my home country, I was given Faktu suppositories (policresulen and cinchocaine), and it helps a lot. Whenever the pain comes, I will just insert it and the next day I can have a normal BM (even though the stool was a bit hard but its okay since I think my sphincter was normal back then).

But, 5 months ago I moved to Netherlands, I didn't bring Faktu with me since it was out of stock in several nearby pharmacies. Of course, I was worried, but I try to keep my diet fairly healthy so I will not get constipated. Generally, my diet consists of brown rice in the morning, always with veggies and protein, pretty much the same for lunch, and smoothies for dinner. Still, whenever I'm near my period of the month, sometimes I get constipated. In those 5 moths, I think I had one episode of bloody stool beside this one, but I didn't pay much attention, hoping it will heal by itself, and it did.

Now, starting from around mid April, I got severe constipation, for several days the stool came out but very big and hard (pardon my language), and I felt incomplete evacuation after each BM. After that, the urge is still there, regularly, every morning, but the stool just didn't come out. Apparently, I got impatient and pushed it, and the next three days I always have blood after every BM. The sore/ache in the anal/rectal area was quite disturbing, but since I've been living with irritable tummy for years and getting use to this pain, again I ignored it.

The last time I had 'almost normal' BM (at least the stool came out pretty much, even with blood and pain) is on 25 April, 9 days ago. in an attempt to push it out, perhaps the tearing got pretty bad and that's when this all begin. It was when I noticed the spasm and throbbing, burning, excruciating pain which is the worst I had in my life. I call the GP seeking for relief, but they're only available for appointment a week later. I drag myself to a nearby pharmacy asking for medicine similar with Faktu or any available OTC, but faktu is not sold here. I bought lidocaine 5% with zinc oxide and bismuth subnitrate (theranal), but my sphincter was too tight I couldn't deliver the medicine inside. So it doesn't really help.

I literally writhing in pain for three days after the 'Big Tear', every movement is a torture, event lying in bed the excruciating pain still comes every three minutes or so. I can't cook, can't move, can't stand, only lying in bed gritting my teeth and gripping tightly to the bedsheet every time the pain peaking. I think the worst pain comes from my rectum attempting to expel the dried plug near the anal opening while the anal canal itself is injured (oh, can't believe I would discuss it like this, but I know you'll understand). So it's like pressing/scrubbing the fresh open wound into a rough dry surface. The only thing to relieve it is by getting rid of the dried plug. But with the fresh wound and the spasm, I was tortured. So I decided to go to the ER, diagnosed with AF, and being given diltiazem and lactulosa, and also being told to continue the lidocaine and do a warm water bath.

Since my visit to the ER on 28 April, I notice that diltiazem eases the spasm a bit so I can insert the aplicator for lidocaine. Because of the reflex to expel the plug, I need to go to the toilet several times a day, but usually with no luck instead of a mess that I need to clean while trembling with pain, and what comes out just the size of a small pebble.

I'm getting worried, not only because of the pain itself, but also the 'obstruction' which I think may impede healing (?). I don't know for sure, but reading many advises here, it sounds terrible to have impacted stool. let alone in the newly developed fissure. The lactulosa apparently has 67 mg lactosa per ml, and since I'm lactose intolerance now my stomach grumble, but the stool is ot what will I consider as soft. It's not dried and hard, but still solid and feels blocking the opening.

I read about miralax but it's not sold in Netherland, one article say here it comes by Transipeg name, but different in term of electrolyte or something. Has anyone tried transipeg? it's also PEG3350 like miralax. I'm afraid the electrolyte will cause more burning sensation down there. I also doubt that it will act faster than 2 days. I considered enema for quicker action, microlax with sorbitol is what I spotted on nearby pharmacy, but again, will enema hurts more, or is it better than letting the plug stay longer?

Any advice will be really appreciated. I'm sending prayers to you all suffering the same condition, hope we will get rid of this soon.

Miralax is just a brand name for Macrogol - polythethylene glycol (PEG) - and Transipeg is another. You can buy Transipeg in Netherlands. The version I use here in U.K. is called Laxido, and there are many other names:

https://www.drugs.com/international/macrogol.html

Many people find that Macrogol is helpful in AF, and works as a stool softener. But people are different with regard to transit times, so it's hard to generalise.

Sorry to hear you are having a hard time with pain. Some posters here have found that the drug gabapentin is effective as a nerve pain blocker in AF. I have been using Lyrica (pregabalin) for a couple of years now in order to keep the fissure pain under control, and it has worked for me, within certain limits. I'm sorry that there isn't a pain management section on this forum - in my opinion there should be one, for pain is one of the most trying and exhausting aspects of this condition.

In your post you don't mention visiting a CRS. In view of the suffering you are going through, I think it would be a good idea to arrange to see a CRS as soon as possible, if only for reassurance in the first instance.

David

Hi, David, very thankful for the feedback... The info on gabapentin shed a new light for me, I think I would ask if the doctor will prescribe it for me. I assume it is on prescription, not OTC?

And yes, I havent got an appointment to see CRS, the ER doctor told me to call my GP if the problem persists. I made an appointment for tomorrow, hopefully she agree to refer me to the CRS.

As for now I try using water enema, bought microlax but afraid of using it, so I empty it and fill the small (5 ml) bottle with only water. It helps to soften a bit, and some of the plug came out. Need to wait for more BMs to really get rid of it, since I cant do that in one go. The pain is unbearable.

Anyway, about miralax/PEG again, do you think it will also soften the stools which has been quite some time (more than 5 days) on the lower passage? Or is it only make the unformed stool not being too hard?

Anyone here with hard/impacted stool for several days care to share some experience with Miralax? Also, how about glycerine suppositories? Is it also soften the stools from the distal, or only lubricate?

I read here about glycerine supp, and thought to get some online. Think it wouldnt hurt to try. Wish me luck!

Sending prayers to you all!

Hi again - yes, you will get gabapentin on prescription, not OTC. Same is true of pregabalin, which is also worth trying, imo.

Re stool softeners: I take Macrogol (Laxido) in combination with lactulose, and find that this generally produces a soft stool. My original problem was very hard stool, and this has more or less solved that for me, though I still have trouble with recurring fissures, which I'm told is probably related to stenosis (skin tags). Certainly lactulose at a sufficiently high dose is almost guaranteed to produce a sticky, greasy stool (sorry for tmi), so you might want to try that (though be sure to ask your GP first about the correct dose for you).

I have occasionally used glycerine suppositories, and found that they worked to produce a BM, but whether they actually made the stool softer, I don't know. I suspect not, but that's just a subjective opinion.

Good luck with finding the right CRS, it's sometimes a difficult process, but worth the effort.

David

Hi sorry to hear your suffering,
I can agree the spasms are the worst pain ever I have lived quite normally with crohns and IBS but this fissure wrecked my life for a good year.
Get a referral to the CRS asap as they will know what would work best for you. I agree get some gabapentin it changed my recovery and works well now when my crohns flares and irritates the scar tissue from the fissures. I don't think the glycerine suppositories actually soften the BM as I have never used them.
Gilmore Girl a member on here had a fortnight of impacted stools and went to the ER you could PM her on here as she may have much more helpful advise and would be happy to help you.
I wish I Could be more helpful but mostly my issue is diarrhoea and I only get constipated when I over do my meds
All I can say is most fissures heal very well with cream and dont need much intervention. Keep up with the sitz baths as many as you can as they really do help. This pain truly is indescribable a level of agony I didn't know existed but it doesn't last and you will get better
MPB