LIS or botox when pregnant?

LIS/botox

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Re: LIS or botox when pregnant?

Postby Allthepain » 19 Feb 2018, 23:36

Your CRS mentioning the tear meeting up with a bad vaginal tear is terrifying! I wonder if she has experience with pregnant women actually delivering with an active AF. I have no doubt mine will still be unhealed by then. I've read a lot online but mostly only found speculation about delivering with an AF. I did read about a couple of people who had them and said delivery went ok, but not much else. Like you, I'm terrified delivery will make it worse and I will require the LIS. I feel like I have a chance of healing with creams once I'm no longer pregnant/breastfeeding. As long as I'm careful with diet, I can somewhat control the pain and bleeding. It's so hard to manage though and one bad bout is beyond excruciating.

It's interesting that you read about anterior tears not being caused by pressure issues. I also have an anterior tear and wonder how it will be healed? I still need to talk to my OBs about delivery with this thing. I'm afraid they will blow the issue off as nothing if they don't have experience with it, but it will be life altering if the pain gets any worse for me. Please keep in touch and let me know what you decide for your birth plan. I think I will still likely have a vaginal delivery but I need to have a discussion with my doctor still. There's another pregnant person that just posted on here too so hopefully we can all keep in touch with each others progress.
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Re: LIS or botox when pregnant?

Postby PreggoAF » 20 Feb 2018, 10:29

Allthepain, yes my CRS mentioned having had pregnant patients that elected for C-Section with an active fissure. She seemed pretty convinced it was the right thing to do. My OB was more skeptical and said she had delivered lots of women vaginally with thrombosed hems. Now obviously, we know that an AF and a thrombosed hem are two different animals, but I’m really on the fence with what to do. I’ll keep you posted. Who’s the other pregnant gal in the forum? Man, this whole thing is really terrifying. Worse part is I can’t really gain enough pregnancy weight because I’m too afraid to eat many foods. I’m nearly 34 weeks and have only gained 16 pounds. I started out at 116 at 5’6 so I was thin to begin with. I am STARVING!

As for the anterior fissure and the normal pressure issue, I am actually pretty sure now that my resting pressure has increased as a result of the spasms I’m having. It seems to be getting more difficult to have a BM despite it not being that painful while I’m going. I’m actually starting to do manual dilation with my pinky to see if that helps. There’s a study out there that showed that it helped cure acute posterior fissures so I thought I’d give it a try. I am definitely a lot tighter than I thought and think this will be slow going for me.
Chronic fissure: January 2018
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Re: LIS or botox when pregnant?

Postby Pregnantandinpain » 20 Feb 2018, 11:12

Hey guys! Boy am I glad to find you ladies! Allthepain posted on my thread about pregnancy and PreggoAF I'm glad to find yours!

Congrats on being 7 mos pregnant, I'm half way with my third babe. Boy it's been a struggle, I think this is the easiest pregnancy I've had except for this AF! It makes it horrible.

Like you guys I feel there hasn't been enough support for pregnant mommas. Drs seem lost except for my ob - she has been the most helpful. I posted all that in the other thread.

With the Dilitazem I was extremely worried since taking it by mouth during pregnancy is a big no no. The gi surgeon I saw had no clue if I should take it and called a RX, the RX said if it makes me lightheaded it will make the baby the same and that it'd be ok. I looked at him like he had 3 heads and said that wasn't good enough. Spoke to my ob and she said it was ok. That wasn't enough for me so I have a trusted RX that I work with. She dug around and found some good studies and contacted her trusted RX friend who also has a wife thats a dr and they all 3 agreed it was ok. And not to take nitro or a steroid. I'm happy with that since they really did due diligence and backed it up with what was out there. Which isn't a bunch. And it was nice with the RX told me 'I can see why you are worried', finally I felt heard. Amazing how much of an advocate we have to be.

Anyways glad we met and can support each other!
Carolyn
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Re: LIS or botox when pregnant?

Postby PreggoAF » 20 Feb 2018, 11:56

Hi Carolyn,
Thanks for finding me and I'm sorry you're on this forum, too. It sounds like we've all been experiencing the same difficulties in finding help to heal our fissure while pregnant. Thank you so much for posting the information about the Diltiazem. My CRS gave it to me and my OB thought it should be okay, but I have been feeling guilty using it for the past few weeks. I did some online research too and found that it was likely okay, but it's good to hear that the RX friend also told you it was fine. I saw a different CRS for a second opinion and she wanted me on Nitro as she thought it was more potent. She said that she had prescribed it to several pregnant patients who had no issues as a result. I tried it for a few days but stopped and went back to the diltiazem because I couldn't find any evidence that nitro would be safe for pregnant women. It seems ridiculous that there aren't more standardized treatment protocols for pregnant women with AFs.

Congrats on your third babe! I also feel like this pregnancy has been much easier, if it weren't for the AF and hems. I've been so careful this pregnancy to keep BMs regular and even use Vaseline before my BMs to lubricate the area, and I still ended up getting a fissure on the inside of a hem. It happened after a mild case of flu-induced pneumonia that had me coughing around the clock, and my CRS suspects all the coughing started the issue. It's frustrating.

Have you talked to your OB about how the fissure might affect delivery? I'm hoping that you'll be able to heal yours before that time, as you still have several weeks. I'm just a little over 6 weeks away from my due date and I'm starting to freak about what to do. Obviously I'd really prefer to do the vaginal delivery because of less recovery time and intervention, but I feel terrified about this fissure getting even longer and deeper from all the pushing. (Just thinking about it makes me want to cry.) On the other hand, if I got a C-section I would have to take constipating painkillers for at least a day or two, which could obviously cause the fissure major injury too. I honestly don't know what to do and feel very alone, as my health care providers either disagree on the subject or seem apathetic.
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Re: LIS or botox when pregnant?

Postby Pregnantandinpain » 20 Feb 2018, 19:07

Oh man, I totally get if PreggoAF. It is a major struggle without any help!

I see my OB Thursday and plan to ask all kinds of questions regarding delivery. I can't justify a c-section for an AF. It's so ridiculous, surgery is not without it's complications. I'm a med/surg nurse and tend to veer away from any kind of surgery. I used to float to PN and I saw all kinds of hems but never AF's. Are you both in the UK or states or? I'm in the states and we don't let anyone tear. Or at least that's the mainstream practice here. Honestly if a C-section is needed there should be no reason why we can't get coordinated care and have a GI surgeon come in after the C-section and do what needs to be done. It requires coordination and unfortunately lots of advocacy on our part. Sadly we have to have a loud voice and be proactive.

The whole nitro thing is crazy, that your Dr said she prescribed it and there weren't any problems. Maybe not a problem delivering but what about ongoing. These Drs are not following up with the care and development of the baby ongoing. Who's to say there isn't a problem months or years later. Ugh makes me so mad! I can't remember why but both my GI and OB Dr said they don't prescribe Nitro anymore. Yet all over this site it seems still in use. I'll have to look through old emails and see the reasoning as to why - sadly I don't remember and it was a month ago! Haha!

So glad we all connected!
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Re: LIS or botox when pregnant?

Postby Allthepain » 20 Feb 2018, 21:29

I'm also in the US and I do feel like I will have to be a major advocate for myself. At my office there are like 10-15 different doctors that I could see and I know they will all have different opinions. It's luck of the draw who will deliver me and I know they will all have different opinions on delivery. As of now, I plan to take Miralax close to my delivery date. I won't be healed but I'm hoping it will help. Hopefully, the creams will work for you guys. I might try it again if you have luck. My main problem is that I don't have my constipation 100% under control so it would be hard not to retear even with a cream.

I can't imagine not eating much. That must be awful! I've been ravenous this time around lol. I mostly eat what I want mainly because I haven't found a diet that doesn't leave me constipated. I've recently been eating lentil pasta in the evenings and coffee in the morning which has improved things some, but it's still a struggle. I tried using vaseline type stuff for a while too and even kept it in my purse... how freaking awful. I've honestly tried almost everything. I am at least at a point where most of my pain and bleeding is just during the bowel movement. When I was breastfeeding the pain lasted all day long. Anyways, it's nice to at least have a few people who know what this is like. I'm pretty sure my husband is tired of hearing me complain haha.
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Re: LIS or botox when pregnant?

Postby missy moo » 21 Feb 2018, 17:51

Allthepain it's funny you says an anterior isn't ment to be caused by a high resting pressure I've also read it has better blood flow then the posterior, so why do we have these anterior fissures that either wont heal or like mine keep coming back? Can you guys ask you crs about this the next time you see them I don't have appointments with the crs who did my Botox here in NZ you just get it done then that's it go see your doctor which they seem to know less then me about what a fissure even is I'm not paying to sit an explain to one more doctor what a fissure is at my doctor's appointment ever again how do these people become doctors move over I'll do your job. No offence to any good doctors out there but alot just don't even no the basics.
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Re: LIS or botox when pregnant?

Postby PreggoAF » 21 Feb 2018, 18:08

Carolyn, I'm in the Bay Area of California in the U.S. It's interesting to hear that your docs say that they don't prescribe nitro anymore. The CRS that told me that nitro is best for an AF is one of the best reviewed and popular CRS's in San Francisco. I honestly can't understand the differences in approaches between all these docs. Shouldn't they all be reading the same available studies and literature on the subject and come to the same conclusion? Maybe it's not as easy as that but it's still frustrating on the patient end.

AllthePain, I'm the same way with complaining to the husband. It's hard not to do so when he's one of the few people I've told about my issue. My mom, MIL, best friend are the other three that know. They're all health professionals so they've been helpful and sympathetic. But my poor husband. I actually made him take a look at it for me about a week ago with a flashlight and I think I traumatized him, lol. So much for romance around Valentine's Day.

Missy Moo, yeah, I don't get why our fissures are not healing either. I've also heard that anterior should receive better blood flow than anterior. I've seen in several places that they're usually not associated with high resting pressure, like posterior ones. I swear though that the spasms from my anterior AF are giving me high resting pressure now. I couldn't even get a pinky tip inside to apply lubricant for my BM recently and it's also felt more difficult to actually get the BMs to come out despite being of good consistency. I started self-dilation on Sunday after reading a lot about it on this forum and also a study that showed it cured AFs. I'm just using a gloved finger with lubricant 2xday, but I already feel like my sphincter is loosening up a bit. Hoping this helps things a bit.
Chronic fissure: January 2018
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Re: LIS or botox when pregnant?

Postby missy moo » 21 Feb 2018, 18:17

Yea I'm planning on starting the dilation once my fissure closes I had Botox 10 days ago and an exam while I was under so still swollen in to scared to damage the open fissure at the moment but I'm looking forward in seeing the benefits let me know how you get on with it how long have you had your fissure ? Does it come an go?
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Re: LIS or botox when pregnant?

Postby PreggoAF » 21 Feb 2018, 20:08

Missy Moo, yeah I'd be afraid to do dilation that so soon after Botox too, but that's great that you're going to start it after the fissure closes. I'll definitely let you know how my experience with dilation progresses. Hoping it works for me because nothing else seems to be working right now and I'm being sooooo careful with everything. I've gotten several fissures in different spots ever since after I had my daughter in 2014. I've always managed to heal them with steroid cream and looser BMs and sitz baths and diltiazem with the last one. But this current one is not going anywhere and also coinciding with pregnancy hemorrhoids so things are extra inflamed down there right now. I got this one almost a month ago and it's only gotten worse despite using the diltiazem for a few weeks and being careful to have soft BMs once a day. Coconut oil, olive oil, comfrey, aloe vera, manuka honey- I'm throwing everything at it. So frustrating.
Chronic fissure: January 2018
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Miralax and Magnesium
LIS, tag removal, hems banded: July 2018
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