Evening water bulb enemas & manual dilation worked for me

What worked for me to conquer the chronic fissure without surgery

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Evening water bulb enemas & manual dilation worked for me

Postby bungholio » 19 Aug 2018, 09:29

Disclaimer: I'm sure everyone has somewhat unique physiology and other circumstances when dealing with fissures. What worked for me, may not work for others. However, I believe things that ultimately worked for me were simple enough that I can see them work for at least some other people or they can provide them with at least more sample points to consider their options.

What worked for me consistently:

1) Using enema bulb every evening with regular clean water and lubrication

What I used:
Enema Bulb
: https://www.amazon.com/dp/B078S3C5S2
Lube Shooter: https://www.amazon.com/dp/B008ASBIU0
Water based lube w/o additives: https://www.amazon.com/dp/B0161J28AI

I noticed that using a Enema Bulb with regular tap water EVERY day before sleep WITH lubrication (using lube shooter) to avoid any insertion injury or pain makes the next morning stool very consistently soft for me regardless of my diet (even if I drank alcohol and ate chips). It was by far the most effective method for me in controlling softness. I've tried vs Colace, Miralax etc.
My theory is that if you do not empty bowel before you sleep no matter how little there is, the matter that is already down there dries up while you sleep forming into a denser dryer mass. I never noticed any habit forming and always had normal stool in the morning afterwards. I tried to find information about using bulb enema's with regular water to just quickly clean out the bottom of the colon, and didn't see much concern unless you use actual laxative formulas (i.e. fleets).

Process:
Load lube shooter with lube. Carefully inject its contents into rectum subject to tolerance. Ideally inserting it a little bit to make the lube goes in. Fill the bulb enema with comfortable temperature clean water and slide it in carefully. Squeeze it gradually to empty it in. Wait about 30 seconds at minimum and go and let it go. Water and lube should in theory help reduce any irritation you may have there. (This gets much better over time as things continue to heal)

The method above really worked well for me, but it did require a loyal daily application. At one point I slipped and skipped one evening and immediately got a bloody re-tear the next morning. This taught me two things - the method really works for me, and that I want to see what else I can do to remove this daily dependence. This inspired me to focus on another thing that worked wonders early on but what I did not do consistently. The dilation I describe below allowed me to stop doing the water bulb enemas daily and I only now do them after days when I eat and drink a lot and suspect problem may come.

2) Manual dilation to decrease the tension and increase the "throughput"

What I used:
Vibrating dilator set: https://www.amazon.com/dp/B074BCFB8J
Silicone based lube: https://www.amazon.com/dp/B003CP153Q
Cheap non-lubricated condoms: https://www.amazon.com/dp/B0078OZBKA/

I've read on this very forum first time about benefits of dilation and it made theoretical sense. The key problem here is the "cold start" that is to start with it when you are already very tight and in pain. I first tried this method after I struggled with combined thrombosed hemorrhoid AND chronic fissure for about 6 months and almost gave up on non-surgical options (tried nifedipine, diets, creams etc).

At first I also used same water based lube as mentioned above. It was not messy since it was water based but I also found it didn't work quite as well as silicon based one.

I found that vibration was helping with insertion better than those that don't. I also found the sizing to be pretty good. I felt that the smallest size was not much larger than a finger, so a good strategy for me was to start with my own finger (covered in latex and with lube ofcourse). I bought super cheap non-lubricated condoms to put on the dilators to ensure both cleanliness and eliminate any scratching from surface imperfections on the dilator.

For me personally the path was: Start with your own finger and just gradually work your way up. After a week of doing this every day I worked up to the largest size of the dilator set. It looked crazy large when I first bought the set, but body can do magic sometimes. Key is to take it slow and try to do it when you are least irritated down there. For example, if you just had a re-tear, try to first manage it with diet and let it calm down. Some mild discomfort is OK, but everyone's physiology is different. I read somewhat that some people use lidocaine - I did not. I felt it was better to feel what you are doing down there to avoid making more damage.

To maintain the tension I now use the dilator every 3 days before sleep and don't pay much attention to my diet anymore with regards to the fissure. I always start with small and work up to large for about 20-30 minutes, then wash it all out with a soapy enema bulb due to usage of the silicone based lube. I still do use the regular water bulb enema on days I can tell things can get too dry.

My general finding is that chronic fissure underlying issue may never quite go away without at least some maintenance. I can feel that the surface/tissue is forever different down there. I do think that having a process that keeps things in check helps not only to keep the fissures at bay but also mitigates other potential things that can always otherwise flare up down there.

Hope this helps at least some folks. Keep fighting!
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Re: Evening water bulb enemas & manual dilation worked for m

Postby TomatoSoup » 19 Aug 2018, 17:28

Very interesting. Thanks for sharing. Everyone's path to healing seems to be different and we're all our own lab rats :)

I was curious what age range and gender you are?

I'm a 36 yr old male who just joined to post my LIS surgery recovery experience. It's up in that section of the forum. Going really well.

I just wanted to pass along that what worked for me in terms of overall rectal health. I tried something from an eccentric health blog that sounded crazy at first. The rule was: Do not eat until you've had a bowel movement and drink water until you have a bowel movement. It's worked like a charm for my digestive health and like you I also had great easy bathroom trips regardless of my diet. I've seen some folks call it "Water Therapy." I'm hooked. Just wanted to pass it along in case anyone wants to try an alternative to the enema therapy. Both require a bit of daily ritual, it's just a matter of finding what fits your life.

Glad this combo is working for you.
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Re: Evening water bulb enemas & manual dilation worked for m

Postby Deleted User 7275 » 20 Aug 2018, 13:32

Great posts tomato. I noticed you said no stool softerns anymore, what is your diet like?
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Re: Evening water bulb enemas & manual dilation worked for m

Postby bungholio » 21 Aug 2018, 07:26

Tomato, 36 male here. Great that LIS worked well for you. I was too worried about potential complications that I know are rare, but I wanted to exhaust other possible options first.

The rule you mention with eating/drinking seems interesting, but I suspect its tricky for compliance. If I go out with friends to a restaurant, I would then need to make sure I had a bowel movement. Then I may end up pushing which is not great as we all know. I try to only go when I know I won't have to push.

My goal was to find something that worked for me without imposing constraints. For past two months, dilation twice a week and an occasional bulb enema is all I do. No re-tears and no sensitivity of any kind while having bowel movement or sitting for too long (which I do a lot of due to my occupation).
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Re: Evening water bulb enemas & manual dilation worked for m

Postby TomatoSoup » 21 Aug 2018, 10:33

Sorry, I should've clarified. I meant "Don't eat until you've had a bowel movement THAT DAY." This is just a morning routine and then I go about my normal business. I've been into intermittent fasting so this fits my life well. I just spend the first hour of my day reading and drinking water until I feel the call to head to the bathroom. It almost always results in a fantastic expel.

Then I feel light, hydrated, and ready to start the day.

I could see how impractical it would sound if you had to have a BM before EVERY meal. Nope, just the first one of the day. This water therapy also seems to aid in digestion because I can eat practically anything without fear for the past year.
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Re: Evening water bulb enemas & manual dilation worked for m

Postby TomatoSoup » 19 Oct 2018, 23:22

Hey how are things going for you?

I'm back to the forum 64 days postop since I'm still having issues. No pain, but still seeing the occasional drop or two of blood in the bowl. I'm very nervous about retearing the fissure. Still dreaming of a healthy anus. I can't lie, when I see a porn with anal sex in it I'm thinking "How in the world do they not all have fissures?!!!"

I'm interested in using a vibrator anally, but am also very afraid to insert anything. I've been applying nifedipine with a gloved finger and am so nervous to insert it. I'm also not a newbie to this. Over the last few years I incorporated fingers and anal toys into masturbation but had to lay off that due to the fissure for the last year. Honestly I miss it.

However, I mentioned that stuff to my surgeon and he was pretty opinionated about avoiding anything like that while healing from a fissure. I couldn't tell if he was anti-anal sex stuff but I was like "ok nothing goes in there I promise." Now I'm two months postop and starting to wonder if I'll get a full recovery so i'm thinking about alternative treatments.

On that note, shouldn't a healthy anus be able to have a lubed finger inserted? Isn't that what proctologists do at every visit?
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Re: Evening water bulb enemas & manual dilation worked for m

Postby bungholio » 24 Oct 2018, 07:09

Hey, things are going great, but I did make a some adjustments. I stopped with the dilation as I felt it required too frequent application and chasing the larger diameter was sometimes bringing in slight sensitivity. I also felt that it created enough elasticity and that occasional thick stool was no longer as dangerous. I still think its a great way to gain some plasticity and reduce the pressure, but I noticed that what really really works well for me is just the daily routine of fleet enema with water and lube.

What I'm specifically doing is using the lube shooter that I mentioned above to gently insert it and inject the water-based non-scented lube and to rotate it a bit there kind of like finger to decrease the tone a bit. It becomes like a small dilation (the shooter is MUCH smaller than the dilators I've used otherwise). I've found a new bulb enema on amazon that has a soft one-way applicator, that I use right after with water. I give it a few minutes and let whatever is there to come out. Given that I've dilated it a little bit with the lube shooter and injected lube, and injected water, things come out relatively easily regardless of thickness. In the morning I have regular stool and I have never seen it get dry/thick following this evening procedure.

In other words, I've been super consistent in doing the above every single night and I have not had any hard stool or sensitivity of other problem for some months now. I don't constrain my diet much - nuts, pizzas, pasta, bread, rice, alcohol etc. This would have been insane to me say six months ago.

P.S. I would imagine those who have anal sex, do get fissures if they don't lubricate and don't go carefully. At the same time, something tells me that due to more relaxed tone they may experience overall less issues passing stool. Although you probably also don't want to go nuts here as the tone can be overly relaxed and then issues of incontinence can creep up.
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