Been reading for a while and want to introduce myself - I've typed this and lost it about four times in the last month now (thanks to my cookie free rowser I guess)!

As I'm sure you know AF can be quite an isolating thing to deal with so I would be really grateful for any replies, even if just a wave hello. Feel free to skip to end of my long post if you have the spoons to answer some questions on what helps!

TLDR: Fissure and doing IVF. Spasm mainly gone but not healing and stinging. Polyp and surgery referral. Can't work as all day is pain management. Would like some advice.

Here's my history:
End of Jan GP appointment 1 - telephone appt., suspectes hemorrhoids so prescribed Proctosedyl. Also given helpful advice on increasing fibre in diet and getting a squatting footstool.

Week later GP visit 2: BMs had become softer but still in incredible pain for hours afterwards. Had a digital exam, suspected thromobosed hemorrhoid and the doctor fought my corner to get me a surgical assessment at the hospital next day.

SAU hospital appt: Saw doctor then consultant which meant two more digital examinations (yes, very painful). They found a benign polyp and suspected fissure based on how much pain I was presenting with. Prescribed Dilatezem.

I am having IVF treatment at the moment so medication and treatment is tricky. I have been referred to surgery to remove the polyp and possibly botox, but if I conceive then obviously can't go under anesthesia or have the op so will have to loose my waiting list place and be re-referred after. So non surgical is the route I need to focus on anyway.

GP appt 3: Hospital pharmacy told me Dilatezem wouldn't come for 4 to 6 weeks and to go back to GP. Prescribed Sheriproct. Seemed to cause more pain so stopped using.

Dilatezem finally arrived ten days ago. Seems to be helping - spasm has mostly stopped although there's still a lot of stinging pain which is quite debilitating.

I am getting through the day by having baths or sitzs baths, doing some diaphragmatic breathing and pelvic physio videos (Dr Bri mainly and used Michelle Kenway videos on how not to strain). Heat pad or hot water bottle essential. Doing heat and sitz a bit less since using the Dilatezem, as overall a lot of moisture and I have a sense that is making the stinging worse, as well as seeing a visible exterior cut which I didn't want to irritate.

I am on a high fibre diet and trying to remember to drink at least 2 litres fluids. Any less and I get set back, this seems regardless of how much fibre I had. Prune juice helps but not sure I should have everyday.

On Asprin as part of IVF, understand this might limit the wound healing (IVF is the priority) but also feel it helped lessen the spasm. (Please talk to your doctor before grabbing a pack of Asprin though - it is a medication with lots of side effects). I also use a rinsing pot with tepid water to wash before wiping with witch Hazel wipes. Have to put the polyp back which was painful and then actually caused me to have panic attacks - have worked hard on the pelvic physio to make this manageable but I do feel it's preventing the fissure from healing.

Have felt I am healing slowly, but then get set back. I am hoping to get pregnant and also to find a job before I need to go on maternity, so really want to heal! Apart from mild constipation the main setbacks have been if I have a BM first thing in the morning before I had my Asprin and used some vaseline.

My quality of life is pretty poor as all I can do with my day is very gentle yoga or sitting on something warm. Walking the dog is a highlight and some exercise. I can't imagine being able to get out the house and onto public transport in order to get to work (I don't drive), unless I somehow only had BMs in the evening.

Thanks is you read this long post!

Some questions if you can help:

I would really love to know how you manage to work if you're still needing lots of pain management.

What kind of exercise do you find helps without making things worse? (Many yoga poses are not suitable for me now).

And how you manage any stinging / burning pain? Nothing topical seems to help, ice sometimes but hard to get right.

Hi there. Sorry that you haven't had any replies yet. It's been a while since you posted this. Has the pain improved since then?

Thanks for your reply!

I am making some progress and generally in less pain. According to the app I use to record my symptoms it's nearly 40% better than in January when things started.

Diltiazem, Macrogol, lots of water, fibre in diet and some YouTube pelvic floor physio are the things I stuck with. Cut out sitz and most creams as just seemed to cause stinging.

Heat is my main pain relief, along with some paracetamol. I try to do gentle yoga soon after a BM so the spasm can't set in. I was on Asprin for the ivf - have stopped that in the last couple of days so will see how that goes.

Pain is greatly reduced, feels like the spasm is managed, and I am managing to do some things with my afternoons and evenings now. I don't get the feeling the fissure itself is healing though, so still waiting on the surgical appointment.

Thought an update might be helpful.

Probably the fissure has healed, experiencing almost no pain and certainly none of the severe spasm I had back in February.

My prescription medication was Diltiazem and macrogol. Worked slow but likelihood is it was this and time that helped the most.

I also eat a high/er fibre diet - I am a lifelong vegetarian so wasn't a huge change for me, just dropping some of the non- wholemeal carbs for wholemeal and upping veg. Getting the soluble/insoluble balance is tricky. I've been able to eat a bit more freely recently (ie. Have a pizza! Occasionally) and use Movicol. At one point I only ate soft vegetables (for me this meant peas, Brocolli, edamame beans. Cooked carrots) for a couple of days that seemed to give healing a head start.
Also, fully aware there are advocates for a low fibre diet here. Carnivore diet is not culturally or morally a good fit for all of us and there is plenty of space elsewhere here to share your research and thoughts on that. I have healed with my diet, which most days includes 20-30g of fibre.

Otherwise I used a squatting stool, perineal bottles to rinse. Cold water helped me more in the end. Heat afterwards helped a lot, a heat pad or hot water bottle.

I worked hard at pelvic floor physio and just relaxation in general - Dr Bri has some videos on YouTube that I found helpful. Getting over the psychological hurdle of the pain cycle was important for me.

I found taking pain relief ASAP or prior to a BM helped, and doing some physical activity soon after. I think this is the same as menstrual cramps for me, if they 'set in' they are so much worse so preventative pain relief and exercise helps.

Recently started using a little aloe gel too. Can't say if it helped as I was already feeling better, but didn't seem to do me any harm. Also helpful to moisten toilet paper with.

Still have a polyp and waiting for surgery for that but just so happy not to be in pain all day.

Thank you so much for your update, it is so encouraging to know someone has healed! Im Still trying to heal and appreciate these posts so much. I hope you will continue to stay healed and that your IVF journey is much smoother now that the pain is gone.