I feel controlling tear and spasm is like walking on a rope, the slightest mistake can take you back to square one. After lots of trial&error I established myself the rules below. This board is Godsend, many thanks to all board members. This is a puzzle I've put together from things I've learned from other members. Can't believe pooping has now become a discipline. The price I'm paying for totally disrespecting my body for 2 decades long.
DIET
- vegetarian, bread, liquids, paraffin oil twice a day (doctor prescribed). Nothing else.
- dropped flax seeds, making stool too soft. Will reintroduce once I start eating meat again.
- only lost 2-3 kilos
BM
- Bristol 5-6 ensured by diet, every 3-4 days - only way I can function and work. Can't afford 8h pain everyday
- schedule BM to 7-8PM, not to spend the whole day in pain. Hope to fall asleep 2-3AM
- bath 38-39C before BM, relaxes sphincter
- plenty of vaseline before BM, make sure to cover the fissure with a thick layer
- painkiller and anti-spasm pill after BM
- no push, let it flow naturally
- do not open anus completely, that's when tear happens. More here:
http://anal-fissure.org/t6597-how-not-to-tear-vaselinecontraction#88352- if it comes too fast try to slow down by slowly contracting the anus
- getting lots of swelling during BM, but no major pain
- no toilet paper, use shower
- bath right after BM, temp is crucial. 38-39C seems to work best. Cold contracts, hot inflammates
- if pain is great, no ointments after BM, they just irritate more and trigger spasm
- if pain is moderate ointment or anesthetic gel might work, otherwise it just burns more
- lay down after BM, legs up on pillow stack
- if spasm starts kicking in, go back to the bath tub, watch temp
- passing gas seems to break spasm for a while, as it slightly opens the muscle
MEDICATION
- magnesium, 1 pill/day
- painkiller and anti-spasm pill before BM
OINTMENTS (twice a day)
- initially started with a mix of herbal ointments and smashed suppositories (containing Balsam of Peru and Hyaluronic Acid), eventually kept only the one given by the doctor, which I found has the best cooling effect. It contains: oregano, blackberry leaves, blackwort (comfrey), fallkraut and pot marigold
- Manuka honey
- using applicator (thin 1ml syringe), lube with Aloe gel. Try to hit the fissure with the tip of the syringe and release
- release some excess ointment in the rectum as well, it will build up and mix with faeces, keeping them soft. It's OK as long as it's herbal
ANAL MASSAGE
- crucial for relaxing muscle, increasing blood flow to the area and prevent fissure from folding into itself, thus scaring incorrectly (according to my doctor)
- wouldn't work before botox, anus tight and painful
- try to insert the tip of the finger at least
BATH
- twice a day and before/after BM 38-39C
- no salt for me
- initially neglected the importance, but crucial for relaxation and blood flow to the area