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Question about bleeders

Postby P4inintheb4ckside » 14 Jul 2015, 18:19

Hi folks, brand new on here, so go easy!

I've had an anal fissure pretty much my entire adult life.

Didn't realise I had one till I self-diagnosed then the doctor confirmed it.

Initially got prescribed diltiazem, then it turned into Glycerol.

It's been kinda on and off these past 5 years, sometimes I could go a few weeks without any blood or major pain, other times it would hurt near enough every time and bleed too.

Generally I find that the pain isn't overly unbearable - it's the blood that plagues me. This year overall the fissure hasn't been that bad but recently I had major stress and the fissure got ruptured (I literally sat on the pan, pushed slightly and only blood came out - no pain at all), and blood reappeared. That was Saturday.

Like I say, the pain isn't excruciating but seeing blood and feeling it soaking up your tissue paper is just the most disheartening thing ever and I would love to see an end to this.

This evening I decided to take ages - let the stool come out slowly and no pressure. And half of it did indeed come out without much pain, and no blood. Unfortunately the rest required a little push and when I felt the pain I knew the blood was coming.

Only this was a total downpour - worst I've ever seen.

I can't have surgery as there is genetic history of problems with it (bowel, gastric and digestive) in my family (I also have a massive anxiety disorder so hospital isn't really an option), so I am left trying something topical - the glycerol is hit and miss.

However, my main question is this:

I am seeing a lot of good reports about coconut oil, and using suppositories in the anal canal after a bowel movement.

Problem is, how do I do ANYTHING, apply ANYTHING after a bowel movement when blood is pouring all over the place?!

If my fissure is open again, and blood is coming out, sliding a suppository up there isn't really viable.

But then, IS coconut oil my best bet? What about Yunnan Baiyao? And I read on here an Indian vegetable called Suran?

I've had this problem so long - the pain is, if not minimal, not gigantic - it's the blood that dispirits me.

Absolutely appreciate any advice you guys have. I'm not sure I trust doctors any more with this.

I also forgot to add: how can I apply ANY solution when my anal fissure is so sensitive that merely applying a topical treatment can in itself cause my anus to bleed too? Quite often I'm trying to apply glycerol (not near any BM) and my anus just starts bleeding again. Thoughts?
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Re: Question about bleeders

Postby hurtinend » 14 Jul 2015, 20:18

How much blood? Drips and some on toilet paper is no big deal but it sounds like you are bleeding a lot.

I think you need a more thorough check to make sure nothing else is going on.
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Re: Question about bleeders

Postby Scientist2516 » 14 Jul 2015, 22:15

I agree. Bleeding a lot, with minimal pain, doesn't sound like a typical fissure. I would see a specialist. I don't know whether a gastroenterologist or a colorectal surgeon would be better.
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: Question about bleeders

Postby msimon » 14 Jul 2015, 22:34

I also think this sounds like you really need to be evaluated by a Doctor (a specialist). Fissures don't usually bleed so much with little pain.
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: Question about bleeders

Postby owmybum » 15 Jul 2015, 03:43

It may be internal hemrhoids. I bled ALOT when mine flared up, and the pain was nothing compared to a fissure. I too used to strain on the toilet most of my adult life.
I agree with the others... This much blood can't be ignored, you have to be checked out by a colorectal specialist. Please try to put aside your anxieties and get seen soon.

OMB x
fissure after hem banding and tag removal feb 11
Pelvic floor therapy
Diltiazem
Botox June 13
Nitro
Internal flap July 14
EUA and polyps removed Nov 14
Diagnosed with neuropathy Jan 15
Diagnosed with HS EDS type 3 (causes poor wound healing )
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Re: Question about bleeders

Postby P4inintheb4ckside » 15 Jul 2015, 05:16

Thanks for the replies.

I may have downplayed the pain a bit. It feels like razors - it's just that I'm so used to it anyway that I played down how sore it is.

It is sore, not always excruciating, depending on the size and consistency of the stool but it hurts. A lot.

Put it this way, if it's a softer smaller one, like I just had, it makes me wince and I have to adjust myself to deal with the pain. If it's a bigger harder one I can literally feel the fissure being torn as it comes out.

The internal haemorrhoids suggestion sounds quite plausible - add that to a fissure and it would account for a lot. And make me very lucky indeed (!)

As for this being more serious, I have already had it diagnosed by a doctor - it IS a fissure, and quite a severe one.

So, on the basis of what I'm saying, what are the topical options?
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Re: Question about bleeders

Postby Scientist2516 » 15 Jul 2015, 12:22

You've had the fissure pretty much your entire adult life and not been able to heal it. You tried diltiazem - have you tried nifedipine or nitroglycerine? I'm a big believer (from my own experience) in different medications working differently in different people. So, nifedipine did nothing for me, but both dilt. and nitro helped a lot. I would definitely try a few weeks of one of these drugs and if it doesn't help, try another, as they are the only ones known to cure an anal fissure.

If your bleeding is so bad that you can't apply the cream at BM time, put it on at a different time, not right before or after a BM. Don't put the cream up inside. It is absorbed through the skin, so just put it on the external anus.

Try heat. Either a sitz bath or a full-body bath, or a hot water bottle or heat pad. It's another way to increase blood supply to the anus and relax the internal sphincter. The advantage of a heat pad or HWB is that you can sit on it for hours, even at work. That's what I did. Just don't make it too hot, as that can set off spasms. You are aiming for a soothing heat.

If you are bleeding a lot, maybe your skin is thin or your tissue fragile. There are genetic conditions that cause this, or it could just be temporary. In any case, you could try an oestrogen supplement, eg Estrace. According to my OB-gyn (a man) small amounts applied topically are OK for men and women. But your doctor may not agree to prescribe it, and truthfully it may not help. It helped me, I think, but it's far from a standard treatment for AF.

If you can't lubricate from the outside, try lubricating from the inside. I personally found that Kondremul mineral oil made my stools beautifully soft and easy to pass. It's an emulsion, mixes well with stool and actually tastes pretty good. Unlike coconut or olive oil, it's not absorbed by the digestive tract so makes it all the way to your anus. Don't take it last thing at night or before you lie down (you don't want to inhale it from your throat into your lungs). Otherwise I found it completely safe and benign, and I was using it for months. Also, it's not habit forming. I was able to stop taking it with no problems.

I do still think you should see a CRS about the bleeding. You say you've seen a doctor, but do you mean a specialist, or just a GP? It doesn't sound as though what the doctor presribed has actually helped, and I don't know about glycerol - never heard of that being used by anyone else here. I would see somebody who really specializes in fissures if you haven't already.

I hope this helps. I know how difficult this is (we all do, on this forum). I'm one of the lucky ones who healed, but I did a lot of reading and research and trying different things before I succeeded. Sometimes that's what it takes.
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: Question about bleeders

Postby P4inintheb4ckside » 15 Jul 2015, 18:10

Lots of information there, all of it valuable. Thank you.

My first port of call will be to give the coconut oil a shot, and if I don't get success from that, nitroglycerin will be the next shout, so thank you for that suggestion.

The Kondremul suggestion is also a very interesting one - I tried a laxative the GP prescribed, but it actually constipated me! I'm not sure where I'd find Kondremul here in the UK though, but a decent laxative would certainly help. Any equivalents I could get here?

How much time from the beginning of successful treatment did it actually take to fully get healed?
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Re: Question about bleeders

Postby Scientist2516 » 15 Jul 2015, 19:15

Oh, if you are in the UK it might be difficult to get hold of any mineral oil laxative. A chemist in England told me that they aren't allowed to sell it because it's supposed to be unhealthy. I live in the US and I got Kondremul from Amazon.
Most people here use miralax - I think it's called movicol in the UK. I never tried it, but most people swear by it.

How long from the beginning of successful treatment to fully healed - well over a year, but don't be discouraged. After healing started it was never as bad. I mean, no nights in agony, no glass-stabs when pooing, etc. There was still pain, but it got less and less bad and less and less frequent. I won't lie, it was very discouraging every time the pain came back. I just tried to take the long view, and realise that each month was better than the one before. I really felt I had my life back around the 4th month or so of successful treatment.

You can read the whole thing here :roll: :
a-one-person-experiment-on-af-drugs-t7231.html
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: Question about bleeders

Postby P4inintheb4ckside » 16 Jul 2015, 05:33

Thanks for all that again.

I also don't think I can get Nitroglycerin here either. I also mispelled what I'm currently using:

Glyceryl Trinitrate.

A year eh? No big deal, I've had it for 10+ - what can another year hurt?
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