Hi everyone,
I'm new here and have been looking around for a few days and really enjoying all the advice and expertise. A lot of the questions I'm going to ask will be no doubt answered or discussed elsewhere on the forum - feel free to redirect me if needed. If you don't want to read my life story feel free to scroll down to my point form questions at the end. Thank you so much! BTW I'm writing from Sydney Australia. Please reach out if you're local and have any advice about the right medical people.
The fissure has been on and off for about a year, but usually went away in a few days and was misdiagnosed as haemorroids by 3 doctors (I first noticed a haemmorhoid/ skin tag a few years ago but don't think I had flare ups until about a year ago). On Christmas eve I had a constipation event after a long road trip and missing a BM for one day. I must have torn it a lot more than usual as the pain has not gone away or subdued much since (over 3 weeks now).
Finally I saw a specialist and got the correct diagnosis of a fissure. I was already using rectogesic (0.2% glyceryl trinitrate) for 10 days which had been advised by one of the doctors as it can work for haemorrhoids too (which I supposedly don't have, but doctor thought I did).
On the day I saw the proctologist I was having my first pretty much pain free day which was amazing. The proctologist decided that the rectogesic must be working and said to keep using it and come back in 2 weeks. That afternoon I went for an ocean swim and I suspect I just spent too long sitting up in the car that day (2 hours total after not sittin gmuch on previous days). Or was it swimming in the ocean and not washing and putting ointment straight back on for a couple of hours? I suspect this was a big mistake. The next day the pain was back, and then to my horror a bit of a constipation with hard BMs followed.
I have eaten a predominantly vegan diet for years (at least 5, before that was vegetarian). Over the last few years I put on 5 kilos, assuming it was age related (early 40s) and deciding to stay body positive I didn't think much of it, but did notice the weight was all at my belly which seems bloated a lot. I had a lot of explosive / too soft BMs (sometimes up to 4 or 5 times a day) for a while too, which eventually went away; the hypothesis was that mental health issues had caused that as I didn't change my diet but the BMs got better formed as I was happier. However, my doctor thinks that the stress of that time caused what was first diagnosed as haemorrhoids to appear in the first place.
Fast forward to now - because of the fissure I wanted to make sure everything would flow through me so I focused on a high fibre diet and even cut out bread and other wheat prodcuts which I feel add a lot of bulk to BMs, bulk which I don't want as it increases the girth! I've been eating cooked beans and lentils, vegetables, salad, fruit, oats, psyllium, chia, dried fruit and some nuts (have since read on this forum lots of ppl cut out nuts)!...basically everything recommended for high fibre diet but without the wheat. Oh and prune joice. Maybe I took it too far, but I couldn't find proper guidelines anywhere and the Proctoligist just said 'everyone's different, it's trial and error'. I know that everyone's systems respond very differently to different foods, but there's no room for error with a fissure. So much pressure!
Meanwhile, I have heard people say you can have too much fibre. This was always in the back of my mind and I've been trying to reserach it in the background. Why, when I was eating so much fibre, all the recommended foods, did I get all blocked up?
2 days ago I also started taking Actilax (lactulose 3.3g to 5 mL) at 15 mL 2ce daily. Finally a soft BM this morning and so far only one (yesterday I think I went 3 times and they were all a bit hard).
Meanwhile, I have done more reserach on the fibre situation and am now pretty convinved that no fibre is the go (I read this clinical trial which was published in 2012, however it hasn't been cited many times since then - only 11, but it makes a compelling case for no fibre diet to releieve constipation https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435786/).
Since I feel sure that we should be able to produce a soft and healthy BM without taking laxitives (and I need a long-term option), I'm convinced that there's a diet that could help with that. Eating mostly vegan, I didn't get constipated often, but did have bloating often and hard BMs sometimes and I just want to clear it all up. Today I have eaten white rice, tuna, an egg and some soy milk. Last night I had a banana smoothie with protein powder (no fibre in).
Here's my list of questions, apart from diet it's all the general care stuff:
- Does anyone have experience with a no fibre/ low fibre diet? Any vegetarians?
- Sitz bath: I was using a big plastic tub and sitting in that but it's not super comfortable. I tried the ones that fit over the toilet and found it horrible for my back, also i read you should soak in magnesium up to the hips and that one is kind of just the arse! Anyone found a comfy way of doing sitz bath? Unfortunately I don't have a full size bath to use.
- Coconut oil. The proctologist said to lay off 'in case it interacts with the Rectogesic' - clearly he doesn't know if it does or not, I would be using them at seperate times throughout the day, so many people found coconut oil beneficial, any opinions on this?
- Rectogesic (GTN) safety: I read a claim on a forum somewhere that this causes thinning of the anal walls which leads to the ultimate worsening of fissures. I could not find any research to back up this claim but that doesn't mean it's not a possibility, has anyone head or know anything about this?
- Tumeric - I also read somewhere to mix tumeric and oil, (they said olive, I went with coconut), put it in the fridge and then apply it at night time. I tried it for the first time last night and it was messy! It may have helped with less pain in the morning (I felt pain free when I got up before BM), and less painful BM, but also the lactulose had kicked in so softer BM also helped. Anyone else triend this? I'll use fresh tumeric next time as the powder doesn't have a good texture even in oil and is so messy! I only put it topically and gently though.
- Evening primrose oil - saw it mentioned a few times and wonder if anyone had success using it as a suppository.
I think that's it for me now! I'm sure there'll be more!
Thanks so much.