hi all...

just want to update everyone and get some thoughts. im so tired.

so ive been dealing w this thing off and on since may. may was the worst, until i got nitroglycerine in june and since then have been on it - today marks 6 weeks. nitro has healed the external part of the fissure (according to my crs) but not the internal - which is still there and painful after tough BMs and sometimes just normally - a burning kind of pain.

miralax helped me keep things softish but i really wanted to wean myself off so i learned how to do normal BMs again, and bc it was making my gut HURT - so bloated and gassy and the stools were so loose. unfortunately i think i messed something up in my flora bc after 5-6 days of not being on it, i now feel a little constipated - or im straining to go. i tried magnesium citrate last night (natural calm) and it made my morning poop really large and sticky rather than soft. i ended up straining to get it all out and tho my fissure hurts now, i did not see any blood in the wipe thank goodness. anyway, im terrified now of figuring out the right solution to poop soft again...do i start miralax once more or tough this out? my diet is the exact same it has been for weeks before this became a problem and i drink 3.5 liters of water!

i saw my third opinion crs today (after seeing a GI specialist who prescribed nitro but didnt give me any details about my fissure, then seeing a CRS who didnt do much of an exam and said he only saw an external fissure and a sentinel pile) and he was a lot more holistic in his approach. he did a digital exam - i know patienceandhealing has said there's no reason for them to do this, but i really needed an understanding of the internal landscape - and he said my sphincter was really tight, that he didn't see any evidence of an external fissure and thinks it must have healed while the internal part is still active, and that he suspects my problem isn't diet but how tight my butt is. he also said i wasnt necessarily constipated so much as my inner sphincter is not properly relaxing to let me go.

i guess my question is - now what? where do i go from here? is it diet? supplements? PT? how do we lower the resting pressure? how do i relax? breathing exercises do NOT help when you can feel poop weighing heavily in ur rectum but its not coming out.

im so sad. i feel so scared about how to fix this. he said i need to relax - that i'm obviously partway healing and that's huge. but the GI issues (bloating, only going 1x a day versus my normal 2-3) have really stressed me out.

guess i just want some empathy and thoughts. thanks all.

Hi there! I would say go back to miralax if it was working for you to get things moving and help you go. That feeling of not emptying is awful!
I had to stop miralax because i was using it for too many years and it stopped working the same for me. I’m using colace now and realizing that I very well may be lactose intolerant.
So for yourself, definitely tweak your diet and see if it helps to rid of that “full” feeling. Don’t push at all! That’s something really challenging for me when I feel like I need to go but it won’t come out.
I’ve been dealing with fissure pain for 8 years. I do go through times where I feel great and normal… but I get so comfortable , I stop my routines.
Sorry to mention this, however, one for sure pattern I’ve picked up on through the years is self pleasure. If I am masterbating and have an orgasm, my anus has full on spasms and it gets super tight. It’s bad. And usually a couple days later, sure enough I get a fissure. It’s so weird. And I came to terms with the fact that I can no longer orgasm unless I want a fissure.
Honestly, I’m just as sad and down as you right now. Key is finding what works best, sticking to it, and not getting comfortable or else we risk the relaps.
Heating pad on my bum helps it relax. Lessens the amount of sitz baths I take. Maybe try that? Good luck. I’m sorry.