Hi again,

So I'm still dealing with one or more very nasty fissures. It's been about 2 months, and the pain has only increased. It got to the point where I had to go to emergency, and was prescribed morphine for the pain. It is helping enough that I can get through the day without throwing up from the pain, but it's still terrible.

I'm having the most trouble getting my bowel movements to be smaller in volume. My sphincter is VERY tight. I have soft stools but they are basically just a very large mess, not formed, and very hard to pass completely. Also, in the morning, I just have to go and go, and this is very irritating on the fissures.

Any advice on how to get my stools smaller and less frequent/less at once?

Thanks

More questions after doing some research...

My whole pelvic region is in a constant ache, and the burning stabbing anal spasms NEVER let up. When I try and have a bm, it is next to impossible whether the stool is soft or formed. I thought perhaps this was just because of sphincter spasm - but now I believe it may be due to spasm of the puborectalis muscle as well, after reading the following:


"PARADOXICAL (NON-RELAXING) PUBORECTALIS SYNDROME:

WHAT IS PARADOXICAL (NON-RELAXING) PUBORECTALIS SYNDROME?

The puborectalis muscle is a muscular sling that wraps around the lower rectum as it passes through the pelvic floor. It serves an important role in helping to maintain fecal continence and also has an important function during the act of having a bowel movement. At “rest,” the puborectalis is contracted and pulls the rectum forward; creating a sharp angle in the rectum that helps to prevent passive leakage of stool. During the normal process of defecation, as one bears down to pass stool, the puborectalis reflexively relaxes and straightens out, allowing stool to pass more easily through the rectum into the anal canal. Paradoxical puborectalis syndrome occurs when the muscle does not relax when one bears down to pass stool. In some cases, it actually contracts harder, creating an even sharper angle in the rectum, resulting in difficulty emptying the rectum, a term sometimes referred to as obstructed defecation. Patients often complain of the sensation of “pushing against a closed door”. Often, there is a history of needing to use an enema to have a bowel movement. Generally, there is no associated rectal pain or discomfort, which helps distinguish it from other pelvic floor syndromes. The exact cause is unclear, but it is thought to be due to a combination of factors that may include improper functioning of the nerves and/or muscles of the pelvic floor. Psychological mechanisms may also play a role."


Obviously in my case it's not "paradoxical" - the spasms are caused by fissure pain.

So - with this in mind, any additional advice on how to have a smooth bowel movement? I think I'm going to have to use an enema for it to go smoothly. I HAVE tried squatting and it so far has not made things easier for me.