Fissure gone, fissure back, CRS' advice helps but hurts

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Fissure gone, fissure back, CRS' advice helps but hurts

Postby healthybutt » 06 Dec 2016, 19:36

Hi everyone,

I've been reading on here for the past 6 months when my fissure wouldnt heal, and I didnt quite understand why, as they had always healed within a couple days in the past. I tried a bunch of things, but after a few weeks found that Magnesium (Mg) was the best, although occasionally it would result in 3-4 trips to the bathroom the next day...but at least it didnt hurt. Constipation has never been my problem, but hard stools resulting from lack of water and possibly lack of fiber and overdoses of stress.

Like many of you, you feel healed after a few weeks, start to get complacent, then BAM. Fissure returns. I finally decided to go see a CRS and got nitroglcyerin ointment. He told me to ease off the Mg and add fiber (psyllium). This was the interesting thing he told me. He said that if I continued having runny poops on the Magnesium, my sphincter muscle (cant remember which) will not be able to expand as much as it had before -- I guess it begins to atrophy. He said adding fiber would help restore the muscle's function and so once I was healed, I'd be able to pass normal BMs once again without tears -- whereas if I constantly used Mg and then stopped suddenly, I would probably get a tear because my muscle wouldnt be able to expand to handle it (he did a nice demo of the spincter muscles and anal canal by opening and closing his fists). He said I could slowly add fiber and wean myself off Mg (I was taking 1000 mg/day at this point)...and he said my sphincter muscle wasnt "that bad" and not something he would consider requiring surgical. My fissure had almost healed at this point and I wasnt in pain, so I felt pretty good and relieved after seeing the CRS finally. (Word of advice: Go see a CRS. I wish I had done this back in the trial and error phase in the first few weeks). I felt I didnt even need the ointment at this point, and used it only for a couple days then went about my pain free way for 3 weeks.

I followed the CRS' advice, afraid that I would always need a huge dose of Mg and possibly loose stools for the rest of my life if I didnt add more bulk to my stool. Added only about 1 tsp of metamucil a day first, then 1 tsp in the morning and 1 in the pm. I eventually got down to about 500 mg Mg a day with the fiber and was impressed by my poops, the way only people with a fissure can look triumphantly at their poop when they have a pain-free BM.

But one day I upped my fiber content (at this point i had used up my metamucil and switched to psyllium pills from Costco, so I was taking about 9 g of fiber pills a day (half in am and half in pm)) and didnt drink enough water. I got complacent and even drank coffee that day. I took Mg as usual, but I think the culprit was not drinking enough water. It wasnt a full blown pass out from the pain kind of tears I'd had earlier this year, but it was enough for some blood and panic. I kept up my fiber regimen and stepped up my Mg again, and even added a dose of good old miralax just for the hell of it. Started using the ointment again, too. Headaches :(

The 2nd day of the recurring fissure -- again another bulky poop to start with (it wasnt overly hard, but not soft and clean like the days of yore), followed by the deluge resulting from the Miralax and Magnesium...they dont call it "the runs" for nothing! I had a lot of water the previous day along with the Mg and Mlax, so I was outraged on top of my pain that my poops were still well formed initially, perhaps the dreaded initial firmer plug that some people get (it was real, not just because my sphincter was tight). Fine then, I took 1500 Mg, determined to really make things soft and loose (I gave the miralax a break this time. Also noteworthy -- my CRS said it is fine to take Miralax daily everyday for those worried about that). I did a sitz bath, continued w/ ointment, drank water, about 8 g of fiber, lots of fruits and veggies...

So this morning was expecting nothing short of Niagara, only to have another relatively bulky difficult passage resulting in minor pain, which I think I lessened considerably by assuming a semi-squatting position and vigorously jiggling my ass cheek and kind of moving my pelvis back and forth while still seated in a semi-squat -- yeah it sounds weird, but I think it helped and also it was a nice little 2 min cardio workout to keep a steady jiggle, almost like i was trying to push it along with my ass cheek. Then after I got to work, the waterypoopworks turned on from all the Mg, but even that poop seemed firmer and bigger than usual.

My only conclusion is that I was taking too much fiber. I generally eat healthy but go on occasional cheese binges, which also happened the day before the fissure returned. Perhaps I added too much bulk too fast. So whenm your CRS tells you to add fiber, dont go nutso with it like I started to do after 2-3 weeks. Especially if you already eat a decent amount (altho I think I probably dont come close to eating the recommended daily dose even tho I have a few servings of veggies/fruits a day usually).

Anyway, so I'm back on the path towards healing -- nitroglycerin cream, Mg, maybe Miralax if things get dicey, sitz baths, hot water bottles on my bum at night, and after reading here again am gonna try to lube the area before a BM with vaseline to see if that helps while the wound is healing. I am only taking 3 g psyllium a day now, as I dont want to risk the bulks. I am meeting with a naturopathic doctor in 4 days regarding this, too, since the CRS cant really help with nutritional advice and am wondering if there is some way to speed up healing with diet and even acupuncture? Havent looked into it, but thats the ND's job!

Best of luck to all of you and happy holidays. <3
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Re: Fissure gone, fissure back, CRS' advice helps but hurts

Postby GilmoreGirl » 06 Dec 2016, 22:15

Hey there - sorry to hear you're having a tough time!

Maybe eating smaller meals (or more nutritionally dense meals) while continuing to take your fibre would help keep things a little more manageable for your pain at the moment. For instance, instead of a large salad and a burger, maybe a smoothie with fruit, psyllium, and some protein with some toast and pb? Just an idea - I think that has helped me, and allowed me to eat a little less while minimizing weight loss.

Regarding the magnesium - I've been looking into this because I continue to have muscle spasms despite both my fissures being healed. I've read that magnesium can help relieve muscle spasm - but like you describe I've been nervous to take it because it may cause diarrhea (and I already have ibs). I've looked into trying a topical magnesium oil or spray to use at the site, have you ever tried that?

Hope that you get some relief soon
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Re: Fissure gone, fissure back, CRS' advice helps but hurts

Postby healthybutt » 07 Dec 2016, 13:59

Thanks Gilmore Girl!

I like your idea of eating smaller meals -- in fact in the trial and error days I skipped dinner for a week to see if that helped (it didnt, but that was before I tried fiber supplements, miralax or magnesium). Since this latest recurrence, I have been eating more smoothies and more soups since it happened, which i tend to eat small portions of, and I do think it has helped. I think all the extra fiber from the smoothies and soups with my fiber supplement might have been too much, though -- because my soups are veggies with tofu and smoothies are various fruits and kale.

Yesterday I went back down to about 3 g fiber/day, drank a cup of water every hour (excessive as I had to also go #1 every hour too, but wasnt going to take ANY chances), ate my healthy soup and smoothie, and this morning was pain free! YAY! without feeling like I'd fought a battle. I also did 2 sitz baths yesterday, and when I had to put the nitro ointment on after the 2nd one, things felt more relaxed back there, and stayed that way when I inserted vaseline before my BM this morning -- I think that was a huge help, too. I felt actually relaxed this morning using the toilet knowing that I had done all these things and that it shouldnt hurt, and it didnt!

I have not heard of topical magnesium oil or spray, and I've read up on the magnesium threads here and dont recall seeing those. How good is Mg absorption transdermally (as opposed to orally)? That might be something to think about too and discuss with doctor? As I get thru this phase of the fissure I am fine with taking my 1000 mg dose of Mg a day, but after a month I'd like to not have to do that (and my CRS also thought the same). Also, it seems that the loose watery stools I used to get with Mg are being balanced out with my fiber intake -- this morning I had 2 BMs, both pain free, but it wasnt the superfund sites I had got used to from the high doses of Mg. It was still soft, like soft serve ice cream or froyo that has begun to melt a little (gross i know because i LOVE ice cream). I'm going to see an ND this weekend and will ask her all about Mg, including topical Mg oil and will report back.

(As an aside form my previous post -- dairy probably isnt the culprit...I ate something yesterday that my lactose intolerant friend used to eat, so I assumed it had no dairy, but I am pretty sure it had cream in it. Maybe it was my lactose intolerant friend's one exception because it was a very good pastry. However going to stay away from dairy till I discuss diet with the ND this weekend. )

Thanks again and have a lovely day :)
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Re: Fissure gone, fissure back, CRS' advice helps but hurts

Postby Mypoorbutt » 07 Dec 2016, 14:21

Hi GG and HB,
You can have magnesium flake baths so you can pop it in your sitz baths. I did ask a mag group about transdermal spray as I use it on my nan for her arthritis....they said yes but as my fissures were active and very open it would probably sting like heck....so I have never tried.
I don't do the mag baths as I have really low blood pressure and the mag can make me a little dizzy along with the hot water.
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Re: Fissure gone, fissure back, CRS' advice helps but hurts

Postby healthybutt » 07 Dec 2016, 18:15

Thanks Mypoorbutt! Did the spray provide instant relief for your nan's arthritis? I am wondering how it will work if applied after I heal -- I imagine it will relax the muscles but wont have the stool softening effects.

Oh and GG -- I found this this in another thread here, about magnesium: http://www.huffingtonpost.com/dr-mark-h ... 25499.html

"• Most people benefit from 400 to 1,000 mg a day.

• The most absorbable forms are magnesium citrate, glycinate taurate, or aspartate, although magnesium bound to Kreb cycle chelates (malate, succinate, fumarate) are also good.

• Avoid magnesium carbonate, sulfate, gluconate, and oxide. They are poorly absorbed (and the cheapest and most common forms found in supplements).

• Side effects from too much magnesium include diarrhea, which can be avoided if you switch to magnesium glycinate.

• Taking a hot bath with Epsom salts (magnesium sulfate) is a good way to absorb and get much needed magnesium."

Apparently, magnesium glycinate might be a good option for soft stools and relaxed muscles without the diarrhea. I ordered some (https://labdoor.com/review/doctors-best-magnesium) to see how it compares to my current Life Extension magnesium supplement, which is a mix of different forms of magnesium (primarily oxide, which apparently isnt absorbed). I'm hoping the glycinate works!
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Re: Fissure gone, fissure back, CRS' advice helps but hurts

Postby GilmoreGirl » 07 Dec 2016, 18:52

Thanks healthybutt that's great info. I will ask my doctor about the magnesium this week. I'm sure my fissures are healed over - I have no pain going to the bathroom - but I still get spasm most of the day if I go a lot, and I find it very hard to sit or stand, I feel all bruised and achy. So mpb maybe the magnesium would work for me - if the fissures are healed? I do use Epsom salt baths that I find help.
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Re: Fissure gone, fissure back, CRS' advice helps but hurts

Postby healthybutt » 09 Dec 2016, 15:22

Hi Gilmore Girl!

Well i got the bottle of magesium glycinate in the mail yesterday, much faster than I was expecting even for labdoor, which is prompt anyway. And so I was wondering whether I should try it because I am not healed yet -- I'm only 5 days into this recurrence and I know it will take at least 3 more weeks if it follows the pattern of my previous fissures.

Because the magnesium supplement i was taking before gave me 3 loose stools yesterday (despite pretty good fiber intake), I decided I probably had enough of that magnesium in my system (I'm not sure how fast Mg gets metabolized though) and I could risk substituting it with the glycinate chelated form I got. So instead of taking 1000 mg of my life extension magnesium (that is mostly oxide), I took 500 mg of it and 200 mg of the glycinate before bed.

I get into bed maybe 15 min later and I already feel different. Like more relaxed and have a heavier feeling than usual. Hm that was interesting. I fall asleep, dream, etc.

This morning have had 2 lovely BMs. The 2nd BM is usually where things get loose, even when I have taken fiber, as in the last 3 days. But today the 2nd one was actually still "formed" and soft. Hm. Nothing changed (I even ate the same food) since the day before...and the last time I had miralax was a half dose 38 hrs earlier. Anyway, things are looking hopeful and maybe I can eventually transition completely to the glycinate. I'm still going to ask the naturopath about it Sat and made an appt with a new GP monday to have blood work done, although I will have to take Mg fore the next fee weeks so might just get my cholesterol and glucose levels checked and get the other stuff done after I'm healed, but I want to run my fissure protocol by him too just for the 2nd opinion (which my insurance covers..unfrtunately the naturopath is out of pocket but I want a holistic approach as well). Anyway sorry to blab.

TL;DR version: Optimistic about magnesium glycinate keeping things soft but not loose!
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Re: Fissure gone, fissure back, CRS' advice helps but hurts

Postby Abu » 11 Dec 2016, 13:37

I am very interested if your doctor's recommendation is correct. Mine said exactly the same, that we should not take supplements to make our BMs soft as the sphincter will heal the fissure on a very narrow opening. However, I do not believe this entirely. The fissure occurred exactly because a bigger than the hole BM passed through. If we keep allowing big stools the fissure can never heal. I am personally scared of allowing natural stools specifically not to upset the fissure. However, I have no idea which is the best course of action...
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Re: Fissure gone, fissure back, CRS' advice helps but hurts

Postby healthybutt » 12 Dec 2016, 15:11

Hi Abu! Yeah I have seen that pop up here on the forum so other CRS' have the same opinion that passing small/loose stools will over time make it difficult for the anal passage to expand. The remedy my CRS urged was increasing fiber, but this added too much bulk and, combined with possibly not drinking enough water, ended up in a re-tear :( I did however find that I could pass regular stools again with the right ratio of fiber and magnesium -- they were softer until the re-tear even (and even after when I was still trying to get the right ratio) but some were quite large! I was shocked and secretly happy I could pass them again without pain (until the re-tear). Noticeably the re-tear had a harder stool. I thought of doing anal dilation but I am trusting my CRS on this as long as I remember not to go overboard on the fiber and drink enough water. He didnt seem to think it would be a problem.

Some people swear by mineral oil helping keep their stool soft but still with "body", but I cant get myself to drink the stuff. I also tried Miralax but it basically had the same effect as the Mg, and then for whatever reason stopped working after I'd used it for 3 weeks or so. Have no idea why.

I went to the naturopath and she switched me to flax seed and chia seed for fiber; she said psyllium was a bit harsh. She also is getting some topical balm as well as a supplement ("Bottoms Up") to strengthen my tissues, since re-tearing seems to be a problem (as well as not healing all the way, altho this last time I am pretty sure I was healed before re-tear). She mentioned witch hazel and horse chestnut were good herbs for tissue healing and strengthening and is ordering the following for me (a balm and supplement) : http://www.wisewomanherbals.com/index.c ... mit=Search
She said they used to have a suppository but she said I could use the balm and insert intra-anally like i try to do with the nitroglycerin ointment.

SHe also said that I can't overdose on Magnesium -- overdosing results in diarrhea, which I am of course aware of! She told me to continue figuring out the amount of Mg that worked to soften stools without diarrhea. I switched to the glycinate form, which apparently isnt supposed to cause diarrhea, but that is NOT true as I found out yesterday and today. Not true at all -- too much Mg, regardless of the form will result in diarrhea! Gilmore Girl, I forgot to ask about the topical magnesium, sorry! When I was discussing the different forms of Mg with the ND, she didnt mention the topical one; I think she would have if it had been relevant for my problem. I have noticed that the magnesium glycinate no longer gives me the sleepy feeling it did the first 3 nights. Kinda miss it!

Anyway Abu best of luck to you -- I am optimistic that with my diet change, the nitroglycerin oitnment, lubing the area before the first BM (even tho i dont think i need to do that now given how soft everything's been), sitz baths, eating "gentler" fiber and not overdoing it on fiber in general, using the balm/supplements from the naturopath, drinking water, and taking enough Mg will speed up healing and also help prevent re-tearing.
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Re: Fissure gone, fissure back, CRS' advice helps but hurts

Postby Mypoorbutt » 12 Dec 2016, 15:40

Hi,
You are quite correct any form of mag can cause diarrhoea....I cannot take any form of mag orally and have to be careful with how much I put in my bath as even transdermal can set me off.
You could try the baths and the transdermal spray see if it helps but just be careful of more watery stools as they do tend to be acidic.
Another thought is oil of oregano in either olive oil or coconut oil my friend gets very constipated with her IBS and she swears by the oregano oil says it makes it like toothpaste (which I wouldn't like) but know is meant to be good. Again I haven't tried this as I don't need any help to soften my BMs
Good luck
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