Hi guys
I just got back from the GPs to get some more rectogesic and whilst I was there she recommended I stop taking Movicol and start with Lactulose instead. She said that the consistency of the BMs would be better with Lactulose than Movicol and I would heal quicker.
Not sure about this. Movicol has worked well for me but if Lactulose works better then of course I'll try.
Has anyone got any opinions on this??
She also said (and this just seems like utter madness to me) that diet didn't really matter too with fissures so long as I took lactulose. This seems absolutely mental and contrary to everything else I've heard. I've had this fissure for nine months, there's a skin tag and and everything gets very very uncomfortable if I eat lots of doughy foods or red meat.
And if she's saying things like that should I take everything she says with a pinch of salt?
Sooo confused!

Lactulose is usually the first laxative prescribed by "DIM" GP's, it's absolutely crap (in a word)..
Movicol on the other hand is an intense laxative and doesn't suit everyone, it makes stools very soft and sometimes overly runny causing irritation, if it's consistency you want then a fibre supplement would be the best thing to bulk up the stools, I find that Fybogel is the only thing that has helped me in this way

Layla,
I have not tried lactulose so I have no experience or opinion about it but regarding the diet I do. It has NOT made much difference what I eat as long as I take Miralax/Movicol.
What your doc said isn't mental but it is contrary to popular believe. And so is my believe/experience with fiber. To me, fiber is BAD in every way, it makes stools bulky which causes re-tears, pain, blood, etc.
I discovered a foundation for such results here:
http://www.fibermenace.com/gutsense/transition.html
To that I have to add that I do not eat a lot of bread and meat.
Steve, in my experience, Movicol has not done anything to make stools runny or irritating, as long as you know your dose. If you take, lets say, 2 teaspoons, I doubt it will have an intense effect. However, I have to say that my body did get used to it and eventually 2 teaspoons do not produce desired effect.

In the UK Movicol is in 13.5g sachets that cannot be watered down or lessened due to the electrolyte content, it has to be mixed precisely using a measuring jug, BTW, Movicol did not agree with my system 100%, I only produce runny and irritating stools from using it and more trips to the loo = more pain (obviously), using fibre supplements gets rid of more poop in just one trip to the loo and is preferred by many CRS here in the UK, the plus side of using fibre is that it keeps the sphincter from becoming too tight due to passing narrow stools (from Movicol), larger and bulkier stools prevent anal stenosis and are less painful in the long run (tried and tested by me)
For me it's easy, I only use the loo no more than 2 times a day with Fybogel which gives me much less pain that wears off pretty quick, if I was to use Movicol then I'd be going 5-6 times/day with intense burning due to irritation
Conclusion: Fybogel wins hands down.

I guess every body is different. I only go once a day and it's not loose at all, just not hard. I have never heard that sphincter may get too tight from passing small stools and for me Miralax doesn't produce narrow stools anyway.
But again, this is not exact science. According to the article I read and posted in above post, large stools do nothing but damage the area on the way out.

small and thin stools can cause narrowing of the anal canal over a prolonged period, that's a fact, I would rather pass a bulky turd anytime, for me the pain isn't bad at all
Stenosis may be caused by an intrinsic or extrinsic pathologic process of the anorectum. Anal stenosis may follow almost any condition that causes scarring of the anoderm. The causes of anal stenosis include surgery of the anal canal, trauma, inflammatory bowel disease, radiation therapy, venereal disease, tubercolosis, and chronic laxative abuse
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675080/
Taking Movicol over a prolonged period could be classed as laxative abuse resulting in stenosis, I suppose it's how you interpret this.

I also take miralax/movicol and have no loose stools. I go once, maybe twice some days. It just proves what we have all been saying about everyone being different, Lol...
I think it depends a lot on what you eat too. If I ate tons of fruit or something that would normally create looser bm', then miralax would probably cause me some problems. When I took the full dose, I often had thinner bm's. Now that I'm taking a much smaller dose, the bm's are bigger but still the frequency is the same... Still having one or two a day with less volume on some days. It really does depend on the person in my opinion. If you have a sensitive stomach then it may not be for you...

Thank you for your replies guys, this is really useful info.
I think I will be definitely giving Lactulose a miss, thanks for the head up on that Steve :)
I have always got on pretty well with Movicol (and I think as long as take it I don't worry 'too' much with what I eat- although I always feel that I should) and will stick with that for the time being.
I have had thin BMs since I had this fissure and have never been sure if it was from Movicol or from a tighter sphincter. I've only ever taken two a day max. The stenosis thing was something I've never heard of and truly terrifying...I've used Movicol since January on and off and feel afraid to come off it but maybe switching to Fibyogel would be safer in the long run.

Passing small stools may cause narrowing of anal canal in some people but it is not a fact. This is in no way an exact science. For me and for many others, bulky stools cause nothing but pain, are undesirable and result in re-tears, etc.
There is no evidence in the article that you listed that Miralax can contribute to anal stenosis. Miralax is considered stool softener not a laxative. Prolonged use is not qualified as "laxative abuse", you can say the same thing about using fiver supplement because fiber is as much a laxative.
Article does mention that OVERuse of laxatives may be the cause. However,
"Ninety percent of anal stenosis is caused by overzealous hemorrhoidectomy... In patients who use laxatives improperly, physiologic regular dilatation is abolished...Patients with anal fissure or who abuse paraffin laxatives may develop a disuse stenosis"
What I am trying to say is that there are no rules here that will work 100% for everyone.

Hi my doc gave me lactoluse and movicol he said the movicol loosens the stools and the lactoluse softens them I take 4x5 mls twice daily of lactoluse and movicol twice daily i still have bother getting to loo i eat loads of fruit and veg everyone reacts differently to meds