I always need to push to start a BM. I have the urgency to go but I can't seem to go without pushing. Sometimes it's a small push and sometimes it's a larger push. I haven't been straining but I have been pushing. I'm concerned this is delaying my healing (been on nifedipine for 5 weeks now with a little bit of healing). I know these fissures can take a long time to heal sometimes but I'm trying to figure out a way to push less.
I eat a lot of fiber (pears, raisins, fiber bars, broccoli, etc) and my stools are soft, between 4 and 5 on the bristol stool scale. They are not as soft as soft serve ice cream that some people mention but they are soft.
I asked my CRS about this issue and my CRS seemed surprised that I would need to push at all. My CRS recommended taking a hot bath before the BM, which I tried but no improvement so far. And my CRS recommended more fiber. I asked my CRS if pelvic floor therapy would help and my CRS said no since I wasn't incontinent. I asked my CRS if Miralax would help and my CRS said no since I wasn't constipated. I mentioned squatting helping some people and my CRS didn't comment on the idea.
Any advice would be appreciated!

Darkeyes,
I think it's mental issue maybe and you have perhaps become so used to "pushing" a little, that is has become part of your routine - almost a habit, just like nail biting.
Habits are hard to break but trust me I was the same as you - it's all I'd ever known to do! The one day, I made a conscious effort NOT to push at all and just totally focused on that stool naturally moving down my anal passage and out and it just happened and I was surprised at how easy it actually was! I never knew you could expel without any force whatsoever. I too have soft stools, rarely issues with constipation and I now find it pretty easy. You could try lubricating the area with a generous dollop of vaseline to help. I now do this religiously as it also protects the fissure area. I also squat and this has made a tremendous difference - everything seems to come out a lot more naturally and quickly too. I don't ever strain and on the odd ocassion, I do have almost an "internal" little push to get things moving but just the one and a very gentle one too and this hasn't given me any major issues!
Good luck

Ever the Optimist: Thanks for the advice. I'm going to try to see if I can refrain from pushing and try squatting. Did you use the vaseline just externally or did you use a little internally too?
I read your success story. That's great news that you are healed! I always get encouraged hearing that other people have healed.

Yeah I'm having this problem too. In my case managed to get to the point of squatting and not pushing with Vaseline however it ended up leading to me not passing enough on a daily basis and an embarrassing trip to the ER where I was given glycerol suppositories lol..
Perhaps some of us maybe have narrower passages (maybe because of the inflammation around the fissure) so it makes it difficult. Anyway have doubled my lactulose at the moment which is making things a bit easier.
So even if you've not got constipation problems maybe start taking a softener anyway, it might make things a bit more effortless.

Hi Darkeyes,
Just apply a huge dollop of vaseline externally aroung the opening and if you can insert some internally over the fissure area, that's even better. Glycerol suppositories are actually also meant to be really helpful if you are struggling a bit - they come highly recommended from a friend of a mine! It can be difficult to pass stools if the sphincter muscle is in spasm, so trying to be as relaxed as possible when going is also very helpful. The area will be very "tight" and others have suggested that hopping into a hot bath pre BM works magic......If you naturally have soft stools, then there should be no real need to use a stool softener, but I still continue to take Lactulose to this day because I think it also helps and it's also a stool softener that is safe for long-term use.

Darkeyes wrote:My CRS recommended taking a hot bath before the BM, which I tried but no improvement so far.

I had the same problem and eventually I realized I wasn't getting the water temp right. It has to be couple of degrees above body temp in order for the sphincter to dilate. It's kind of obvious, but I didn't realize at first.

A little suggestion from a veteran:
do some exercises before BM, taking a 30mins' walk is good enough. And drink some water and eat some food before you exercise because that too will induce BM. If it's too hard, try eating some green vegetable along with the meal. Anyway that's for me and it always does the trick.

I don't normally have any issues with constipation and don't use stool softeners, but I can understanding the pushing issue. There are some times when I have to push more than others. For myself, it's because I'm not relaxed enough or am in a hurry. I make sure to set aside a time each morning to relax myself and have a BM or two. If I'm in a hurry or stressed out, I tend to push more. You just have to let it out naturally.
And I agree with levelworm. Exercise and a meal helps to induce a BM in the morning for me, as well as drinking a lot of water. I don't drink coffee, but I drink a lot of water each morning and this helps me a lot.

Check your Magnesium level by doing a blood test. I think you are not getting that pressure required to have a normal BM. A Magnesium supplement (250 m) will make you go. Also, add EV olive oil (about two tblspn cold pressed organic when you sit down to eat) to your lunch and dinner. This would lubricate and soften the stools more. Always drink lukewarm water. Apply A&D cream before and after. It cures and relaxes the muscles because it has vitamin A and D. Do not have raw vegetables. Also, you would be surprised to know that cooked green leafy vegetables are actually hard for delicate stomach because it takes time to digest. Cook carrots, sweet potatoes, broccoli, sweet peas, red kidney beans, green beans, baby corn and potatoes in tomato soup for lunch and dinner for at least 5 days. Have fruits like strawberries (10), honey dew melon (2 huge slices), black grapes (20-25) navel oranges (2) in between meals. For breakfast eat 2-4 brown rice pancakes (whole food market). Stay away from cereals or juices that have been fortified with calcium and iron. Calcium contracts muscles, while magnesium relaxes them. Also, most importantly, chew your food in such a way that the saliva is coated with food completely. This saliva is important to build that necessary pressure to go without pushing.

Well you have a lot of ideas to consider, but I'll just add the most important part of my routine is to drink water before I sit on the toilet. I usually am 'ready to go' right away when I wake up. I apply ointment (some type of lube) and then drink cold water--my naturopath recommends two glasses of cold water (to get the bowels moving). After just a few minutes (?5) this increases the urge and the BM's seem to come out more easily. He also says some degree of muscular pushing (not straining) is normal. But probably not ideal for most of us! I find it really easy to overdo with stool softerners like Colace (ditto for Miralax for me) and end up with very loose stools, which aren't good either. I would stick with eating, drinking (cold or warm water), exercising as ways to get the bowels moving. Good luck! :)