I've been dealing with a fissure for awhile now, about 2 1/2 months, & wondering if some of you can offer me some tips about how to keep my stools soft consistently. I have been trying to eat fiber, etc, greenery. I have been taking 1-2 stool softeners a day, & eating a serving of beans most every day. My CRS told me no diet restrictions, as long as I keep stools soft. Occasionally I am having issues when I need to poo, basically I of course don't strain, & I don't try & force it out, unless it slides out on its own. Sometimes the initial tip of the stool is larger & I try to use my anal muscles inside to compact it a bit hoping that will help it come out. Once it gets started, I'm usually ok. It's just avoiding the initial larger diameter stool that I want to avoid. How can I do this?

I have been taking 1-2 stool softeners a day, it seems when I go down to just 1, my stools get larger in diameter, so harder to pass. But I don't like having to rely on softeners either. I have been taking Metamucil tablets, could this be why the initial diameters seem larger? Maybe I should avoid Metamucil for a bit? Mainly I just want healthy soft stools that slide out on their own therefore not bothering my fissure area. The last few mornings, I have put a little bit of Miralax powder in my coffee, & that seems to help a larger stool work its way out, but again, it seems the issue is the initial tip.

Thanks for any ideas.

Hi AlexP

This is a really common complaint with fissure sufferers. It's usually a matter of tweaking fiber levels and also balancing insoluble and soluble fiber intake. You might want to think about how much insoluble to soluble fiber you're taking in. Insoluble fiber is generally the kind that creates more bulking because it passes through the intestines pretty much intact. It is found in things like leafy greens, bran, whole wheat, grains, the skins of fruit, the stringy parts of veggies, the white pulp part of an orange (the juicy part of the orange would be higher in the soluble fiber). Soluble fiber, on the other hand, is soluble in water and attracts water into the colon and creates a kind of soft, gel-like mass that is easy to pass. Soluble fiber is found in oatmeal, berries, the inside part of an apple (without the peel), and veggies, squash and zucchini and cucumber and sweet potatoes (without the peels... the peels will be insoluble fiber).. You can google lists of foods online, but keep in mind that some of these lists are contradictory in their information, so just use them as a general guideline. Also, cooking vegetables instead of eating them raw can really help break down some of the fiber and make it easier to slide through.

Also, many people complain that Metamucil bulks their stools up too much to be comfortable for fissures. While Metamucil is high in soluble fiber, it has enough insoluble fiber in it to be problematic for a lot of fissure sufferers. Also, water intake throughout the day is critical when you're working on your fiber intake. Without enough water, fiber can actually be constipating.

So, I would likely keep your regimen of stool softeners and Miralax the same for now (yeah, no one wants to have to use these things but most of us feel the pain of a fissure is just too much to bear without the assistance of some kind of help from products like these).

It would also be a good idea to keep a diary of the foods you eat and the result you see the next day. It can give you a really good picture of how your body is responding. We're all so different, and every fissure sufferer becomes their own (mad) scientist when it comes to diet. It's easy for a doctor to tell you not to restrict your diet, but they aren't the ones feeling what those bigger stools do to a fissure sufferer.