Smart Question= So what constipation actually mean? Does it mean you cannot shit at all sometimes? Like you want to and it just wont' come out at all? Does the valsalva maneuver (holding your breath and pushing), during BMs mean constipation? 6 days a week, a sit down, breathe in and out, and my abdomen contracts and my poop flows out without any effort. 1 day a week, randomly, or if I drink alcohol (which I don't anymore), I have to use valsalva (i.e. hold my breath for a second), to get it going... Is that constipation? Or is that just perfectly normal to my fellow fissure friends?

For most of my life I used to push in order to poop. I had to push, otherwise I wouldn't be able to poop. Constipation was when I didn't have the urge to poop and pushing didn't help at all.

After I got the anal fissure, I learned that you aren't supposed to push when you poop, or at least not very much. I made changes to my diet, got a squatty potty, and used miralax. All these changes help so that most of the time I don't need to push to poop. I don't consider needing a gentle push to be constipated. But I do consider needing a bigger push to be constipated.

Thanks. And just to be brutally clear, when you say "push" you mean a Valsalva Maneuver? Correct? That is when you are not breathing and pushing down with your diaphragm? Or would you consider Valsalva Maneuver constipation too?

For me, constipation is when holding my breath and pushing down is not enough.
I try not to use Valsalva Manouvre any more (didn't know it was called that!). But if I have to, and it doesn't work, I call that constipation.
I think using the VM too hard is what caused my fissure.

Personally, I feel like the meaning differs for everyone. I used to be a once-a-day person with BMs without any effort before this hell started. Then one day out of the blue I had a hard stool for the first time in my life and that's how I got this fissure. Since then, I just cannot seem to get a regular consistency in my stools. I go like clockwork very morning but somedays it's smooth like nothing ever happened to me and other days just the tip is hard. I don't believe this is constipation for me because after that initial hard tip, everything is smooth. But by then the damage and pain has already started. Even on these days I do not need to strain anything out. It just takes time to exit out but by then the pain cycle has already set in. Also, I have noticed that now I go two times a day. Once when I wake up and then again after 30-40 minutes. I'm becoming phobic of my BM schedule and sometimes at night I can't relax and go to sleep because I'm already thinking about the next morning. I feel like my symptoms could be IBS and I'm scared to death about this new issue with the fissure already wrecking my life. Oh and my boss didn't get his research grant so they have to let me go. With only 3 months of my job left, I am in complete panic about my health and career right now.

Hi SSK,

Horribly sorry about the job...but thankfully in NYS you will still have health insurance through COBRA for at least 18-36 months, and you can always sign up for Obamacare/Medicaid if need-be. Still, that just adds more stress to an already maximally stressful situation. Your BM cycle sounds a lot like mine, mostly easy, occasionally a push just to get a harder "tip" out first, then smooth. I don't think that's constipation, personally, I think that's just life, and if I had a healed fissure, the pushing wouldn't cause a re-tear. I begged Feingold for the Kenalog thing in an email this morning. I've done 25 of those HBOT treatments, and still bleed regularly, and have same level of symptoms overall, so my plan, if he OKs, is to do the Kenalog thing, and then get back into HBOT immediately so that I have two angles working for me. Good luck with everything.

Hi asdf,
Your plan to go after this thing with a two pronged approach sounds very smart. Hopefully you will beat this thing once and for all.
I am not a citizen of the States so I'm actually on a work visa here. If I stop working, I will have to leave the country or go as a dependent on my husband's visa. I am not even thinking about looking at job openings right now, I'm such a mess. They say when the going gets tough, the tough gets going. How? And which moron said it? God, I am so mad at life. Sorry.....
Thanks for your message and good luck to you too.

Ahh that is rough. God life sucks or what? I would personally say, F**k the job hunt for the time being, as long as you can get health insurance and a visa through your husband? Is that possible? I hope so. I personally have not worked in 2.5 months because my third surgery which was supposed to heal in a few weeks remains unhealed...but I fortunately have been on sick leave and frankly at 26 years old, I could give a shit about my job at this point. It's a quality of life issue, if I am walking funny in pain with an open wound in my ass, what's the point of a job I hated to begin with. Anyway, good luck again. Are you making any progress in your treatment? You were going to get some tests done? Have you tried any of that yet?

p.s. where are you from, if you don't mind disclosing. I only ask because American healthcare is notoriously shitty compared to the many other countries'. I have no experience with other countries' healthcare systems but know that this one definitely sucks. Do you think that you might get better care if you returned to your home country for a brief time? Although that would be a major decision to have to make, but it's just a thought...

Well, after feingold told me that he couldn't see anything wrong with me during the exam, he suggested that I consult an OB/gyn. A pelvic MRI was done which came back normal. I also saw a pelvic floor therapist who hooked me up to some electrodes and did a biofeedback test to see if I contract and relax my pelvic, rectal and abdominal muscles the right way. She said that I seem to have some tension in the muscles but nothing nearly as bad to suggest the severe pain I have.
After all this hogwash, I am convinced that my problem remains the same. The hard stool in the beginning causes me the most pain and I do pretty good when the stools are soft and loose.
Oh I am Indian and though I agree that doctors are much more accessible there, I do not trust the medical expertise in India. My family has been begging me to return for just a few days to at least get a proper diagnosis.
Let's see how things go....for now I will just transfer to my husband's visa and not worry about a new job or traveling 14 hours on a plane.