Postpartum fissure - nearly 6 months and counting

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Postpartum fissure - nearly 6 months and counting

Postby Gracie » 05 Mar 2015, 13:42

I've relied on the wonderful advice on this site for some time now, but after a few bad days, think it's time to share my store to get some more personalized guidance. Here it goes... I gave birth (vaginally) to a wonderful baby boy in September. The fissure pain started two weeks after he was born when I didn't take Benefiber for a few days and had a hard BM. It was excruciating and I had no idea what it was or whether it was normal postpartum pain. After suffering for a week with pain escalating to the point of bringing me to tears with every BM, I went back to see my midwives. Unfortunately for me, the new woman in the practice had the first available appointment and she wasn't experienced or savvy enough to identify my problem as a fissure. She took a superficial look, told me I had a hemorrhoid (I'm still not sure whether what I have is a hemorrhoid or skin tag from the fissure), and sent me on my way with a hydrocortisone cream. I got very little to no relief from the cream and at my 6 week postpartum check-up, another midwife knew immediately, based on my description of my symptoms, that I had a fissure before she examined me. It was a such a relief to have a proper diagnosis. She advised me to liberally apply vaseline or A+D ointment before going to the bathroom to protect the fissure. This did help some, but not enough.

A month later, I saw my GP. He examined me and prescribed me Nifedipine with lidocaine. Around that time, I added Miralax to my regimen. When I apply the Nifedipine, I can tell it has done its job in relaxing the sphincter. I still take Miralax nightly and had just been congratulating myself on a month without bleeding when the fissure tore open again this week. It almost feels like I'm starting back at the beginning. My GP told me that if the Nifedipine didn't work within a month (it's been nearly three), surgery was the next option and gave me the information for a CRS. I've been reluctant to even have a consult with a CRS because I'm unwilling to pursue any treatment options that would impact my breastfeeding relationship. It's entirely possible she'd have ideas other than surgery, but I've been afraid to even ask. Right now, baths are helping relieve the more acute pain, but I've been taken back to a place where I fear going to the bathroom. Every BM is like razorblades escaping from my body. It's amazing how something so tiny can cause so much pain and the daily re-injuiry just feels so unfair. It's far worse than giving birth (unmedicated!). I would love some advice regarding treatment options that are compatible with breastfeeding, particularly from others who have suffered with postpartum fissures.
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Re: Postpartum fissure - nearly 6 months and counting

Postby Jbl22424 » 05 Mar 2015, 21:51

Hi Gracie,
All treatment options are compatible with breastfeeding. For surgery, you can do IV sedation and abstain from breastfeeding for a day or two. Same with botox. I wish I had done surgery earlier for my postpartum fissure. I waited 4 months and suffered severe ppd because of the pain I was in.
Developed fissure from constipation due to breastfeeding 7 weeks after delivery (Jan 2014)
Nifedepine
Colace
Magnesium
Miralax - godsend
Nitro - some improvement
LIS (May 2014) - cured for 3 months then setback
Diltiazem
Feeling better for now
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Re: Postpartum fissure - nearly 6 months and counting

Postby PainedSA » 11 Mar 2015, 00:47

Hi Gracie - 6 mo post partum fissure here too :( The start of your story mirrors mine. I am so sorry someone else is going through this and scared of ruining their breastfeeeding relationship too.

I have not used all the creams that I could and I have put off going to the CRS, I figure it will still be there after I finish breastfeeding so I just am putting up with it and have it under control with diet now.

Thankfully I haven't had PPD because of this (lord knows how) but if that were to be happening I would definitely say have the surgery and continue feeding after!
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Re: Postpartum fissure - nearly 6 months and counting

Postby jlm1 » 11 Mar 2015, 08:22

Perhaps botox would be an option for you?
fissure May 2014
nitro, diltiazem
botox July
fistula surgery, piece of skin tag removed Oct
fissure declared healed Dec
currently have burning/pain-told it is nerve pain
physical therapy, sitz baths, valium suppositories
hoping I am healing
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Re: Postpartum fissure - nearly 6 months and counting

Postby Gracie » 11 Mar 2015, 08:41

I actually went to the CRS yesterday and am so glad I did. I broke down and made an appointment last week when I was in a lot of pain and she happened to have a cancellation, so was able to get me in very quickly. The exam was painful, but mercifully short with a little lidocaine applied at the end to take the edge off. She told me that although it doesn't feel like it, my fissure isn't actually that bad and looked to be healing. She prescribed another round of Nifedipine and gave me more intensive instructions for use than my GP did (Apply internally three times a day for 4-6 weeks. If pain subsides in that time, continue to apply for 2 more weeks because pain usually disappears before the fissure is fully healed. Continue with high fiber diet, Miralax nightly, and Benefiber twice/day. She said because I was pain free for a month, we know my fissure can heal and was optimistic for a positive outcome.

However, if this more conservative treatment doesn't work, her suggestion for me was to skip Botox and go straight for surgery. She understood my hesitation about coming to see her in general and the possibility of surgery, but she really put me at ease all around--she's never made anyone incontinent and has a 95% cure rate. She said I might have to pump and dump for 24 hours, but the pain medication she would prescribe following surgery would be compatible with breastfeeding. She also reminded me that women take narcotics following C-sections and are able to breastfeed safely. KellyMom has a brief post about breastfeeding and surgery (http://kellymom.com/bf/can-i-breastfeed ... m-surgery/) that also makes me think that 24 hours would be very conservative and that I could actually nurse my son as soon as I was alert if surgery is truly needed. In addition, I asked the CRS about future vaginal deliveries after surgery and she said that because I didn't tear while delivering my son (first child), she had very little concern about the surgery being an issue.

I'm feeling optimistic I can tackle this with another round of Nifedipine and diet. I've gotten a lot more serious about diet since this last bout of pain. My diet is now primarily plant-based, I've minimized dairy and wheat, and it's made a world of difference in just a few days.

In all, I wish I'd gone to the CRS sooner. It really took away a lot of the mystery and fear surrounding my fissure and treatment options. It's a problem that I can't see, so I'm glad I had an expert take a look and educate me. I'm going to do all I can to avoid surgery, but don't think it will be nearly as devastating as I suspected if it turns out to be the option best suited to treat my fissure. PainedSA, I'd really suggest making an appointment--it's your choice about what treatment options to pursue, but at a minimum, having information may bring you some measure of comfort.
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Re: Postpartum fissure - nearly 6 months and counting

Postby PainedSA » 15 Mar 2015, 18:40

Sounds like you have a lovely CRS - Where are you located?

How have you been going? Hope no setbacks atm. How is your little one? xxx
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Re: Postpartum fissure - nearly 6 months and counting

Postby Gracie » 01 Apr 2015, 20:53

Thanks, PainedSA. We're in the Washington DC area. I had about two weeks without pain, but the past several days have been really difficult. I'm losing hope a bit, although I'd like really to see this round of Nifedipine through.

Little one is fantastic and a wonderful distraction. Hope you and yours are doing well!
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Re: Postpartum fissure - nearly 6 months and counting

Postby Broncosgirl » 02 Apr 2015, 10:37

Hi Gracie,
I was in almost the exact same boat as you. I developed a fissure for the same reason. My baby is 5 months and I just had surgery because the creams were not working after 8 weeks and it was actually getting worse. I have continued to breatfeeding my baby throughout.

The infant risk center where all of the research is conducted on breastfeeding and medications told me I could resume breastfeeding 4 hours after recieving IV sedation for surgery. Here is their number in case you ever need it: 806-352-2519.

I hope this round of creams works for you, but do know that surgery is an option for us new mommies.
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Re: Postpartum fissure - nearly 6 months and counting

Postby Gracie » 02 Apr 2015, 16:47

Hi Broncosgirl,

Thank you for sharing your experience. Are you pleased with the results of the surgery? If you don't mind me asking, where was your fissure located?

I believe my fissure is anterior (located next to my perineum), but I've become confused about anterior/posterior and 6 o'clock/12 o'clock positions when it comes to the anus--I've seen conflicting descriptions of the clock descriptions and it can all depend on the position of exam. In any case, I've read that people with anterior fissures typically don't have high resting pressure in the anal canal. I actually don't believe I do, although the fact that Nifedipine has offered me some relief may suggest otherwise... My husband and I plan to have more children and I'm concerned about compromising the whole anal/perineal region with surgery. Did your doctor discuss any of this with you? I had a fabulous vaginal delivery and would love to do it again (and maybe again!). It's a shame to have had such a wonderful birth experience, but to be left feeling so damaged afterward.
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Re: Postpartum fissure - nearly 6 months and counting

Postby Broncosgirl » 02 Apr 2015, 18:41

Hi,
My fissure is located closer to my spine so it sounds like it is in the opposite position to yours. When they so surgery I don't think they make the incision in the same location as the fissure so I'm not sure if fissure location makes too much of a difference of possible complications post surgery. That would be a really good question to ask your CRS.

I had a wonderful and easy birthing experience as well. From what I have read online, having future uncomplicated births shouldn't impact contenance after surgery but if your have a baby bigger than 8 pounds or in a difficult position (i.e. breech) you have more risk. If I have future children I plan to do a planned c-section. The fissure is taking up too much mental energy that I could be using to spend with my daughter and the possibility of a c-section was worth it to me to have this gone. I believe a number of women have given birth just fine after LIS, but as I said, you have more risk if birth is not smooth.

I am only a few days into recovery so it's hard to say what the final outcome will be. I know that it was the right decision for me because I was tired of my attention and ability to care for my daughter being taken away by the fissure pain. I think you get to a place where the probable positive outcome from surgery far outweighs potential issues.

Having a consult with my CRS beforehand and asking every question under the sun, especially as it relates to current and future little ones was a big help for me. Just know that in my experience CRS are not going to push for surgery because they want it to be fully the patient's decision. If I had listened to my gut and had it done sooner I think my recovery would be moving along much easier.

Let me know if you have any other questions. It's so hard to make these decisions when you have babes to think about as well.
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