Hi All

I finally went to the surgeon today for a 'proper' examination. I was quite nervous for him to examine so I think he only saw the 'tip of the iceberg'.
I'm a little confused as what he said contradicts a bit of what I have learnt from this forum.

Firstly he said to make sure I bulk the BM's. Here everyone says to not bulk. When people say not to bulk... do they mean don't go larger than an everyday sort of BM or do they mean try and make the stools as narrow as possible. I understand that having narrow stools for too long means the internal sphincter can get tighter which is bad. It also means the scar tissue forms too tight as well which is also bad. But then can an AF actually heal if passing 'normal' sized stools? He suggested psyllium but if I were to increase the insoluble fibre I would prefer nutritious food as I'm fading away so perhaps I'll add some LSA to my porridge.
Interestingly, lately when I had normal sized stools it has hurt the same or less than the narrow stools and the same amount of blood. I just get nervous that they might be firmer than is desirable.

Secondly he proposed two procedures if my conservative methods don't work over the next three weeks, given its been 5 months I'm not sure there will be much difference over that time. They are either to stretch the internal sphincter by him putting fingers up there and stretching it like that or the other is a sphincterotomy. The former will probably mean retearing anything that has healed, no thank you. I've not even heard that method discussed on this forum. Since I am wanting more children some day I'm not sure if either are a good idea.

Anyway, I've been given a script for lidocaine and some more rectogesic so hopefully they will work wonders :) He said he would do a more thorough examination in a few weeks.
Something else I wanted to mention but I forget. Ah yes, do people here know how deep their AF goes? cm's?

Thanks heaps for reading, a bit of a long one.

Actually, self dilation (as apposed to the doctor doing it) is discussed on the board and has worked for some of us, me included, and it was done during the time that I had the fissure. Slowly and surely it worked. You might like to read the thread, which is a sticky on the forum. Also, people who have anal flap surgery - for instance - are told to dilate after this.

self-dilation-t4261.html

You might like to look at these two links too. Just two of our members who had Standardized Anal Dilation, and were off and on with their lives just about immediately:

my-standardized-anal-dilatation-this-morning-t4104.html

my-sad-standardized-anal-dilitation-experience-t7524.html#p98144

Bulking up is a bit of a euphemism for getting the right texture and size for a BM. Don't worry about the size. Just try to not overdo the fibre (not more than 25 grams of fibre a day for a woman). I do not eat anything like large portions and I have given up the looking-in-the-loo-to-see-how-large-my-poop-is number I have veggies (I don't eat red meat, but do have a bit of chicken occasionally and fish once a week) every day, but just a small portion. I also have a Metamucil biscuit and drink plenty of water during the day.

I also nearly faded away (lost almost forty pounds) during the whole thing, and took me a year to get back to relatively healthy weight. I ate baby food at one time!

I never knew how deep my AF went. All I knew is that I was in absolute agony for bloody hours on end.

Any questions you might have, feel free to ask.

Hi hopefull,
I agree with Savaici about fibre. My experience was that big bulky stools were painful and seemed as though they were slowing down the healing. But soft stools are really important. Once I realised that, I gave up the psyllium. Personally I recommend red lentils or the small green lentils, thoroughly cooked. Very nutritious and very softening! You can add turmeric to the cooking water, since turmeric is considered good for healing (and makes the lentils smell wonderful).

Dilation has mixed reviews here. Self dilation has the advantage that it's under your control, you can do it every day yourself. Do read the accounts Savaici recommends.
The other kind that is recommended is (as Sav says) Standardized Anal Dilitation, which does NOT involve the doctor's fingers, but rather precisely sized dilators. Again, read Sav's links.

Have you looked into supporting your anus during defecation? The colorec toilet seat, or the DIY version where you press firmly on the skin above your anus? I found that when I did that, defecation was less painful and more complete. Well worth a try. Try searching the forum for colorec.

Here's a recipe for lentils I posted a while ago:
Gently saute some onions and garlic in a saucepan. If you like, add some powdered spices, like cumin and ground coriander seeds, or garam masala. When onions are soft, add about a cup of red lentils (rinsed), a teaspoon of turmeric, some salt, and two cups of water. Boil until lentils are cooked - 20-30 mins. You may need to add more water. If you want, when cooked, puree in a blender. The lentils should be pretty well pureed just by cooking, but you may want to get rid of the onion lumps.
There are so many variations you can make. You can add some slices of ginger root in the boiling water - if you want, remove them before puree-ing. You could add a squeeze of lemon. You could cook the lentils in chicken or vegetable broth. Sometimes I add some nutritional yeast. Sometimes I'll sizzle some whole spices, like cumin seeds and chopped garlic, in veg oil or ghee (in a separate pan), and stir that in at the last minute.
Onions, garlic and turmeric are supposed to be good for healing.

Thanks for your replies and links, I've taken a bit of time to read over them...
Savaci, I started to do self dilation a few weeks ago but only with my fingers, it seems to be helping, still haven't worked out how wide I need to work up to. Awesome that it has worked for you, that's very encouraging. Funny you mention baby food, my wee one has just started solids and now I'm determined to change my diet to foods that are different to his, prior to that we would have been having the same meal

The surgeon seemed very confident about both procedures and his success rates but I'm still nervous and hope like anything that I don't have to see the surgeon again. He didn't use the term 'dilation' so I suppose I didn't link it up.

I'm loving the lignocaine, used 5 min prior to a BM and I don't feel any pain :) Still stingy from 30 min after the BM once the lignocaine wears off. It takes the over thinking out of the motion, not sure if that's a good thing or not. Pity I've only got a weeks worth.

Scientist, I had your lentil dish for dinner last night, thanks so much for the recipe, might make it my go to food. I'm always wanting new recipes that are anal fissure friendly. I might try it with some smooth peanut butter and perhaps coconut milk in it. Always trying to fatten up food :) I made some walnut butter yesterday, today I'll make almond butter. I also made a chia dessert of chia soaked in almond and oat milk, honey and blueberries. I'll have a another look into colorec, I read a bit about it a few months ago but I think I got too nervous to try.

Still a bit confused about bulk vs size but I achieve soft stools all the time, touch wood, so will keep doing what I'm doing.

Hi Scientist, I see that the colorec is successful for posterior fissures, mine is anterior. Did you have anterior or posterior?