Delayed Pain after BM and Low Fibre Diet

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Delayed Pain after BM and Low Fibre Diet

Postby 2409 » 27 Sep 2012, 12:58

Hello
I am puzzled about what seems to not work for me, and how I should proceed from here. Comments would be most welcome!
For the past 8 months I have had increasing frequent diarrhea. In order to alleviate this, I first quite drinking coffee (I probably was accustomed to too much), then quit drinking milk, then dairy products, and finally quit gluton containing products on September 1. The last diarrhea type episode was three days after eliminating gluton products from my diet. I suspect the frequent diarrhea lead to an AF. This was first diagnosed on May 22. I had been having increasing pain, for about two months prior to this day. My family doctor prescribed a 0.2% nitroglycerine ointment and recommended Metamucil tablets. Subsequent symptoms were erratic, but with periodic severe episodes. On July 31 I had a colonoscopy, that showed everything was fine except for an AF. I felt rather good on the day of the colonoscopy, although I had been quite poor prior the examination. The poor condition resumed some time after the colonoscopy was completed. (I don’t recall how long.)
By Aug 14, I could no longer drive, and went to see a clinic doctor. She prescribed a 2% Diltiazem cream in Versabase, and confirmed the AF diagnosis. At this point I was spending most of the day lying down. At the time I was still attempting to go to work, but generally could not manage a full day, and missed some days completely. August 16 was the last day I managed to get to work even for a few hours. Since then, although there has been considerable fluctuation in the level of pain, it has been getting progressively worse (up until five days ago).
Although BM’s were painful, (at times excruciatingly painful), the pain immediately after was often not too bad. Sever pain would start 2 to 5 hours after a BM, and typically last for 4 to 8 hours. Other times were varying degrees of highly uncomfortable to moderate pain. (I have not noted this pain pattern in reading others accounts.) Also, passing gas for me was never painful (different from what others are reporting). Passing gas would often offer a second or two of slight pain relief.

I met with a CRS on Sept 22. He confirmed the CF diagnosis, and prescribed a high fibre diet (25 to 30 grams /day) plus a heaping teaspoon of Metamucil twice a day (rather than the tablets), along with lots of water. I had been taking five Metamucil capsules per day since the condition was first diagnosed. I followed this diet a precisely as I could, keeping very careful track of all food, adding up the fibre content, while also eliminating dairy, caffeine and gluten. BM’s were massive, with about two per day. Pain increased. By September 26, I could not tolerate the pain. Most of my time was spent soaking in a warm bath, or trying to find a spot to lie down where I could tolerate the pain. The pain was excruciating, and nearly continuous. I could not get the energy to eat on Sept 26. In the early afternoon I took four Dulcolax tablets, and an hour later drank 2 Ѕ litres of “Kleen Prep”, used to flush the system prior to a colonoscopy. Once BM’s started from the Kleen Prep, I started to feel better. A few hours later the pain had subsided to the point I could sleep. This was four days ago, and I have continued to improve every day. I am, however, concerned about diet and eating. I drank only water on the day of the Kleen Preap and the day after. The third day I had a tablespoon of brown beans, two tablespoons potatoes, and two tablespoons of cooked carrots with some prune and apricot juice. The next day I increased the food quantity and added yogurt, and a small portion of cantaloupe and banana, while continuing with lots of water and some prune and apricot juice. Today I had a very small BM, completely painfree!!!! with something close to toothpaste consistency. Life is great again (at least for the time being).
This diet that I have been on for the past five days is about as far away as possible from the CRS recommendations, and is counter to the advice of nearly everyone on this site. I would very much appreciate comments. Has anyone else had difficulty with the high fibre diet? Does anyone have recommendations on how I should proceed from here to get back to a “normal” life?
Thanks in advance for any advice or comments.
Regards,
Ken
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Re: Delayed Pain after BM and Low Fibre Diet

Postby Lauren12 » 27 Sep 2012, 14:07

Hi there Ken,
I had a problem with too large stools from too much fibre in my diet, combined with taking Movicol and Lactulose and also prune juice. I calculated I was eating about 35 grams of fibre a day! So I reduced it to around 26 grams a day.
This was during the recovery period from my LIS operation. I would only have one bowel movement a day, but often it would go on and on and was abnormally large. It was very tough on the anus passing so much and I was developing minor fissures. The CRS had me eliminate the Lactulose, halve the dose of Movicol and continue with the prune juice (200 ml) per day. I had been on stool softeners and prune juice a long time - the two years I'd had the fissure, plus the recovery period after the LIS op. The surgeon's aim was to reduce them gradually and then eliminate them. It had to be gradual because I didn't want to become constipated.
Now, 17 months post LIS operation, I don't use any stool softeners and haven't done for several months. I still take 200 ml prune juice a day, to prompt bowel movements. I'm also completely recovered and back to leading a normal life. I still stick to eating around 26 grams of fibre a day, and that and the prune juice keeps the stools regular and relatively soft.
So yes, my experience was that I was eating too much fibre and that, in combination with some of the stool softeners I was taking, made the stools too large, which repeatedly caused minor damage to the anus on the way through. The surgeon said that the aim was for me to have smaller stools, but still soft.
I'm in the UK so the brand names of softeners and laxatives that we use won't be the same. I can't comment therefore on the precise things you're taking. It does seem a case of trial and error, trying to find the precise foods that give you soft and easy to pass stools. I also tried to concentrate on soluble fibre rather than insoluble, and water-logged fruits and vegetables rather than scratchy nuts, say.
What really got me back to normal though was having the LIS operation. Prior to that, I spent hours laying in bed after bowel movements. Sometimes the pain would be worse after the first few hours following a bowel movement. Usually it had alleviated somewhat by evening, unless I was having a bad day. Like you, I found that passing gas offered a few seconds of slight pain relief and the surgeon I saw at the time said that some of her other patients had mentioned that.
If you have any queries about diet or how to proceed to a cure, why not refer back to the surgeon, giving him/her feedback about the effects different changes in diet have had?
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Re: Delayed Pain after BM and Low Fibre Diet

Postby PinkSparkle » 27 Sep 2012, 15:19

Hi Ken and welcome to the forum! Image
I have a fissure since April and since then it happened to me 3 times to get diarrhea because I was eating too many fruits in order to increase the amount of "healthy" food. Image From my experience I can say that you have to try many times to combine different types of food in order to find out what is ok for your body.
Flax seeds were great for me.
If you have to sit on a chair for too long (due to work or whatever) and you are in pain while sitting, try a "donut" pillow (it's a pillow that has a hole - it doesn't allow you to sit directly on your fissure-google it and you'll find pictures).
Good luck!
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Re: Delayed Pain after BM and Low Fibre Diet

Postby jr2 » 30 Sep 2012, 09:09

Hi Ken,
I agree with what's already been said, but just wanted to welcome you as well. Actually, there are quite a few of us on the forum for whom the high fiber diet has only made the fissure problem worse. Everyone is different and everyone's fissure situation is different, but I was only getting worse and worse when I was eating tons of fiber. It just made no sense to me to continue doing something that was clearly worsening my condition.
Experiment with your diet and find what works for your own body.
Wishing you the best.
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Re: Delayed Pain after BM and Low Fibre Diet

Postby bruce phyllis » 07 Aug 2018, 17:12

my doc mistook a fissure for piles on my first visit and prescribed stool softeners and whilst my motions with it were smoother they were fatter and more painful to pass. eventually saw a rectal specialist who put me on magnesuim hydroxide to slim things down and that helped so much.
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