Getting your stools consistent day in and day out is a HUGE factor! But so d@mned hard to do!
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I went for my appt. yesterday to the CRS. She looked and said she doesn't see fissures, just an ulcer that looks like it's healing. When I got home, I looked online and everything I read is that ulcers and fissures are the same thing. So, I'm confused. But, she said it's definitely not a fissure.
Anyway, she told me to get back on the fiber, so she recommended Benefiber instead of Metamucil because it's tolerated better by some people. Here's the thing. She said she wants me to take a Tbsp. 2x a day and also get in 30-35 grams of fiber on top of that! Doesn't that sound like alot of fiber? She gave me a diet to use, 3 servings of fruit, 3 servings of vegs, 2 pcs. of wheat bread, bowl of cereal, I can't remember if there was anything else. I don't have the paper in front of me right now.
I told her my tummy's been really upset and I have burning in my upper stomach. She said that shouldn't have anything to do with fiber.
She did say when I have a BM and it feels like glass cutting it or a sting, that night I need to use nitro cream. So, I had to use it last night because yesterday morning it stung when I went. Gave me a tad of a headache, but nothing bad. She did say to immediately take 2 tylenol to keep it from hurting too much.
I asked her why the primary said I had fissures. She just shook her head. I told her he said to keep it moist down there with vaseline or Tucks. She said no, that's the worst thing. She thinks I may have a yeast infection down there and I need to keep it dry. She told me to buy Lotrimin AF and put it there 3 times a day for 2 weeks until I go back to see her. But, she said Tucks are fine throughout the day, just no Vaseline. So, there's another thing the primary said that was wrong.
My stomach is still not great, but a little better. I know I won't be able to eat everything she wants me to for awhile, but I'll do what I can. She did say if the stomach problems continue, I should see about going to a gastro doctor. This should be interesting.
Julie

Oh, I know what else she said. I told her that when I was on the Metamucil the BMs were huge around and it felt like it was just popping things open each time I went. She said you want them to be big and soft like that even though you have an ulcer or a fissure. And it'll heal anyway. I'm trying to wrap my head around that. I guess your anus gets used to being opened up that much and eventually heals anyway. If anybody can explain that to me, I'd appreciate it.
Julie

I think you will find that doctors will often give you conflicting information even doctors within the same practice. This used to drive me crazy because I don't like ambiguity. I want to know if I follow steps 1,2, and 3 I will poop the right way, heal and lead a normal butt carefree life. After 5 years I am seeing that I have to consider their information but I am the one that has to poop out of this bhole and live with the pain and dysfunction. I find some things help and other things I have tried and it set me back. So I take into consideration what my body can handle, how it functions best and I don't do something that makes the pain worse.

I think an ulcer is a wound that hasn't healed. When I think of a fissure I think of a cut but they both hurt, can both bleed and take awhile to heal.

I posted an article about constipation that discusses that some people cannot tolerate extra fiber and that is can be counterproductive. I am not saying this is typical but one size does not fit all in terms of fiber recommendations. If you take extra fiber I wonder if adding a bit of miralax would help. I know must doctors say that big fluffy cloudlike stool are the easiest to pass. I do find that if it is thick enough my voluntary muscles don't have to push as much then if it is thin or explosive.

If you find your stool are bulky and you are worrying about scraping your anus then add some fish or flax seed oil supplements to help lubricate the stool.

I know it is frustrating. Hang in there.

Oh, I wanted to mention that I get about 35-40 grams of fiber from my diet. I swear by All Bran Buds cereal with soy milk.