Went to Colorectal Doc Yesterday--Feedback Welcomed

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Went to Colorectal Doc Yesterday--Feedback Welcomed

Postby fieldingmellish » 09 Mar 2016, 14:07

Hey everyone.
First time posting here.
Been dealing with fissures off and on the last few years. They come and go (healing and getting opened up again), but after the pain a few weeks ago, I finally went to the colorectal doctor yesterday. I have a fairly decent diet but my bowel movements tend to be hard. I've never had any blood (knock on wood).
He gave me the exam (Holy hell, that was beyond unpleasant), but he did confirm that it was a fissure. I was a little too woozy to ask if it looked like it was in the process of healing or not.
He recommended the same stuff that it looks like most of you have been prescribed (diltiazem) and a pain relief gel (tetracaine). I only started using the diltiazemgel this morning. He also recommended increasing Fiber and drinking Miralax.
Couple thoughts:
1) the doctor recommended I go "up to the 2nd knuckle" when applying the diltiazem. I tried this morning and I don't think there's any way I can go that deep. Will the gel be worthless if I can't go that deep?
2) He recommended drinking Miralax as well as taking a fiber supplement daily, but I feel like the combination of those 2 things will make things...uh...explosive? Won't that possibly irritate my anus even more?
3) What are people's thoughts on stool softeners? Should I use them in PLACE of Miralax or fiber, or in addition to?
4) I started using baby wipes. Yay or nay?

I dunno. This whole thing certainly isn't the end of the world but it's a real bummer dreading having to poop everyday.

I'd love to hear from some of you that have dealt with this. Most of my pain tends to dissipate after having the bowel movement (which can be excruciating), so I didn't use the Tetracaine this morning yet.

Thanks everyone.
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Re: Went to Colorectal Doc Yesterday--Feedback Welcomed

Postby thedude » 09 Mar 2016, 15:08

Both my Doctor and my pharmacist said to not apply the Diltiazem interally. Only to spread it around the outer area of the rectum. My diltiazem container even has a big red sticker on it that says "FOR EXTERNAL USE ONLY" haha. That being said, there seems to be conflicting information as to whether to use it internally or externally. Personally, after a week or so, I started applying internally (between first and second knucke). Not sure if that helped more or not, but I do it anyway. With that being said, even if you can't get it in far enough per your Doctors recommendation, the gel will still work and be absorbed into the skin. Perhaps after some use externally down there, the muscles will be relaxed enough where you can start to get inside a bit more.

Regarding miralax and fiber supplement, I believe there is a fine line..you don't want explosive bathroom trips, but at the same time you do want them regulated, and of a good consistency. I don't take a fiber supplement, but rather just focus on eating fiber rich foods throughout the day and take a stool softener at night before bed. My BM's are usually in the morning hours so taking that before bed let's it work for several hours. You'll have to play around with what's right for you.

Regarding miralax, I think it's a laxative / stool softener correct? Like your second question, you'll need to just be careful and play around. You don't want to take to much of this stuff and have diarrhea. I don't take any laxatives, just a stool softener and eat my daily allotment of fiber. I also make sure to drink a good amount of water as that helps to move things through the system and helps prevent stool from drying out.

As for baby wipes, I think they're fine, you just have to make sure you don't use a lot of pressure when wiping. I use a mix of TP and then use some witch hazel pads at the end. If I'm home, I just use a little bit of TP, then take a shower to rinse things off and help relax.

Also, one thing that seemed to help me was coconut oil. I'd take some coconut oil and use it around my rectum and as I was able to eventually get a finger in there, I would put some on the inside, then eventually I made some coconut oil suppositories. I think the main thing they did for me was it helped keep the anal canal lubricated which made it easier to pass stool. It also made sure it nothing got to dry down there which could complicate things. Get use to that swamp butt feeling down there for a while, but I think it definitely helped for me.

Good luck!
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Re: Went to Colorectal Doc Yesterday--Feedback Welcomed

Postby Manitourose » 09 Mar 2016, 15:25

Welcome!
So sorry to hear you are going through this as well. You've definitely done the right thing in seeing a specialist. Though they all can have their own beliefs about how these things work. I'll do my best to answer your questions from my experience. I've seen about 4 colorectal surgeons. More because of moves, but anyways, they each differed just slightly. So nothing you are doing or have been told is wrong really. And finding a plan that suits your needs is what is important.

1) the doctor recommended I go "up to the 2nd knuckle" when applying the diltiazem. I tried this morning and I don't think there's any way I can go that deep. Will the gel be worthless if I can't go that deep?
No kidding, getting that up there can be HARD! Most (doctors and patients alike) believe that the ointment works to relax the muscles and promote blood flow to heal the area. This CAN be done by just placing the cream on the outside. This was confirmed to me by a CRS at Columbia University. That being said I have also have had more healing and effects by placing it inside. But getting it to the 2nd knuckle... Ouch and hard to do! I say do your best but know the ointment will still do a good job just placing on the outside.

2) He recommended drinking Miralax as well as taking a fiber supplement daily, but I feel like the combination of those 2 things will make things...uh...explosive? Won't that possibly irritate my anus even more? Go slowly with adding fiber and miralax, this way you can control the explosive factor. Start with 1/2 the doses and some people also break things up when they go to full doses such as half in the afternoon and another half at night. Or whatever works for your schedule. But definitely go slowly and lots of water.

3) What are people's thoughts on stool softeners? Should I use them in PLACE of Miralax or fiber, or in addition to? I have tried Miralax and I think it is a popular choice on here and doctors don't seem opposed to it. I probably wouldn't add a stool softener in addition to it. If you choose a stool softener over Miralax make sure to stay away from any laxative forms. A brand recommended to me by a CRS was Dulcolax/Colace.

4) I started using baby wipes. Yay or nay? Personal preference. Try to keep them as natural as possible. Most CRS don't prefer them due to the additives but I know myself and others have used them at different times.

Are you also doing sitz or regular baths? They really help as well for healing!

Welcome again and hope you are healing soon!
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Re: Went to Colorectal Doc Yesterday--Feedback Welcomed

Postby Canadabum » 09 Mar 2016, 17:47

just wanted to chime in and let you know that i agree with all of manitourose's response - good advice, perspective and questions

my docs all told me that spreading the diltiazem around the outside of the anus was sufficient...the meds are easily and well absorbed by your skin in that area.
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Re: Went to Colorectal Doc Yesterday--Feedback Welcomed

Postby chachacha » 09 Mar 2016, 18:10

My CRS also instructed me to only use the diltiazem on the outside, even though my fissure was extremely internal. He told me that the skin would absorb the ointment and help more blood flow get to the area.

I find that wet toilet paper is much softer than baby wipes and you never have to worry about scents and chemicals at all. Of course a baby wipe would be good if you're away from home though, and don't have easy access to water while on the toilet (like in a row of stalls in a public bathroom).
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: Went to Colorectal Doc Yesterday--Feedback Welcomed

Postby fieldingmellish » 09 Mar 2016, 21:14

Wow thanks so much for the replies people! Today is only day one so I haven't started with the fiber or Miralax. I mostly just did the diltiazem today and am hoping I won't have to start chugging Miralax or Fiber supplements everyday. I'll be going to Walgreens tomorrow to pick up some Dulcolax/Colace. For some reason my primary doctor (not the colorectal specialist), for a reason I don't recall, was not a fan of stool softeners. Maybe because they can dehydrate. But it seems like a few of you have had some decent outcomes by using them. I'm certainly willing to give it a shot.

It's interesting how there are so many varying opinions on whether the diltiazem should only be used externally or internally. I am following my doc's orders (two go "two knuckles deep") even though I'm not getting nearly that deep. I'm trying to just apply the gel liberally around in there and hopefully I'm getting it close to the fissure....? I really have no idea where it is.
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Re: Went to Colorectal Doc Yesterday--Feedback Welcomed

Postby bort-bort » 19 Mar 2016, 15:54

chachacha wrote:I find that wet toilet paper is much softer than baby wipes and you never have to worry about scents and chemicals at all. Of course a baby wipe would be good if you're away from home though, and don't have easy access to water while on the toilet (like in a row of stalls in a public bathroom).

I agree, although i've taken to carrying a small (about 80mL) bottle of water with me in case I need to go to the bathroom at work or out and about. I just blot the toilet paper with it, and it's small enough that it fits in my pocket (it's not very comfortable so I try to keep it elsewhere if possible).
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Re: Went to Colorectal Doc Yesterday--Feedback Welcomed

Postby fieldingmellish » 20 Mar 2016, 12:48

Just wanted to give everyone a short update:
Been 2 weeks since I went to doc. Finally starting to see some relief. Been taking fiber gummies (bought at walgreens) daily, as well as a Colace stool softener before bed every night. Also using diltiazem gel 2x daily.

Seems to be helping. Pain has reduced a lot when having a bowel movement. Only thing I'm unsure of going forward, is do I basically need to take stool softeners and fiber supplements for the rest of my life?

Time will tell I guess....
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