What exactly is the "plug effect"?

Just curious about the meaning of the term

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What exactly is the "plug effect"?

Postby Luka » 10 Feb 2016, 13:51

Hi there everyone,

I was just wondering what people mean by the "plug effect"? I've heard the term on this forum quite a bit and just wanted clarification as to what it meant.

Does it mean when you use the bathroom first thing in the morning (or whenever you have your first bowel movement of the day) that the first part is harder than the rest to get out? Does it mean your first movement (if you have a few movements a day) is more on the constipated side and it's harder to push out?

I think that's what I've been experiencing since my fissure started flaring up again. I will have trouble going in the morning, like my spincter muscle tenses up and it's hard to go. Plus, the bm is drier/harder. My second movement is usually trouble-free and easy to pass (although tending more toward the diarrhea-side of things).

Sorry for being so descriptive, but I was just curious about what people mean by the term.

How do people solve the "plug effect" problem? Does eating more fiber usually help or stool softeners? What about Miralax? I'm wondering about Miralax, but I'm not sure what time of the day I should take it to avoid the plug effect in the morning.

Thanks everyone!
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: What exactly is the "plug effect"?

Postby Johnny91 » 10 Feb 2016, 14:40

First things in, first things out. This was a living nightmare for me on the first weeks.
Stools get dehydrated constantly if you don't drink enough or if you eat diuretic food and too much caffeine.
I'm not sure if its normal as i never had constipation or hard stool problems before my fissure.

I've figured out two solutions, lube the first thing you eat in the morning with oil (i used to drink 1-2 spoonfuls of olive oil before switching to mineral and vice versa). This way you keep the first stool that will come out lubricated soft and humid and it makes the difference, especially if you are at the point of rip/heal bloody cycle in the beginning.

Also in my case, i've noticed improvement by going first thing in the morning and last thing before bed. This way i don't keep the stool for more than 12h and its a lot better than getting it out next morning when ~24h have already passed.

Finally if it still goes hard for any reason (stress, food, less water intake etc) you can always use a bottled enema to help things out.
They have saved my life multiple times in the past months.

There should be oil based Fleet enema available at your location. Unfortunately i only have saline enemas available here.
You may be afraid of the tip of the enema at first but using some xylocaine gel on it will hurt you at lot less than the hard stool.
You can also heat it up a little and use pressure on it if the stool seems really hard, it helps a lot with ripping it to pieces.
*edit*
Also after LIS they plug the area which they open to get to the sphincter with gazes and antibiotics to seal it against infections
Upon further research it seems that a plug is being put in after fistula surgeries in the area. this type
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Re: What exactly is the "plug effect"?

Postby whatsherface » 10 Feb 2016, 15:05

my solution to the plug effect
2 glasses of water in the morning + magnesium supplement
also drinking 2-4 tbs of olive oil throughout the day. and i usually mix it with a bit of mango juice because i dislike the taste of olive oil.
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Re: What exactly is the "plug effect"?

Postby msimon » 11 Feb 2016, 03:12

You are right about the plug effect. My solution to it is Miralax. There is nothing quite like it. It has helped me, and many many others tremendously. I take it in tiny doses throughout the day, with meals, but I would think a dose with your breakfast would be the most important. Everyone is different and it may take some experimentation to find out what works best for you.
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: What exactly is the "plug effect"?

Postby Luka » 11 Feb 2016, 11:56

Thanks everyone for the information. I was just curious about what the term really meant. Seems like I'm getting that in the morning, which is when I have BMs. : ( Bummer. Maybe if I had a BM later in the day I wouldn't have a problem, but my body doesn't tell me to go until the morning. That's how I've always been and I don't think forcing a BM in the evening will do me any good since I just don't get the signal to go.

Maybe if I don't eat breakfast and just wait untl lunch to eat will help so the stool isn't in there so long, although I get really hungry in the morning sometimes. I lots and lots of water throughout the day, so that's not the problem.

So, I have some options: Miralax, magensium supplement, and mineral oil. I will give each a try and see how I do. More experimentation for me!
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: What exactly is the "plug effect"?

Postby Johnny91 » 11 Feb 2016, 12:34

The more you eat the better. It keeps your digestive system active. While sleeping you get dehydrated and the colon draws even more fluids off your stools. If it gets really bad do try enemas, its better than ending up with a bloody mess.
Try sitting in the toilet before going to bed. Most of the time the position works for me and i have a successful 2nd BM every night.

It makes a great difference
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Re: What exactly is the "plug effect"?

Postby Luka » 12 Feb 2016, 13:12

Johnny91 - I agree that I need to eat more. I've never been a big eater, though, and it's difficult when you're in pain. Kind of zaps your appetite. : ( I'm a petite woman in her 30s and am currently 95lbs. I've lost about 15 lbs because of all this. The majority of what I eat are veggies and fruits, as well as whole grains. It's hard to gain weight when eating that.

I don't think I'm to the point of using an enema (and hopefully never will be! They kind of scare me...). As far as using the bathroom at night, I've tried and my body just doesn't want to cooperate. It doesn't get the signal until morning (I've been that way my whole life), so I guess that's just the way it is. I don't want to use any strong laxatives to force it, so I'm just going to try to solve the harder stool in the morning issue.
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: What exactly is the "plug effect"?

Postby Johnny91 » 12 Feb 2016, 13:58

My biggest problem when this started (and what made it worse), was overdosing with insoluble fiber.
Maybe this is your problem too. I was told by doctors that i needed to eat more fiber but my diet already had plenty and i ended up with even bulkier stools that kept ripping the fissure.
Check this topic, it explains whats going on with soluble/insoluble and has some interesting links.

Regarding the enemas don't be afraid of them as they are more fissure friendly than hard stools while on your period.
You could struggle 23 days a month and get to point zero again because of this, so just give it some thought.

Also regarding the plug effect, there are times that i can easily go 2-3 times a day and then again there are others that i have to wait until 2-3 am for that urge to go. Sometimes i just get to bed but i know that there's a possibility i'd regret in next morning. Oils in general help stools reach fresh air quicker though.


There's also a possibility that you already have a level of stenosis and you might need some dilation done but i cant help you with info on that. I think Savaici has some experience on this and she might help you out with tips.
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Re: What exactly is the "plug effect"?

Postby Luka » 13 Feb 2016, 12:10

Johnny91 - I think most of the fiber I eat is soluble. That's what I've been trying to eat, at least. I eat prunes, strawberries, peaches, lentil soup, brown rice, white potatoes, lettuce, broccoli, carrots, sweet potatoes, some chicken, and some banana bread in the evening. That's about all I eat (though what I eat varies... it isn't all of that each day).

Thanks again for all the advice. Going to take it a day at a time and try out the GTN and a few others things.
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: What exactly is the "plug effect"?

Postby Johnny91 » 13 Feb 2016, 13:00

Hi Luka
Not all fruits have the same effects. I remember back in June i had the most painful stools ever with strawberries & watermelon. I also didn't have any help with peaches, pears, fresh prunes(eating dried make me go 3-4 times), despite the common belief that they do help with constipation etc. I also remember a retear i had in september due to replacing apples with pears to avoid going to the supermarket to replenish my stash. Lentil's might not be a good idea, although i didn't had a tear the one time i ate after the fissure, but it sure hurt because stool wasn't formed quite right, they also have iron so it might cause some hardening.
I don't know a lot on IBS and i have no idea on how your bowels will react but maybe the problem on your stool form is the time and the foods you are eating.
Try replacing lentils with butter beans, replace prunes, strawberries and peaches with apples and oranges. Limit the consumption of rice & potatoes, exclude lettuce for a couple of days to make sure raw greenleafs don't affect you and keep on with the rest. Oh also refrain from eating banana bread.
If you manage to have a normally formed bulk enough stool, then you can try mineral oil. If its too runny there's no point in using it.
In addition, if these work for you i can expect some similarities with my GI tract and could give you further advice.
The worst thing on this is that you eventually turn yourself into a guinea pig in order to figure out what works and what doesn't...
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