Why the recurrence?

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Why the recurrence?

Postby ttt31 » 28 Jun 2013, 13:01

Hello everyone!
I'm so happy to come across this site- I guess it's just a relief to share with people who understand the pain! I'm a new sufferer, with the first occurrence 2 months ago. It happened after about 5 days of constipation, and the hard stool was just waiting to rip through my anus. After 2-3 days of glass shards scraping out my rear, I saw an internal medicine specialist who prescribed antibiotics for infections and stool softeners. The antibiotics- Neurobion- caused quite a lot of pain, so stopped those. The stool softeners were OK- (Isapgol husk) but Gotu Kula (penniwort, or rau ma)- was better than anything I've tried in softening stool, although you may get green stool. Sitting in a bucket of hot water, in lieu of a sitz bath, was helpful but made me at times question the purpose of existence. Having a loved one nearby and knowing details if necessary can make a HUGE difference, and I recovered within 2 weeks.
I decided to change my diet. Stopped eating meat entirely and made a conscious effort to include more fibre in my diet. Then now about a week ago, it happened again. First, a minor pain and bloody tissues after wiping, then a couple of days later, the full-on fissure experience. It's been over 3 days now, and I've just done my first epsom salt bath, and taking Duphalac lactulose syrup and an ofloxacin/ordinazole pill. The doctor gave me some hydrocortisone- despite me asking for 0.2% nitroglycerine- but decided against it from reading about its mixed effects on fissures online. Hopefully this will what will get me through this bout of fissures. Has anyone else followed this prescription? Any recommendations or advice?
But I'm also here to share my experience at an allergist I saw. Seems I may have adverse effects to eating eggs and dairy. I was wondering if anyone else has had this diagnosis, and I'm just wondering if the eggs and dairy somehow prevent mucus from lining my colon/anus which causes stool to damage the lining of your digestive tract easily? I'm no detective, but this is the only thing I can think of, because I bloody became vegetarian- now vegan!- which didn't seem to help. Alcohol must also be kept away from for the rest of my existence.
Thanks for listening! Thanks for sharing!
Kayo
ttt31
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Re: Why the recurrence?

Postby Guest » 28 Jun 2013, 13:38

damned those bloody AFs!!!
Sorry for your recurrences ttt31. Lots of AF folks stay away from milk or dairy products whether for lactose or other reasons. Your not lactose intolerant are you?
Be careful of what type of fiber your taking in as too much insoluble will give you huge bm--too bulky=retears. Balance the insoluble with the soluble, its a tricky game but experiment.
HTH GL
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Re: Why the recurrence?

Postby Ever the Optimist » 28 Jun 2013, 13:43

Hi Kayo, :) 
Welcome to the forum, but sorry you also have to be here with your plight. Having the comfort of people around you and someone just to share your pain with makes a huge difference in the way you are able to deal with it all.
Unfortunately, my belief is, once you've suffered an anal tear, whether small or large, which heals quickly or turns chronic, means you have fundamentally inflicted trauma to an extremely fragile area which in turn, does make you more vulnerable to a relapse.
Once you tear, it's almost a sign you need to change and maintain new dietary & toilet habits for life and part and parcel is the experimentation you describe in trying to find what works for you.....Sorry I'm unable to comment on the effects of eggs & dairy in particular because I don't know, but hoping someone else can answer that one for you....
A few suggestions I would make, are:
1) if you don't pre-lube your anus with Vaseline prior to a BM, then consider doing so, because it helps ease stool evacuation and can coat the fissure whilst passing stools to help protect the fissure.
2) If your pain worsens or stays the same but does not reduce, please consider asking for Rectogesic or Diltiazem cream to help reduce spasm of the internal sphincter muscle and to promote blood flow to the area, which in turn, can help the wound heal better.
3) I would also seek a referral to a CRS, who will diagnose and advise better than any standard GP because they are the specialists.
The stool softeners are a great idea when dealing with an acute fissure as recommended but I would also be wary of hydro-cortisone, which is not recommended for long term use because it thins the skin in that area, thus leading to potentially more complications....
Personally, I also avoid any tough red meats/ processed stuff but have never had issues with fish/ turkey or chicken, so if you've been avoiding these purely because of the fissure, they really don't seem to cause too many any additional worries if you do eat them - Of course, if you've increased your fibre, just ensure you are drinking adequate fluids too.
Fissures are frustrating beyond belief and recovery, can be unpredictable, but the bottom (no pun intended!!) line is, if you keep your stools as soft as soft, never allow yourself to get constipated, never strain or push in anyway during a BM & never "over" wipe, then you are taking some of the most important steps in helping to get over them - these of course, always combined with eating the right diet/ taking lots of fluids/ stool softeners & Sitz baths to promote blood flow.
I truly hope you find out what works for you very soon and hope you manage to deal with your fissure whilst still acute as they are easier to heal at this stage as opposed to one that becomes chronic. All the very best to you :) 
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: Why the recurrence?

Postby ttt31 » 28 Jun 2013, 16:05

Ever the Optimist and Buttastic, thank you so much for your reassuring words!
I haven't actually tried lubing up with vaseline before bowel movements- will definitely give it a try! And I've been using bog standard toilet paper (pun intended) with water to wipe which seems to be working ok.
I think so far I've been doing ok with balancing soluble and insoluble fibres. Although about soluble fibres- apples are in this category, but I've heard people say apples are bad news for AFs. Why is that? Doesn't seem to bad for me I think. I've heard this with orange juice too- should these be avoided?
Is a CRS the same as an endocrinologist? I met one of those and he wasn't overly helpful. My internal medicine specialist says I should maybe get a colonoscopy if AFs continue to recur. Has anyone got this? I looked into it and it looks like an incredibly expensive procedure, so i'd like to avoid that for the moment. Speaking of costs, how much does a Lateral Internal Sphincterectomy usually set one back? Again, only to pursue if things get hard.
Thanks!
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Re: Why the recurrence?

Postby Ever the Optimist » 28 Jun 2013, 16:41

Hi TT,
No, an endocrinologist specialises in hormonal issues & imbalances generally, so you would definitely need to seek the advice of a CRS.
A CRS will probably first want to try to examine you internally to see if they can detect a fissure or any other issue. They may use an anoscope to perform a digital rectal examination. This is like a long thin torch which allows them a better inspection. I'm not sure a Colonoscopy would be the first option generally?...They may suggest an Examination Under Anaesthesia to have a really good look if they fail to find anything visually or you are just in too much pain. This is a really effective measure and painless for you because you're asleep.......
Re the apples, I've never had any problem with them either - This totally depends on the individual - the same as Oranges, which actually help me a lot.
Apples are a source of soluble fibre and a lot of people find insoluble fibre better in their diets with fissures because they add bulk to a diet but also have a laxative effect but I personally have a balance of both too and no issues with this & both of course, are rich sources of fibre. They just work in different ways. I think if you are producing soft stools anyway, then don't worry too much about this.
I hope the Vaseline helps you - A lot of us swear by using this on this site!! and a lot of people use the moistened baby wipes, so dabbing with wet toilet paper would probably work as well. I actually use a hand-held shower head to clean up, which is great, as you know and feel like you've had a proper clean-up too.
I'm afraid I can't advise on the costs of LIS because I'm in the UK and if I were to have this, would probably get it done under our public Health Service. I'm sure this has been discussed a few times on this site, so if you search on LIS, you will probably find a very helpful post somewhere though.
I wouldn't worry too much about this just yet as hopefully you might not even need to go that far but I'd definitely discuss one of the recommended creams though as your first option if you get no reduction in your pain. A CRS will absolutely advise you on exactly your best course of treatment also, so it really is important to get properly diagnosed.
Manuka honey & Raw Virgin Coconut Oil also seem to be firm favourites with people on the site for applying to fissures and sore bottoms & some swear they have helped them heal, so these might be worth a consideration for you? Pop back anytime you have more questions......
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: Why the recurrence?

Postby Ever the Optimist » 28 Jun 2013, 17:07

http://anal-fissure.org/t4357-a-key-to-af-healing-soluble-vs-insoluble-fiber
TT,
A little more on Insoluble V Soluble Fibre (A really good read)......
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
Ever the Optimist
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Re: Why the recurrence?

Postby Savaici » 28 Jun 2013, 18:01

Welcome to the forum! Glad you found the best place on the net for all you will ever want to know about the life of an anal fissure... Image
A CRS, by the way, is short for a Colon and Rectal Surgeon, and is the very best doc to see for fissures. As you have only had yours for two months you still have a good chance of healing with nitro, or a calcium channel blocker such as Diltiazem or Nifedipine in a topical form.
Here is a little more about soluble and insoluble fibre. Don't go over the top on fibre, and as said above, make sure you drink enough water:
Fiber is commonly classified into two categories: those that don't dissolve in water (insoluble fiber) and those that do (soluble fiber).
Insoluble fiber. This type of fiber promotes the movement of material through your digestive system and increases stool bulk, so it can be of benefit to those who struggle with constipation or irregular stools. Whole-wheat flour, wheat bran, nuts and many vegetables are good sources of insoluble fiber.
Soluble fiber. This type of fiber dissolves in water to form a gel-like material. It can help lower blood cholesterol and glucose levels. Soluble fiber is found in oats, peas, beans, apples, citrus fruits, carrots, barley and psyllium.
The amount of each type of fiber varies in different plant foods. To receive the greatest health benefit, eat a wide variety of high-fiber foods.
Any idea why the doctor gave you antibiotics?
A good idea too is taking a probiotic. There is quite a lot of info on here about this. Use the search facility, which is at the top of the page, on the right.
All the best!
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Re: Why the recurrence?

Postby ttt31 » 29 Jun 2013, 03:52

Hi Savaici,
The doctor prescribed antibiotics because when he examined me, I was in serious pain so he decided that the fissure may have been infected. But I've always had bad reactions to antibiotics so not sure if this would be the case for other people.
OK- so the soluble/insoluble fibre balance sounds very important. But the catch is, since I saw an allergist a few days ago, I have to stay off soy, red beans, mango, papaya, banana, avocado. So need to get soluble fibre via beans, carrots, apples and oranges, so hopefully they won't cause an adverse effect.
So in the UK, the NHS covers for LIS? That's amazing! I'm moving to the US next week, so I'm crossing fingers and toes that the fissure doesn't get too bad while I'm there, as I don't know yet about insurance plans and the costs people are quoting on this site about LIS is a lot.
I'll also look into Rectogesic/diltiazem/nifedipine as well as the manuka honey/coconut oil if the pain doesn't subside. So many medicines to remember.. But from reading a lot about it, the hydrocortisone cream is something I will stay far away from.
Thanks for the help!
ttt31
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Re: Why the recurrence?

Postby Ever the Optimist » 29 Jun 2013, 05:43

Yes,
The NHS covers the costs for LIS and although we tend to complain about the waiting lists and delays etc. we are very fortunate to have the system in place!! I see so many people on here struggling financially and unable to cover US costs, so we are fortunate in that respect.
Good luck with your move though, and sorting out your balance with the fibres. As long as you are having and maintaining soft stools and no issues with constipation, you will be eating the right things for fissure healing.
All the very best to you!
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
Ever the Optimist
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Re: Why the recurrence?

Postby Guest » 29 Jun 2013, 11:05

ttt31-you said
Then now about a week ago, it happened again. First, a minor pain and bloody tissues after wiping, then a couple of days later, the full-on fissure experience.

Here's where your detective work comes into play; do you remember how your stools were just prior to the recurrences? were they a bit harder-bulkier, a bit looser runnier, or not to different from before.
Yeah, I have to tell you, The "Honorable Vaseline" is invaluable for stopping recurrences and helping ones already "re-curred".
Whenever I was healing from one of my fissures and I felt a huge bm coming I wouldn't hesitate shoving a few tablespoon of petro j up inside me.
And now, even though I have been healed for a while, I f I somehow get too many hard bm's or strains, I'll for insurance ease the straining and pushing with the jelly. (please no straining, fortunately a few is safe for me)
I know this has helped me avoid re-tears & recurr's and I bet it can help you too.
We wish you all the best on your move here. I hope stress on the "upcoming" did not contribute to your recurr, and I have heard in here that a move has help with their AF, so we hope a move help you.
GL HTH
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