Questions for folks who had/have fissures

For you folks who are going through this or who have gone though it... I am so sorry. I can't imagine how horrible it must be/have been.

I am obsessed with the potential of having it happen to me. Scared to death.

So my questions are:

Knowing what you know now, what would you have done differently?

Were there early warning signs?

What can I do to prevent having to go through this?

In other words how the HELL can I PREVENT this from happening to me?

(PS I already drink as much water as I can and I do add fat to my diet intentionally. I also take Mag Oxide with each Calcium dose.)

Thanks so much,

I haven't had them myself but I'm pretty sure you'd have plenty of warning. How are your BM'S? If they are hard and if you have to strain then I'd be worried. Have you battled constipation since having your DS? It's never been a worry for me personally, but then again I have not been constipated at all. I think most of the people that have them have a long history of having to take tons of stuff to poop on a regular basis.

Becky, When I had my first set of twins an after I had my RNY I had a terrible MOFO of a Fissure.  I cried for weeks.  Infact I think I cried my whole first trimester.  Anyhow my advice to you would be to not strain.  If you are havng constipation issues and you are really straining then you will be at risk.  Drink lots and lots of water, make sure you are not constipated, don't strain, get lots of exercise as it helps move things through faster and for me I ate fibre tabs by the bottle to help. 

I don't wish a fissure on my worst enemy, I still worry about mine and it has been 10 years

Diana Cox wrote a very good post on this subject quite a while back. I thought I saved it but I can't find it now. Maybe you can do a search?

www.obesityhelp.com/forums/DS/3693225/Anal-Fissures-Medical- Non-Surgical-Treatment-Regimen/

Becky,

If I could go back in time, I absolutely believe I could have prevented my fissures.  I was too lax about my constipation.

I didn't move to taking MagOx and stool softeners soon enough. On top of that, I had a few days where I wasn't mindful about adding fat and just happened to eat barely any. That was enough and after a couple of very hard stools, the fissures happened

Every time they've recurred, it's been due to the same issues. (Once you get them, it is much easier for them to recur, based on what I've been told.)

It sounds like you are already being mindful of fluids, fat and supplements. If in spite of that you notice issues with constipation or hard stools, I'd add Colace and/or Miralax.

Hope that helps!

Jenna

http://www.obesityhelp.com/forums/ds/4241973/How-do-you-get- a-fissure/#34866114

As per Diana Cox

Avoid foods that make your poop acidic (some people have issues with tomato sauce, for example).  You will know if it stings when you poop.

If you have 'rhoids or other pre-existing issues, you may want to use a diaper wiper to clean up after a poop, to make sure none of the caustic bile acids are left hiding in crevices.

A fissure is a tear in the delicate anal mucosa that essentially ulcerates rather than healing, and ends up burrowing through to the point where it inflames the sphincter muscle.  If you get a sore spot, DON'T IGNORE IT.  Immediately take steps to treat with 'rhoid cream and be particularly careful about how you eat and poop.  Start taking stool softeners if necessary.    Sitz baths, hot tub, shower massager can be soothing and help healing a sore before it turns into anything more.

Don't allow yourself to get consitipated.  Pudding poop is the ideal in terms of it being easy to pass.  Bricks are a no-no.  Peanut-butter pasty is also hard to move.  Diarrhea is also bad, because it's often acidic.  Make sure you're getting enough fiber.

DO NOT BEAR DOWN when pooping -- be patient.  Get Zen with your bowels.  Let **** happen.

DO NOT spread your ass cheeks apart tautly while sitting on the pot.  If you flabby butt cheeks get in the way of a straight shot into the pot, lift and separate but don't do it so tightly that the sphincter is already under tension before the **** happens, because you could cause the muscosa to tear.

Buttsecks is probably not a great idea.

Fiber, Fiber, Fiber!  To get fiber without having all the carbs that sometimes come along with getting enough Fiber I take Psyllium Capsules.  I get the Target brand and I think it is only like $4  for 240 capsules.  BUT I have to take 8 of them a day ( 4 at a time).  Plus if I think things are "not moving easily enough" I take some miralax or the equivilant and that has helped me.  A colorectal doc told me about the fiber capsules though and those seem to work pretty well for me.  But I caution you, what works for one, doesn't necessarily work for all. 

Lucky you for not having had to deal with this issue so far!  Here's hoping is stays that way for you!
Amiee

I  have never once since this surgery been constipated, rather I am one of the ones that goes frequently 3-6 times a day regardless of what I eat. I developed mine from going with some urgency during the first year when I was very high protein, high fat and low carbing. Yes the very way of eating that is best for DS'ers did me in. It was the worse pain I have ever had and I have a very very high tolerance for pain.

I actually had to add in carbs  and fiber in to help firm things up. Benefiber became my friend- i never had a day go by without one or two doses until it finally healed.

So I ended up having to eat higher carb than most but it keeps me from having it re-occur.  I still go from 3-6 times a day but it is not with the super urgency and explosive nature. I may notice more smell to my poops, but they smelled before surgery (its a family thing- Dad is notorious as well).

It seems to be the two extremes--constipation with straining for others, or explosive fatty stools for me.

Just keep things soft and don't force things. Mine started with constipation, so fill in everything Jenna said. I will say I tried fiber, and all it did was make me need to go more, and it was firmer than a regular DS poop. So now I do 2 colace in the AM (which I forgot this morning and will take as soon as I get home in hopes of avoiding what I know is coming in the morning), then four at night before I go to bed. I also had to switch to calcium hydroxyapatite because it was the citrate that was stopping me up.