Posted 7/15/2013 7:48 PM (GMT 0)
OK, so I hope no one minds if I call myself something of a fissure and hemmie expert. I've had them near-constant for more than two years, and seen five separate doctors to try to get them under control.
First off, it might not be a fissure at all. If you're not seeing bright red blood on the TP, it's probably not a fissure. And if you're not feeling like someone is stabbing you with a knife when you go #2, it's probably not a fissure. Based on what you describe, its more likely you have hemmies than anything else. The pain you feel shortly after using the bathroom is probably your sphincter muscle (anal sphincter) spasming. That is, it feels irritated for some reason, and so it tightens as tight as it'll go. This causes pain. serious. pain.
The way to tell, at home, if this is the source of your pain, is to insert a gloved, lubricated finger into your rear. Sorry, I know it's probably gross, but, well, this is what we deal with on this forum. So....it should be fairly easy to insert your finger. Should feel a lot like a gyn exam. If you feel tightness (not with your finger, but like after using the bathroom), or if its moderately to excruciatingly painful, then your sphincter is spasming.
Some people can successfully use diltiazem to remedy this. You can search the web and get lots of resources and explanation as to why diltiazem works for some folks. For others (me), it doesn't. My pain relief has, most often, come from epsom salt baths. I put 4 to 5 cups of epsom salts in the bathtub,, fill it with 6 inches of nice hot water (ok, "nice" and "hot" this time of year don't really evoke comfy kinds of feelings. Just pretend it's winter, or crank your AC), and soak for 20-30 minutes. Now, I should definitely mention the first time I did this, I think I had enough epsom salts water leak into my colon that it caused three extra bowel movements that evening. And they were hellishly painful. So, if you want to go really slow, start by soaking your feet, or perhaps feet and calves in a bucket. Say, 1-2 cups epsom salts for a 5 gal bucket. If you get some pain relief, then maybe step it up to the bath. For me, soaking my feet got me, literally, overnight pain relief. I soaked in the evening, and next morning I didn't have nearly the pain.
OK, if you have hemmies and those are the source of the pain, the best thing to do is see a proctologist who knows the Keesey technique for reducing them. You can google "hemorrhoids Keesey" and get an idea of what's involved. This technique was also key to my healing, though it (obviously) didn't prevent my fissures (drat!). In my city, there are three doctors in one clinic that do this kind of work, and they can usually get me an appointment same-day or next-day. And, of course, when you're suffering with hemmie pain, prompt attention is very, very helpful. Also, a proctologist can see what's going on just using an anoscope; they don't have to go all the way to an endoscope (which requires cleanout, etc).
Until you can get an appointment of any kind, one thing you might consider doing is lubricating before a bowel movement (at least, when you know enough in advance). Again, a gloved finger, and pH-neutral lubricant. It's definitely helped me. Last alternative, though this one has pluses and minuses, is to use lidocaine ointment before a bm. downside is that lidocaine can sting/burn before it takes effect. I had a hard time tolerating lidocaine on a few occasions. But, your primary doc should be able to call-in a script for lidocaine ointment (I'd suggest 5% lidocaine).
OK, that's enough for now. If it turns out you have fissure(s), post again and I'll tell you what appears to have, very recently, healed me in that area.