Flare after pregnancy?

Hi everyone,

I gave birth to my daughter by elective c section 4.5 weeks ago. I managed to stay on remicade the entire pregnancy (had my last infusion at 38 weeks, had c section at 39 weeks) and have my next infusion in just over 2 weeks. Immediately after c section I was quite gassy but I think this is quite common and my stools were a bit looser. I took highest strength of dihydracodeine for the first week on and off because surgery pain was severe and then a week after this I seemed to become quite constipated (only going once every 3 days) and having bad pain when going like glass cutting me and then throbbing/soreness afterwards. This seems to have settled a bit but still getting soreness when going. And past few days waking up with slightly more urgency...

My question is how do you know if this is just constipation and a fissure triggered by taking codeine or the start of a flare?

Congratulations!

Is the pain anally or rectal?
It does sound like hemmie or fissure. A fissure you can see by squatting over a mirror.

Do you have rectal meds at all? You could increase foods for constipation or try stool softeners or maybe Mirilax for a bit to help soften stool and get things moving...see if that helps.
Plus call your doc and ask for something to use for hemmies/fissure.

q

Hi...it sounds like a hemmie or fissure, but you can call your doc and ask for mesalamine retention enemas. In UK available should be Salofalk, Pentasa and one is a foam (I think Asacol). Each have suppositories.

As well, see if there is Proctocedyl ointment.great for fissures and hemmies.

The point...doesn't matter if they arent big on it...just request.

Keep us updated.
q

Congratulations on your new baby! I had c-sections with both of my children (pre-UC) and they really upset my digestion. I didn’t take any pain meds after I left the hospital except Motrin but the surgery does a number on the body. I think my constipation issues took close to a month to clear up. I was prescribed a stool softener to help after my first baby. Reach out to your care team, but fingers crossed it is just healing from the surgery.

Hard to say, my first flare that lead to diagnosis was long and drawn out, started with increased cramps and looser stools before seeing blood few months later. When I flare I tend to start getting worse pain in mornings and looser stools... not having that currently.
Why do hormones affect uc?
Yes I had an epidural.. I had pain from incision and was only on paracetamol

Flare symptoms depend where the extent of the inflammation is.
q

Ribbon, if I remember correctly you have constipation issues. In a previous post you mentioned you were having painful bowel movements because of the constipation. Constipation can cause soreness & fissures. What are you doing to try to alleviate the constipation? A pharmacist can give you some good information for OTC stool softners.

Have you contacted your dr? May be time to make a call. Take care.

Thanks both for your replies. Yes straydog I became constipated after having my baby daughter probably due to codeine I was taking and lack of fruit and veg...
Right now I am having a bm once every other day/sometimes once per day that is well formed with no urgency. I am getting pain that is like glass cutting me that then hurts and throbs afterwards and I can feel an exact spot that it seems to come from. I also had my remicade last week and I'm still having the same symptoms. I had one slightly softer bm and on that occasion it only hurt a little and there was just a tiny trace of blood but since then they have been harder again and it's hurt again.

How are you supposed to know whether its a flare or fissure? It seems so hard to know. All I know is that in my experience of previous flares, this is very different if it is one..

I'm using a GTN cream for the fissure currently.

Sorry that this painful problem is persisting for you, Ribbon. It could be that you have an internal hemmie in addition to the fissure. I think hemmies are rather common post-partum for various reasons. Of course constipation will irritate both hemmies and fissures and delay healing-- so you definitely need to remedy that. If your doctor can prescribe a combination foam of low-dose steroid + Lidocaine analgesic or Pramoline, that would help anal healing and also relieve your pain. The red blood at end of bm seems to indicate that your problem comes from anal area irritation, rather than a UC flare. That's a very sensitive part of the colon with lots of nerve connections so probably your cutting-type of pain originates there, as Straydog seems to think, too. Take care and keep well-hydrated throughout the day, preferably with plain water. You could also try some steel-cut oatmeal (5-minute cooking) to soften bms, or well-steamed yams/sweet potato. / Old Hat