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Anal fissure vs. UC?

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Ulcerative Colitis
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Posted 6/14/2018 5:13 PM (GMT 0)
In the morning I usually have a series of BMs. The first one or two have no blood, but after that the bleeding starts up. It's like the frequency and the force of the stool re-opens something. My stools are mostly formed, depending on what I eat. The formed ones are blood streaked and they tend to disintegrate on flushing. If I have looser ones then there is blood mixed in, but again it depends on which BM it is. If it's one of the first BMs there will be no blood or very little but after a couple hours of evacuating the blood increases. It's nothing like a full on flare but it still concerns me.

I'm having trouble telling if this is UC or fissures? I also have a lot of fresh scarring in my proctosigmoid area from this recent flare and I thought maybe something is being torn open that tried to heal overnight.

My blood work yesterday showed my CRP is 5 and the normal is less than 4.8 so major inflammation is gone but maybe there is something local?

I know a scope could figure this out but I don't have one booked and my GI doctor is not being very helpful. I'm already taking cortifoam but it doesn't seem to impact this problem. I'm also on 15mg of prednisone and tapering.

Thank you again for catering to all my new posts and I am going to try to contribute here more as thank you.
Posted 6/14/2018 5:21 PM (GMT 0)
There's an easy way to know whether it's a fissure, does it hurt like all hell when you go? If not, it's definitely not a fissure. They are painful. Think of lemon in a deep paper-cut, or shards of glass slicing your bottom when you go, but it doesn't go away quickly, the pain sticks around for a while after BM. It's the type of pain that will have you pleading to a higher power for relief.

CRP, while they say it can be a good indicator, often isn't. I've been inflamed badly and had mine normal on many occasions. I am not saying this is the case for you, but i wouldn't use it as the "end all be all" of data in relation to flare up severity. The end all be all is a scope. FCP is better than CRP.
Posted 6/14/2018 5:46 PM (GMT 0)
There are different kinds of pain. My sigmoid area hurts when stool passes through there and that is usually what makes me want to go to the bathroom, but when the stool is actually coming out it hurts in a different way, like razor blades. It feels really raw. If it's a loose motion like I ate something really watery then there will be dripping blood following the stool.

I for sure still have UC inflammation, it's not all gone, but the bleeding/not bleeding is confusing me. I can literally have one BM with no blood and then 15 minutes later have a bloody one. It doesn't make sense.
Posted 6/14/2018 6:06 PM (GMT 0)
Firstly.....you're still flaring. What meds are you on?

Squat over a mirror and hopefully you will see where the fissure is.

You might also have an internal hemmie that's bleeding.
Enema nozzles could also irritate the hemmie.

Ask the doc to add mesalamine retention enemas for night and suppositories to use during the day.

q
Posted 6/15/2018 12:14 AM (GMT 0)
I take pred and rectal cortifoam. Mesalamine I'm allergic to along with all 5-ASAs.

I can't see anything with a mirror but the fissure could be inside, or like you said an internal hemorrhoid. My best guess would be it's lingering rectal inflammation + fissure.
Posted 6/15/2018 3:54 AM (GMT 0)
Ok..got it. Please make a signature regarding the mesalamine, click it to be included in all your posts. Then we know to not keep suggesting it.

How long have you been on the enemas?
q
Posted 6/15/2018 9:08 PM (GMT 0)
Sorry I'm not sure how to do the signature thing. Could you tell me?

I have been taking cortifoam since January or around there. It helped in the beginning but now I'm not so sure. My UC is just so stubborn sad
Posted 6/15/2018 9:32 PM (GMT 0)
You can go up to the top left of the screen and click on "My Profile," then click on "Edit Profile," and fill out the "Signature" section. That sucks your UC is so stubborn. This disease is so frustrating.
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