Diana Cox, Scottie, anyone familiar with anal fissures (probably TMI!)...

So, I upped my iron too much and became constipated about 5 days ago. I took lots of magnesium and stool softeners in an attempt to have a "productive" BM (more than just 'rabbit pellets')...I eventually used Smooth Move tea (Senna) and it did the trick. I tried not to strain, but the BM was still painful, it felt like I was pooping out a handful of gravel (sorry if TMI!)
And now, for the last 3 days, it is painful to poop (sharp, sudden pain and burning during the BM and general discomfort for a few hours following the BM).  And yesterday, I noticed a few drops of blood on my TP....
There is nothing visible down there (like a hemmrhoid) so I am pretty sure it is an anal fissure that is too small for me to see.
I have been doing the 'sitz baths' after I use the bathroom and have continued using stool softeners and upped my fluid intake.... is there anyting else (like a cream, etc) that I can use to heal it faster??
Do I need to go to the doctor?
Thanks, V

I'm all too familiar with your problem.  Try Neosporin Plus Maximum Strength Cream, it helps it heal faster and it contains lidocaine (topical anesthetic) which gets rid of the discomfort. 

KJL

You can get a doctor to prescribe lidocaine gel. It doesn't make you heal faster but it does help the pain when you go to the bathroom; and possibly get a muscle relaxor Rxed because the worst pain is when the muscles start to tighten.

My advice is to cut the iron for now, let your body heal. After your sitz bath you can make a compound of Prep H and hydrocordisone cream to put on to help calm the tissue.

Other then that...it will take time, but make sure you stay hydrated and your poos stay very soft.

Scott

Just FYI,

Hemmorhoids can also be internal, so it's possible it could be either.  Only your doctor can know for sure. All the previous treatments suggestions should work for both. Like scotty said, it takes time. Sorry your going through this.

Hang in there!

Thanks for all the tips everyone! I'm going to try all of that and hopefully it will go away on it's own... if I'm still having issues in a week, I'm going to call the doctor. (which I'm not looking forward to... could there be a more embarassing problem?!!!)

Get thee to a colorectal doc ASAP and get diagnosed first, then get prescriptions for

• Nifedipine capsules (NOT time release) 10 mg I think, taken twice a day
• Nitroglycerine paste to put up your butt twice per day (or after each poop)
• Lidocaine gel (5%) to put up your butt twice per day (or before AND after each poop) (You can also buy this at -- um -- sex shops and over the internet as AnalEaze -- yes, it's for what you think it's for, but it also works for this)

And take sitz baths, or regular baths, or go in a hot tub, or just stand in the shower and get warm water on the butt (I used the handheld showerhead on the pulsating setting).

Be careful of the following:

• Both the nifedipine and nitroglycerine lower bp -- you may have to space them apart in time. The nitro can give you a headache in particular.
• Lidocaine is absorbed into the bloodstream through mucous membranes -- you should use enough to give you relief from pain but not so much to affect your heart.

If you can cure the fissures this way (and mine were cured in 10 days), you should be able to avoid surgery. YOU WANT TO AVOID SURGERY, TRUST ME!!

The nifedipine and nitroglycerine relax the muscles of the anal sphincter, which are spasming from the fissure -- this should allow the fissure to heal itself. The surgery is called a sphincterotomy -- the purpose is to slice the sphincter muscle to make it relax and stop the spasming, and can cause long term anal control issues if it doesn't heal properly -- this risk is not present in using medicine to do the same thing. HOWEVER, if you don't treat the fissure when it is relatively new, this medical treatment is less likely to work, and you could need surgery later.

Violet,

I don't have much more to add.    Obviously fiber and stool softeners should help too.   Don't be embarrassed.   Get the help you need now, before it gets worse.  Please heed Diana's advice.

Wishing you well.

Peace,

William

I am a medical transcriptionist and I specialize in GI issues - and constipation and anal fissures are something I type about daily.

The sitz baths are overkill.  I have never typed a letter about anal fissures where the doctor has recommended them.  The neosporin can't hurt, although it isn't necessary.  As long as the toilet bowl didn't fill with blood, the stools are not black, don't look like coffee grounds, and the bleeding has stopped, you shouldn't need to see the doctor.  This is equivalent to a paper cut in an area unaccustomed to such things.

One thing you could try - if you can get past the yuck factor - is using a little KY or vaseline to sort of lube yourself up (inside and outside) right before stooling.  Just coating your fingertip with a generous amount and doing a quick dip in and a quick smear on the outside should do the trick.  (Wear a rubber glove if you want to.) 

While most of this will come back out, you will have greased the way for the stool that needs to exit.  The more lubricated you can get things, the easier it will be to pass stool without further tearing. 

The other thing is to prevent the stools from getting that hard again, or you'll be doing this all the time.  So keep up with the Smooth Move tea / senna on a regular basis so that you won't have chronic tearing.  If this keeps the stools soft, then you should heal up now and not tear again.

Oh Amy, I am sorry if that's what the doctors for whom you transcribe prescribe, but that is simply insufficient and makes the patients suffer tremendously.  What you have written is preposterous and cruelly misleading.

Sitz baths bring blood to the area to promote healing, and help clean and soothe the area as well.  They are HARDLY overkill!

A fissure is an ulceration that has eaten through the mucosa to the point of causing spasms in the sphincter.  If you've never had one, there is NO F'ING WAY you would ever tell someone that it is the equivalent of a "paper cut" -- for cripe's sakes! 

"As long as the toilet bowl didn't fill with blood, the stools are not black, don't look like coffee grounds, and the bleeding has stopped, you shouldn't need to see the doctor."  Are you KIDDING ME??  The medical treatment for a fissure requires PRESCRIPTIONS for the nitro paste and nifedipine, and possibly also for the lidocaine gel (although that may be available in a sex store).  You have to see the doctor to get them.  The pain associated with fissures is EXCRUCIATING.  But it could also be a thrombosed hemmorhoid, which requires specific treatment, and without a documented attempt at a medical treatment, the fissure could end up requiring surgery.

Amy, you usually are very informed and helpful -- I am completely flummoxed and aghast at how wrong you are on this.

First time sufferer, a few drops on a single occasion...  The source of the problem (the iron) has been eliminated.  Start easy in a case like this.  If it fails (along with stool softening) after a few days, try it Diana's way.  From the OP's description, this sounds like a very mild fissure to me.  Diana's experience seems to have been more severe, and the treatment she describes seems like overkill in the OP's case.