Fissures & Hemmy's - Internal and External!

[kellehbeans]

Hi all,

I have posted this a few times, but mainly in the undiagnosed group. (I am still undiagnosed!)

It all started from a bout of really bad D more than 6 weeks ago (I either get D or 'C', C just being hard to pass pebble stool which can occur 7-8 times a day, now it's just frequent throughout the day), when I got a fissure. No OTC cortisone cream, Anusol or Sudocrem is helping the pain. The cortisone kind of numbs of the pain, but has not been healing it. The hydrocortisone helped the inflammation in my rectum (it was very, very sore, if something was sat in there, it would be extremely painful, and when I went, same and when my GP did the examination with her fingers, I nearly turned around and punched her!) Since I've stopped taking it, the inflammation has come back, and I seem to getting more fissures and now external haemorrhoids! I have always suffered mucus, but never blood (only once, and I passed a clot!). I go pretty frequently to the toilet, so that's not very helpful either.

Has anybody got any ideas on how I can try and resolve these? I am going to go my GP again on the 11th August (I booked this last week!!!!!!! Such long waiting times), so I don't know what else I can do in the mean time. I've tried baths, I drink plenty of water, I eat enough fibre to make sure everything is all soft. The only thing I can think of now is to eat low fibre or low residue and drink Fybogel to keep the stool soft.

Any other ideas would be great. Sorry for the long post. :shifty-t:

 

[24601]

Hi!

I really do feel your pain. I've had an anal fissure in the past as well as a grade IV hemmie which was excruciating! I also suffered again recently with seriously bad felt-like-I-was-going-out-of-my-mind pain from haemorrhoids due to chemo induced diarrhea

I feel like there aren't really any amazingly satisfactory ways of relieving the pain quickly - or if there are I didn't find them! But the best things for my fissure were warm baths after every bm and I saw a colorectal surgeon who prescribed nitroglycerine ointment. With that treatment and relieving the severe constipation I was suffering from, the fissure did heal. For my haemorrhoids, again I found a warm bath helpful (they say this may help as it reduces the high anal sphincter pressure measured in hemmie sufferers but it just seems to be quite soothing anyway) as well as prescription haemorrhoid care cream with lidocaine. I tried germoloids suppositories with some benefit and Instillagel local anaesthetic too - you'd need to ask your GP to prescribe that. I was also prescribed various quite strong opiates for the haemorrhoid pain as it was really unbearable but that sounds like it might not be an option for you right now with the constipation as the opiates would likely worsen this.

Good luck! Hope you get some relief soon :ghug:

 

[kellehbeans]

@24601 - Thanks for your response!

I'm really sorry you had to go through that! Hemmies I thought were not meant to hurt, but I have known different now - plus fissures really do not help the case!

I have some BM's during work, so what could you suggest if that is the case? At home, it's much easier of course! I try using baby wipes etc. to try and help make it softer and use less toilet paper so I am forced to wipe gently.

I don't have constipation any more, it used to happen before this case of D I had that caused all of this! When I was 'constipated', it was more like 8 BM's a day, but they were like I was constipated (hard to pass, pebble-like). Now I'm down to 3-5 BM's a day (some days none), but they are quite a lot, and you guessed it, don't help the healing process. But, I honestly don't think any opiates would be a great idea! The pain is awful, and any BM is hurting it right now, so I think I'm pretty much open to suggestions from anybody!

I was diagnosed with piles when I was younger, like 10 years ago now, when my mother rushed me to A&E because I kept bleeding, but had no pain. This time, it's the other way around. Pain but no bleeding and a lot of inflammation.

 

[24601]

Yes, I keep reading that haemorrhoids aren't painful unless they are thrombosed but in my experience that's just not the case!

Definitely sitz baths are difficult when you are at work!!! I would just do them when you can then. I think a warm sitz bath is meant to help heal the fissure by promoting blood flow so it's still going to help to do it when you can manage.

I found this suggestion for managing when you are at work, although they say you only need to do it 2-3 times daily "Sitz baths — During Sitz baths, the rectal area is immersed in warm water for approximately 10 to 15 minutes two to three times daily. Sitz baths are available in most drugstores, and portable bowls are available to use at work or school. It is also possible to use a bathtub as a sitz bath by simply filling it with 2 to 3 inches of warm water. Additives such as soap and bubble bath are not recommended. Sitz baths work by improving blood flow and relaxing the internal anal sphincter."

Also here's a bit on topical nifedipine as an alternative to nitroglycerin: "Topical nifedipine and topical nitroglycerin — Topical nifedipine is a blood pressure medication that works by reducing the internal anal sphincter pressure. Nifedipine is available in pill form for other indications, but is best used for fissure treatment when compounded into gel form and applied directly to the fissure. Topical treatment with 0.2 percent nifedipine four times a day has few side effects.

Nitroglycerin works to dilate blood vessels, increasing blood flow to injured tissues. It also works to reduce pressure in the internal anal sphincter, which decreases pain and further facilitates healing.

The dosage of nitroglycerin is usually a small, pea-sized dot of 0.2 percent ointment applied around the anal opening two to three times daily, as well as before and after bowel movements. This strength of nitroglycerin must be compounded (custom-made) by a pharmacist. It is very important to use the correct strength and amount of nitroglycerin ointment to avoid dangerous side effects. It is also important to wash the hands before and after applying the ointment."

It may be that your GP could prescribe one of those ointments to help the fissure heal.

And I would definitely ask your GP for a prescription for haemorrhoid cream with lidocaine and also Instillagel as both should relieve the pain from haemmorrhoids and the fissure too I think, and if applied before a bm make that less painful.

 

[24601]

I also meant to say that with all the sitz baths etc. it's really important to prevent the skin getting dry so it's also good to apply an emollient. I've always found vaseline to be the most soothing on delicate skin and it creates a good protective layer.

Is there any chance you can get in to see your GP sooner? Or do you have an out of hours service you can call if you are suffering over the weekend? I think the prescription ointments and creams will be your best bet to get some relief.

 

[kellehbeans]

@24601 - Is Sitz a name for a particular type of salt? Excuse my naiveness! [emoji26] Our toilet is a bit embarrassing at work because it's locked with a key, and if you take longer than others, they automatically presume you're having a 'poo', and that the toilet is going to smell and they'll start gossiping. I only know this, because when I stand around waiting, one particular department like to say it every time without fail about others! I already have anxiety surrounding this, so really not helpful!

We have out of hours, but I wouldn't have been able to go to my local as they have had their a&e department shut all weekend due to flooding and fires. Also, I want to see his particular doctor, but I could always try calling in the morning as apparently they keep them free for a few appointments a day for emergencies. I'll try in the morning. Not really had much relief from OTC medications this weekend. [emoji24]

 

[24601]

Not to worry, nothing special about sitz baths, though you can add regular salt or epsom salts or something else. It just seems to be the generally used term for bathing that area! And it can mean using a basin or just filling a regular bath with a few inches of water. Here's a wiki how on sitz baths http://www.wikihow.com/Take-a-Sitz-Bath

So sorry that your bathroom arrangements at work are so awkward and that people are so immature.

I think it will help to bathe 2-3 times a day if you can manage that outside work hours. I know I felt that it helped me heal the fissure and relieved the hemmie pain a bit.

Hope you can get some of those prescription ointments soon! I think they are much better than the OTC ones.

 

[kellehbeans]

Regular salt as in table salt? I shall try this later I think!

You'd think I'd be immature - I'm 22, they're about 40! I've always been awkward, but I've got much better. Just not nice when they're like this.

I shall give this a go - I think I need nice warm baths as my knee is beginning to really give me some problems (for no reason!) so it'll do two great things at once. [emoji4]

Thanks so much for your help! I cannot wait for these to heal! although it may help with getting a diagnosis.... [emoji123] Really appreciated.

I'm not sure what to do in terms of diet though!

 

[24601]

Yes, just regular table salt. A good handful or about 1/4 cup should do for a bath.

Ugh, you'd think people would be more mature about stuff like this...I mean we all poop. I'm constantly disappointed by people failing to grow up!!! :yrolleyes:

Hope these things help and that you can get a diagnosis soon :ghug:

 

[kellehbeans]

In all honesty, I didn't try this last night, but I did just take a warm bath, but gosh, my left knee is in so much pain - I've had to call my doctor's surgery today and get them to call me back to see what else I can do about my knee (it seems to be correlating with pain in my rectum!! I just want to cry at the moment!), as I'm not entirely sure what I will be allowed to take to help numb the pain!

Thank you, I'm hoping it comes sooner than later at the moment!!!

 

[kellehbeans]

Update: Called the doctor, and he absolutely seemed like he wanted to get the job done and get rid of this problem and prescribed me Prednisolone hexanoate - so maybe they're taking me a little more seriously now? :lol:

Shall see how this goes.

 

[kellehbeans]

I am SO ANGRY.

My surgery is the biggest joke I know. The pharmacist made me wait for half an hour to tell me they'd recalled the ointment, so then told me they'd ring for permission to give me the suppositories rather than the ointment. Half an hour later, doctor calls back and faxes through my new prescription.

When I get it home, I found she'd given me hydrocortisone AGAIN, when in my notes it'd have said it wouldn't have any effect as I've only just stopped taking it with no improvements.

I am so angry and upset right now, I thought my surgery had stopped being a joke. Now I'm crabby from very achy joints from standing too long and just being messed around. I've just lost £8.20 to something that I won't use, and then another £8.20 to get THEIR correction prescription.

 

[kellehbeans]

Oh my; triple post! Either way, thought I'd update the situation.

Doctor used the telescope thing this time to have a little look, just inside. He said there were no obvious signs of proctitis using the instrument he did, but did say I had some very angry, inflamed internal haemorrhoids, plus the small fissure I have externally. Since nothing happened taking Uniroid-HC and AnuSol-HC ointment, he has now prescribed me Prednisolone 5mg suppositories, plus some lactulose because apparently my rectum has just become so tight, it is holding in some stool. :redface:

Only taken two suppositories so far. I woke up in the middle of the night and I had yellow rectal discharge. I can tell that is not normal, but I can't find any experiences with it. I am so scared to pass wind at the moment, and any sneeze I do is being retained the best I can! I only have a 5 day prescription (2 a day), so let's see how this goes....

 

[teeny5]

What other meds are you on? Wonder if the discharge is from another medication reacting with the suppositories possibly???

 

[kellehbeans]

I'm on Lactulose to try and soften my stool because it keeps getting stuck basically. I'm in SO much agony this morning, actually requested a call back from my doctor this morning. I can't really go on like this, it's making me feel extremely fatigued.

Unfortunately, it's the doctor who likes to tell me I have IBS or a virus as the duty doctor today.

 

[teeny5]

Hope you got somewhere with that Dr. Let us know how it went.

 

[kellehbeans]

He basically told me has now diagnosed me with fructose malabsorption because I seemed to be 'switched on' and worked out my body myself by process of elimination. So, that is probably an issue, but I am now not convinced it is fully that that's causing me to pass nothing but 'oil' and small parts of the pred. Maybe it is the pred, but surely this is showing malabsorption of something, and that happens higher up in the GI tract? Who knows, either way, I know I'm in a lot of pain (mid left abd. to lower) and that's all that matters I guess. I just need to get to the bottom of this. Either way, my diet is going very strict to try and stop this. 2 days left of the pred so we shall see if it stops after this.