Questions for Dr. Barbe

Anal Fissure Again:  L

After being free of anal fissures since I last saw you, I contracted, in the last week or so of March, an intestinal “bug” that caused fairly severe diarrhea (“squirt poops”).  My husband Keith also had diarrhea at the same time.  I had six days of diarrhea and my butt was getting sore.  I’d been avoiding taking anything for the diarrhea for fear it would cause constipation, but after about 5 days, I decided to try Pepto Bismo—in small doses.  I took a half dose after several attacks of diarrhea and the next thing that happened was terrible constipation and an anal fissure.

Anal Fissure Questions:

Ø  What dose of Canasa?  I am currently taking 1000 mg as prescribed by Dr. Beeai.  It is NOT working.  It improved from the beginning, but there has been NO FURTHER IMPROVEMENT and I have been on it for 18 days.

Ø  Am I doing something wrong, or not doing something right?

Ø  (Why did it work last time but seems to be not working this time?)

Ø  Dr. Beeai said not to push or strain when defecating, but IF I do NOT the feces come into the rectum, stall there, and do not come out.  They just stay there hurting, and eventually, they retract back in.  This happens over and over multiple times until I find myself inadvertently pushing even though I’m not supposed to.  L

Ø  Should I be taking a stool softener?  If so, what kind?  What about bran?  The stool softener Dr. Beeai recommended seems to give me a bellyache.  (This bellyache happened twice, but has stopped now. ) (Even flatulence hurts, and there isn’t anything much softer than gas.)

Ø  Is bran hurtful or helpful?  If hurtful, how do I wean myself off it without causing severe constipation?  I started taking it after the last event to keep the stools soft for fear of causing another anal fissure.

Ø  What should I do to properly care for my anus, rectum etc and promote healing?  What regimen should I follow?  Do you have a sheet of recommendations to follow?

Ø  Should I use any other suppositories during the day such as Preparation H?  Would it assist healing or impede it? I have been, but don’t know if I should.

Ø  What about externally?  Prep H, an anesthetic ointment, diaper rash ointment? Would it assist healing or impede it?  I tried using it, and then stopped, not knowing what to do. It seems to burn, as does the Lidocaine ointment, which I do NOT use (because it increases pain).

Ø  Should I use a sitz bath? (Dr. Beeai recommended I do this, and I have been).  A hot pad?  If so, for how long and how often?

Ø  What about painkillers?  Ibuprofen?  Acetaminophen? Or?  I’ve been taking Ibuprofen. 

Ø  Is there any way to prevent this from happening again?

Ø  I read that one should not ignore the urge to defecate.  I read that that doing so can cause constipation over the long-term.  But since I’ve had this anal fissure, I feel like I have to defecate all day long.  Then, when I get on the toilet, either nothing happens or only a little comes out.  So I find myself sometimes ignoring it (since I’ve had this anal fissure) so that I am not on the toilet all the time.  L  (I do not normally have a problem with any of this when there is no anal fissure.)

Note to self later:  The doctor did not even glance at this.  NEXT TIME, if there is a next time (I hope there isn't), make a brief outline of trigger words for myself.