RECTIV

How to use RECTIV
from here.

Rectiv, or nitroglycerine ointment, "is the first and only FDA-approved medicine for the treatment of moderate to severe pain from chronic anal fissure."  There is a limited amount of somewhat useful information about anal fissures relatively easily found on the site using tabs.

However, this ointment's sole task is to treat pain.  Symptomatic relief.  I want something that will heal the problem, make it GO AWAY!  I DO want the pain to stop.  But jamming a finger up my butt and wiggling it around when it's in so much pain already doesn't seem like a good way to heal it.  :-(

I read that some people can't take the side-effect headaches.  (I have not tried this, so I cannot report about the headaches.)

To poop or not to poop, that is not the question

Dr. Barbe told me to stop taking the Canasa and prep H suppositories and I did and got worse. The day before yesterday, after a week off them, I started them again, and yesterday, I felt somewhat improved.  (After two days of agony.)  Still not good--I had to sit on a heating pad until 3 PM before I could do anything else.  But the day before, I was in terrible pain all day and until 2 AM.  I hadn't been getting BETTER on them, but I'm improved somewhat.  Not improved enough to do anything, but at least I have less pain.

For a while, I was pooping several times a day, and Dr. Beeai said that with an anal fissure or tear, that was common--the pain makes the anal sphincter contract and stops the movement.  But you still have to go, so it starts up again.  Each time I would poop, the pain and bleeding would be worse.

Then, I was pooping just once in the morning, and it came out sudden and with force and hurt.  At least it was over with in one fell swoop.  If it was early, I had all day to recover.

Then there is the issue of gas.  The stool softener Dr. Beeai told me to take until this was over softens the stool to such a point that the gas seems to have trouble getting to the right spot without taking poop out with it.  The bran causes gas.  So this morning, I passed gas and a small amount of poop, which means I will have to poop again later.  It always hurts worse the second time.  Plus there is a delay in the recovery time.  It already hurts.

I have poetry class tonight.  I may not be able to go.

I think that eating less food might help, but one would have to stop eating altogether for a long time in order to not poop at all.  I'm not sure I could do that long enough.  (But how can it ever heal with poop coming through daily or multiple times a day?)

On another note, I was reading in my records that Dr. Beeai said I had no hemorrhoids, but Dr. Barbe said I did have them.  (Last time, in 2010.)

broken glass

YES!
:-(
this is from here.
click image to view larger

Yesterday and the day before were terribly bad. I feel slightly improved so far today. Not well enough yet to do my exercises or prepare and eat breakfast (at 10:24 AM).  But I'm not in the agony I was in yesterday so far, knock on wood.  Unfortunately, I had too much pain last night to sleep until after 2 AM, the first time it's been that bad at night.

Pain

Pain
this is a digital painting by me

How much pain can a person take?

NO, really, the question is, how much pain am I WILLING to take?

It is 11:27 AM, I have not had breakfast because I've been sitting on
the heating pad. Little by little, I've been doing my exercises. I
have to stop in the middle sometimes and seek relief--a hot washcloth
applied directly to my anus.

I finally decided I needed to eat and went downstairs to make
breakfast. I laid out the pan and get out eggs and vegetables, but
the pain was too much for me. I am back up on the heating pad,
without having actually started breakfast.

The pain was too much. (I am at my lowest weight in several years.
This is a good thing, but the pain and hunger are not.)

I have become an invaid. I can't go anywhere, do anything. I am
canceling appointments, classes, activities. I feel sad.

Canasa and Confusion (Self, pay attention next time) (I hope there is NO next time) :-(

I am very confused.

I thought I had an anal fissure last time, and that Dr. Barbe had given me Canasa for it, and that it had healed right up.  This time, the Canasa did not seem to be helping.

I told Dr. Beeai that I had an anal fissure.  That's what I thought I had been told LAST TIME, by her, when she looked at it.  I thought it was the same thing.  It felt the same to me.  It seemed to be behaving the same.

Dr. Barbe said Canasa is for proctitis.  It is not for an anal fissure.

He says not to use suppositories for an anal fissure, they just tear the rectum further.  (How can it tear it further than a bowel movement?)  So I stopped using the Canasa and prep H.  Yesterday, I was worse.

At this point, I don't even know for sure WHAT I have.

What the doctor said

I had my poetry class tonight and waked at St. Clair Park between the doctor and the poetry.  

So I didn't have time to write about what the doctor said.

I was disappointed in what he said.  I was hoping for an easy solution.  Nope, no such luck.

I wrote about this in more detail on the Psion, which I will download as soon as I can, but not tomorrow, maybe, because Keith has his colonoscopy.  I have to be there to drive him etc.

Here are my options, briefly:

1)continue to endure and hope for the best.  No heavy duty painkillers.  The body, he says, will heal.  But when?  It's been a month.  

2)get shots of botox in the anus. 70% chance of solving the problem.  Must be done at hospital under anesthesia. 1% chance of anal incontinence.

3)have an operation.  95% successful.  1% chance of anal incontinence.  VERY PAINFUL, long recovery time (2 months of pain, no heavy duty painkillers allowed.)

I opted for part one.  If it continues to worsen or becomes unendurable, I will try 2. If that doesn't work, then 3.  Like I said, I was hoping for something better.  A better medication, for example.  Something more healing.

My pain was bad this morning, subsided some in the afternoon (with ibuprofen) and subsided more in the evening (with more ibuprofen) and right now hardly hurts, only a little.  BUt the cycle starts over every time I poop--and I only pooped once today, very early.

I saw baby owls in the wild at St. Clair park today, got a very good look at them, no camera though.

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.

Butt Report 4-23-13

I walked to the library yesterday, after five in the afternoon.  I only pooped once yesterday, early in the morning, and by 5, the pain, while still present, had subsided to the point where I could walk, with two ibuprofens.  (The day before, I pooped 3 times--awful! )  (It felt as if someone was pinching me--hard-down there-with every step.)  When I got there, I sat on the wall in the sun and the heat of the sun-warmed wall soothed my butt for the walk home.

Keith is fasting today for his colonoscopy tomorrow mornings and I am worrying terribly about the pain of my being there--I am required to be there.  My mornings are torture.

Today I am going to the specialist--it is NOT the same doctor I went to 2 1/2 weeks ago.  That doctor, my GP, gave me NO instructions, other than to take the suppositories and a stool softener.  She said to take them for 15 days unless I had a relapse--I'm still taking them--I didn't have a relapse because I didn't get better.  OH, and she also said not to push when I defecate.  Impossible.  If I feel a poop coming on, and sit on the toilet, it moves into my rectum, which hurts like mad, and then hangs out there.  It sits there and sits and there and sits there and doesn't come out until suddenly I can't help pushing.  I've really tried hard not to push, but it NEVER works.  The poop won't come until I do.  I've tried waiting 15 or 20 minutes.  If I wait too long, it retracts back up inside and then 5 minutes later, I have to go again.  Meanwhile, I had 20 minutes of pain.  I have pain all day, but the pain of pooping is worse, a lot worse.

But I have a whole BUNCH of additional questions.  I am wondering, for example, of the GP gave me the same DOSAGE as Barbe gave me last time (2 1/2 years ago, or whenever it was.) 

This is painful, I am sitting on a heating pad which only partly relieves the pain.  For the ten minutes after I pooped, I was crying.

But THAT last time was worse, verging on unbearable.  JUST terrible pain.  I don't want to go there again.

The Red-hot Poker

The red-hot poker
This is not my image.
I got is here.

OK, I admit, it is a BIT of an exaggeration.  But I couldn't find a red-hot poker at the exact correct degree of heat.  So, imagine jamming that thing up your butt.  (Only not QUITE that hot!  (HOT, but not THAT hot!))  That will give you an idea of what an anal fissure feels like--to me.  Especially while pooping and for a good hour afterwards.

I had a perfect exercise day yesterday--though I was in so much pain that it took all day to get the exercises done. I did get a little extra walking in, but not a lot. Today I lept up and did the exercises as fast as I could before I pooped.

I had just barely got them done when I pooped. My pain and bleeding was worse than yesterday, which was worse than the day before. I sat in the tub for 42 minutes and had to leap dripping out to poop a second time.

I am embarrassed to say that I howled so loud from the pain I was afraid someone would call the cops.

(I am really ANGRY at that receptionist who not only wouldn't let me come in to see Barbe, but also wouldn't even lat me talk to him on the phone.)

Then I sat in the tub again, and now I am sitting on the heating pad. I took two acetaminophens. NOTE, in case I haven't previously mentioned it, you can't take codeine-based pain pills--they worsen the problem.  (Something is worsening MY problem even though I am NOT taking codeine-based pain relievers.)

Keith is at work. He, ironically, has a colonoscopy scheduled for April 24 with Dr. Barbe (My proctologist). He is now on a special preparatory diet. He is pleased because he can have mac and cheese and beer for three days, then beer the day before the event. I am worried because I have to take him for the procedure in the morning when my pain is at its worst, and when I may have to poop without access to a tub etc. I don't want to be sitting there screaming and howling in pain. I do not want to be without access to something that helps soothe the pain.

First and most important, I want to heal from this terrible pain. I hope on Tuesday at 2:30, Dr. Barbe will be able to help me.

Red-hot Poker Plant
This is not my image.
I got it here.
THEY got it here.

When I was looking for an image of a red-hot poker (a real poker), I kept finding instead the red-hot poker flower.  Unlike reporters from the Miami New Times, I DID know there was such a flower.  This plant is pretty, but does not have the power to evoke the pain I am experiencing.  My pain is somewhere between the image above and this.  Maybe halfway between, or slightly more toward the actual poker.

Barbed wire where the sun don't shine!!!!

Barbed wire where the sun don't shine!
This is not my image.
I found it here.

I was trying to describe the pain of an anal fissure to a friend, and said it was like defecating barbed wire or broken glass,  These people apparently agree. (I hadn't seen this until after I said that.)

Canasa

The drug I took last time which worked fairly easily and readily was Canasa.

It is not working as well this time.  I am wondering if I was given a different dose or if I am doing something wrong.

I was unable to travel to Syracuse for an opening of the Syracuse Poster Project.  One of my haiku was chosen by Chloe Tran to be made into a poster.  I was very sad.

I had been on the medication for 14 days and am only moderately improved.  :-(  I'm still in a lot of pain.  :-(

I did see a different doctor than last time, so now I am thinking of seeing the original doctor again.

I want careful specific directions.  It has been long enough since my first attack that I have forgotten the specifics of the directions.

Fissure

Hellebore in Rain
digitally altered photo
by me, from my backyard

I was too sick to go to Syracuse today, April 18, for my award and to visit my children, grandson and friends.  I had to stay home, and I was sad and feeling sorry for myself. (I have to admit to doing a little crying.)

Because I hadn't been planning on being in Detroit, I had to go to the store for food,.  I took a couple ibuprofens (not something I normally do when not "sick") and went out to walk to the store with my backpack--halfway there, a torrential downpour started.  It had been HOT earlier, in the seventies, which is hot for April in Detroit.  But the rain cooled it off, thank goodness, about ten degrees to 65.

I huddled under a bare tree, trying to stay under a large branch, but it was raining hard and the wind kept shifting.  (The rain felt COLD).

Finally, it let up a little and I walked the rest of the way to the store in the rain.  Not light rain, but not like standing under Niagara.  I was wearing a T-shirt (no jacket) and no hat etc, because of the heat earlier.

I was pretty wet when I got to the store, but they had the heat cranked up in there for some reason.  So I did my shopping--I kept looking out as I passed the door.  The rain stopped.  I was relieved, but when I went through the line and got to the door, it was pouring again.

I went to the back door and stood in the covered back entry waiting for the rain to let up--and when it let up a little, I clutched the bags as shut as I could and ran home in the rain.  I'm WET.

I am smiling, though, because it is the kind of "mini-adventure" (if you could call it that) that normal, healthy people have.

It makes me feel half-human again.  It--oddly--gave me hope!  I also feel slightly better--two ibuprofens helped.  Sometimes it doesn't help much.  Sometimes the pain goes on and on.

WHAP!

WHAP!                  

I have a very gross but somewhat amusing story.  Don't read it if you are easily grossed out.

                   Every night at bedtime, I have to insert those Canasa suppositories.  They are hard, bomb-shaped with a sharp point.  My butt is swollen and inflamed and it's difficult to find my anus--I know that sounds weird, but the whole area is lumpy with swelling and painful and I can't see down there.

                   It takes a while to find the right spot, and it hurts to jam that hard, pointy object into those inflamed tissues.  If I don't push it far enough in, it has a tendency to pop out again.  It did that a couple days ago, after it had been in long enough to melt some, and was difficult to reinsert. It hurts even more the second time.

                   So last night, I pushed it and it slid out and I pushed it in and it slid out and I pushed it in and it slid out.  I carefully stood up, holding my finger over my anus.  I had not yet added the external ointment.  I stood there and waited to see if the suppository was wedged above the rectal sphincter and planning to stay in place.  It seemed to be.

                   I waited a moment longer, and then bent over to retrieve the ointment.  WHAP.  I didn't really feel anything special, as the bending was stretching all that stressed tissue--it just hurt.  But I had an idea what had happened and I turned around and looked and sure enough, the suppository had shot out at high speed and whacked into the bathroom tile.

                   I had to retrieve it and start all over again.

When I went in to the bedroom and told Keith about it, he pulled the covers over his head to keep from laughing.  He has some idea how much this all hurts, but it was kind of funny.

TMI!!! (The fissure that plagues me)

This post, and this whole blog, is in the category of TMI--Too much information. I am writing about it here, because this is my "fissure" blog, because people have asked, and because what I learn may possibly help someone else with this difficult, painful and embarrassing condition.

Don't read this if you are easily offended by unpleasant details.


A friend just asked, "What is wrong with you?


I said: "Many things are wrong with me.  But I think you mean, 'how am I sick, what is my medical condition?'"


I said, "It is sort of unpleasant and embarrassing, which is why I have not

explained more."

So, here are the explanations:

My husband and I both had some intestinal bug that is going around (here).  It causes diarrhea.  I had it for six days, and, I took some Pepto Bismo after a while, because it was so bad.  I took it near the end of the six days and it caused bad constipation, which ripped my rectum.  

I have an anal fissure.  It is very painful.  The doctor says it was caused by the combination of the irritation from the diarrhea followed by the sudden constipation.  It has been bleeding a lot and hurts badly.  I have to sit in a tub of hot water or on a heating pad.  Or both.  I cannot travel until it has healed.


If this is TMI (too much information), I apologize (but since you

asked  . .  .  or continued reading after the warning . . .   )


I have been taking some medication and treatments.  The first few days it actually got worse and the bleeding increased.  But now, each day, it seems to be getting incrementally better.  The increments, so far, are very small.


I really want to be better in time to take my trip to NY to see my children and grandchild.  I am also going (hopefully) because a poem of mine was chosen to be made into a giant poster to be displayed on kiosks in Syracuse NY and they are having a celebration the night of the 18th.  That was why I intended to go that day, after the opera on the 17th.

This is the second time this has happened to me.  When it has happened once, because of scarring inside the rectum, the risk increases for it to happen again.  The medication that finally helped last time was Canasa.  Nothing else worked.  My friend has suggested honey.  I haven't tried that yet.

TMI: help, I can't find my . . .

Do not read if easily offended:

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~

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HELP!  I can't find my asshole!

I have to put a Canasa suppository into my anus every night, and the past couple nights, I couldn't find the opening.  I can't see down there, and it's all swollen and lumpy!  :-(  The suppositories have a very sharp tip and I was pressing and pressing and it wouldn't go in--it was between two lumps--not in the right place.  It hurt like heck!  I finally got it in, but I riled up the whole area trying.