Patient 31

Date: Thu, 1 Feb 2001 22:11:20 -0500
To: jackfaf6.arc.nasa.gov
Subject: Thanks and a few thoughts

Jack,

Thanks so much for the self-help pages. The wide range of information and links to helpful sites truely made it a one-stop shopping experience. Just wish the motivation could have been less painful! But, since it basically started me on my road to recovery, I am truely thankful.

My history is a little different from most of the patients on your pages. I am a nutritionist and used to do nutritional consulting. So, even though I have not always practised everything I know (my husband is a junk-food addict and I sometimes break down and join him), my diet has tended to be high in fiber and healthy by North American standards. I virtually never had constipation and even tended more toward diarrhea because of liver damage I sustained from an unknown virus years ago.

Then a couple weeks ago I was given a bout of a wicked antibiotic which gave me diarrhea every half hour. By the third day I had an anal fissure, though I didn't know it, and was going out of my mind with pain (trying to "pass razor-blades" and having constant spasms which kept my entire Southern Hemisphere in pain - my butt hurt, my bladder hurt, my whole pelvis hurt, even my legs ached!). I thought it must be a hemorrhoid and 1) wondered how I could have hemorrhoids without being constipated, and 2) was totally bewildered how people with hemorrhoids go on with their life with this kind of pain. Then I found the term anal fissure mentioned on a website about hemorrhoids, looked it up thinking "I probably won't find anything" and eureka! there you were! What a big help! What a comfort to know I'm not just a wimp! The information as well as many of the suggestions were very helpful.

After reading many of the histories, I think that my case was probably mild and I am well on my way to recovery now. I hate to imagine what the pain of a severe chronic case must be like. But I did find a couple things helpful that I didn't see anyone mention. Feel free to use them if you find them helpful:

1. Several people mentioned hopping immediately into the bath after a BM to help manage the pain. I found it a life-saver (if you have time) when I felt things starting to "stir around" to hop in a hot bath BEFORE trying to eliminate. Heat not only relaxes the muscles but also deadens some of the nerve endings. Then jump right back in the tub right after to dull the pain and relax the muscles again. On the worst days I would hop in and out of the tub three or four times to finish one elimination. (This wasn't just one formed BM but a series of "soft stuff"). Even now, although I've improved enough not to have a bath every time, the first thing I do when I go into the bathroom - right after smearing on some vagisil - is heat up the tap water, wet a couple kleenex and stick them up there to soften everything up.
2. Another thing that might be too elementary to mention but helped me a lot was keeping an "open posture" while trying to eliminate. I found that sitting on the toilet with one foot up on the edge of the tub somehow opened up the involuntary sphincter muscle so I wasn't in that deadly battle where the muscles are fighting against each other -- fear and pain trying to tighten down while you try to will yourself to relax and get this over with. This did a lot to help stop the constant re-tearing of the fissure and let it start to heal. Of course this is hard to do with clothes on. But when you're in that kind of pain, who's wearing clothes?
3. Along the same line was the good old-fashioned lamaze panting method. Interestingly enough, when your MOUTH relaxes it tends to relax the other end too! The painful, terrified posture of gritting your teeth and clinging for dear life to the edge of the counter to prepare for the coming blast of pain is only making it hurt more! As I concentrated on relaxing my hands and mouth and gentle panting out, usually everything came out with a lot less pain and fewer re-injuries. (Of course maybe it just kept my mind on something else, but it worked.)
4. Vagisil was a God-send. It is a benzocaine-based "women's" cream and I imagine any benzocaine would help numb the pain and burning, but I used it because I had it and because it's made for "delicate" areas so I figured it couldn't hurt. They say to use it three or four times a day. HA! I used it before and after each BM and sometimes in between, so at the worst times I was probably 4 times the recommended dose. I certainly couldn't recommend that anyone else exceed the dosage by that much, but for me, I didn't have any side effects and it has made a huge difference in the pain.
5. One of the reasons aspirin and advil, etc manage pain like this better than tylenol is that they are anti-inflammatory as well as pain killers. The problem is that all of them are very hard on the stomach and can cause gastric bleeding. There is a new NSAID (non-steroid anti-inflammatory drug) available now called Celebrex. The good thing about it is that it does not cause bleeding or stomach ulcers. The problem is that it is a perscription drug which is usually used for arthritis type pain. So you would have to convince your doctor to be a little creative. Also my Rx can only be taken once a day and I find the effect wears off somewhere around 9 or 10 hours so the rest of the day I had to supplement with White Willow or another pain reliever. White Willow is an herb available at any health store and contains salicin, which is what they concentrate to make aspirin. For me, it is close to as effective as aspirin or advil but because it is in it's natural form, it does NOT promote bleeding or ulcers.
6. I regularly used wheat germ as a cereal, whole grain breads, etc for fiber. But wheat is a fairly "scratchy" fiber. So when I realized what my problem was, I replaced it with oatmeal and oat bran and have had much less painful BMs. Oats provide wonderful fiber which is soft and easy to pass.
7. A couple other nutritional suggestions: Although I'm not any kind of expert on anal fissures, I am an expert - of sorts - on nutrition. My consulting specialty was "How to Be Healthy Without Eating Tofu" or helping junk-food junkies learn to adopt more healthy eating patterns without "being weird" or "going to lots of trouble."

Anyway, PLEASE suggest to people that they NOT take mineral oil over long periods of time (preferably not at all.) It clogs up their system and can have a lot of bad long term effects (I won't write a treatise.) Suffice to say, flaxseed oil or lecithin or any other Essential Fatty Acid will work just as well to lubricate and soften stools, but they nourish the whole body and won't cause a worse problem (like colon cancer).

It's also important to remember that to heal anything (especially an area that's being continually bathed in bacteria and sewage!), your body needs the right building blocks. Vitamins C, A, E, and zinc are absolutely crucial to healing. Vitamin A and E could additionally be used by puncturing the capsule and applying topically.

Also, please be aware that refined sugar is an irritant to the whole body and BLOCKS healing. Adding naturally sweet high-fiber snacks like fruit to your diet makes it easier to cut down on sugar. I won't go on about this because whole books have been written about it. But if anyone is interested, I can help get started with some simple recipes and suggestions for natural snacks etc that help cut back on sugar and increase fiber.

BTW, from a nutritionists standpoint, the formula for the BF&C creme they are talking about looks very good.

Thanks again, Jack, for a fine site and for all the time you've put into this. I heartily agree with your nutritional advice in "what I would do now". And thanks to the many people who candidly shared their experiences.

Date: Sat, 27 Dec 2003 21:07:29 EST
Subject: Be careful before using Celebrex for rectal pain
To: jack1apm-iris6.arc.nasa.gov

Thank you Jack for creating your website. Before I go into anything personal, please make your readers aware of the cautions one must take before taking Celebrex. After reading "Patient 31" posted Feb 1, 2001, I was anxious to try Celebrex, so I called my dr. and he called in a prescription. As no other pain killers were working, I almost popped a pill in my mouth, but fortunately I read the pharmacy's insert. Contrary to what patient 31 said, this medicine may cause stomach bleeding and kidney problems! Also, it is a sulfa based medicine, and if you are allergic to sulfa, this could be disasterous!!! I am allergic to sulfa and have had extreme reactions. So, I'm disappointed that I can't try it.

I am in the middle of dealing with an anal fissure. Extreme pain started around Nov. 9, 2003, but I wasn't definitely diagnosed until yesterday. I requested an exam in the hospital with anesthesia. I'm sorry I didn't remember to ask the dr. to use a PEDIATRIC anoscope, as I am a relatively small woman. Of course, you would think the doctor would think of that, but he didn't. After the anesthesia wore off, I had the worst day and night of my life (and I thought I already had the worst pain on certain days in the last 45 days). NOTHING helped.....not the sitz baths, not the nitroglycerine ointment (.5%), not praying, NOTHING. I thought the pain would never subside. Thankfully, it did, but it was after 14 hours of torture. I am convinced that the exam with a regular sized anoscope traumatized me.

I also have IBS which the dr. says is hindering my recovery. As anyone with IBS knows, we have additional problems, like incomplete evacuation (ugh!) and in many cases (like mine) multiple bowel movements per day. Of course, this further irritates the fissure. During a bowel movement I found if I massage and squeeze the buttocks and the buttocks area, it is easier to defecate. Of course, right before, I apply the nitro and at the same time I try to drink one or 2 glasses of water. I didn't read those two hints on your website, so maybe this will help someone out there suffering like I am. I am encouraged by reading your postings that I will be able to overcome this WITHOUT surgery. Thankfully, my surgeon is VERY conservative and is encouraging me that I will get rid of this fissure on my own.

I hope I will be able to write soon that I have cured myself. Please do not post my email address. If I cure myself at a later date I will then try to help anyone who wants to write.

Date: Mon, 26 Jan 2004 15:25:19 EST
Subject: Re:Celebrex P.S. + other info

Hi Jack, maybe you should add my comments to the random list, also. There may be many readers who will miss the end of the patient #31 report.