Fissure

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thatmdee
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Fissure

Postby thatmdee » Sun Mar 26, 2017 12:32 pm

Has anyone here had to deal with a fissure before?

I went to the doctor about 5-6 weeks ago, and it seems I have a fissure. I've tried to be careful with my diet (wholegrains, fiber, lots of water, etc) but over this time it doesn't appear to have healed.

I've noticed it will seem to get a bit better, then after a bowel movement the stinging sensation returns slightly. Riding (indoors on the trainer) seems to really aggravate it. After a 1 hour ride yesterday, it was the most painful I've ever experienced. I couldn't sit, nor stand -- only lie on my side or stomach. The sensation felt like I had sat on a broken beer bottle and I was basically in tears.

I've read around, and a couple of people have claimed their surgeon or doctor told them cycling shouldn't cause a fissure, but can cause it to tear open while it's healing. So, I guess that means no cycling for a while? :(

I'm using the default Giant Performance Road saddle that came with my Defy -- and I think it's fairly terrible. The saddle appears to be convex. I'm only a relatively new cyclist, so I'm not sure how it should feel -- but it seems like the pressure is not on my sit bones, but between. The saddle even after 1 hour causes pain in my tailbone, which also leads me to believe the pressure is in the wrong place.

I'm really wanting to replace the saddle, but not sure where to begin. I'm worried about having to buy multiple saddles, and I haven't seen a try before you buy offer yet.

RhapsodyX
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Re: Fissure

Postby RhapsodyX » Mon Mar 27, 2017 4:23 am

Hi thatmdee - sounds painful. :(

As for whether or not you should ride - I'd be checking back with the doctor. And don't forget to prop your feet up or lean forwards when pooping. "Western" toilets are not actually compatible with human anatomy, but good luck finding a squat toilet in Australia.

Many good bike shops will have a selection of saddles to "try out". Any of the modern saddles with cut-out centres would be a good start, I'm very partial to the Adamo ISM's myself - but I have wide hips (I'm 1.9m tall). Less padding on a saddle is often better, and if you have some "excess padding" over the sit bones, it's a good idea to wriggle down on the saddle when starting off until you *are* on the sit bones. Which is why I love the Adamo - I can ride it in the correct position, or I can ride on the tip of the saddle - with the width of the nose it still picks up my sit bones, which is very useful if I've developed yet another round of saddle sores.

I once bought a very expensive saddle (specialized body geometry), that was supposed to be the perfect fit (correct width compared to my sit bones, measured using their memory foam measuring pad). On every ride, after about 20+k's it was damned unpleasant... I ended up using some $40 saddles on all my bikes for the next few years as they were the perfect fit for me - at the time.

So - my advice would be to find a flexible bike shop (they often have a bucket of good saddles removed from new bikes because people want wider/softer) and start experimenting. Once you find one that works - stick to it!


And good luck.

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ValleyForge
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Re: Fissure

Postby ValleyForge » Mon Mar 27, 2017 6:13 pm

Sad to say there is no link to your saddle. You need to see your doctor again if it is no better now, and presumably the GP will send you to a surgeon. Or if he's a really clever GP, know how to treat it.

PS - diet makes no difference.
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cp123
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Re: Fissure

Postby cp123 » Tue Mar 28, 2017 5:42 pm

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InTheWoods
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Re: Fissure

Postby InTheWoods » Mon Apr 03, 2017 11:13 pm

Roughly how old are you by the way?

A fissure was one of my first symptoms before I got properly sick a few years later, and was diagnosed with Crohn's disease.

It's a low probability but just in case...

Trevtassie
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Re: Fissure

Postby Trevtassie » Tue Apr 04, 2017 8:18 am

Could also be haemmaroids and a fissure! Or an infected fissure...
Best get a refferral to the bum doc...

enduro2
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Re: Fissure

Postby enduro2 » Wed Apr 05, 2017 9:47 am

and get a hand held bidet for home... maybe a portable one for work or when out

we bought a hand held bidet for one of our toilets and it's great, saves on paper, clean bum everyday and I wish we had one at work too.

keeping your bum clean will be essential in helping reduce swelling and or pain. If the could ever possibly heal, they won't if they are continuously able to be infected.

You can get fissures for all sorts of reasons other than cycling: poor bottom cleaning technique (wiping), dermatitis ...

CycloTron
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Re: Fissure

Postby CycloTron » Wed Apr 05, 2017 10:10 am

May I suggest daily or twice daily salt baths?

Just fill a large bucket (large enough to sit or squat in while in the shower) with enough salt solution to immerse your bottom. Sit in it for 15 minutes or so then rinse off.

Recipe for salt solution - roughly 2-3 metric teaspoons to one litre of warm water (does not have to be sterile). More than 2 teaspoons is not harmful but the solution may then sting a little.

Some like to use Epsom salt but normal table salt is cheap and will be more than adequate.

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ValleyForge
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Re: Fissure

Postby ValleyForge » Wed Apr 05, 2017 9:54 pm

enduro2 wrote:You can get fissures for all sorts of reasons other than cycling: poor bottom cleaning technique (wiping), dermatitis ...

Cycling doesn't cause fissures; neither does poor technique or hygiene I'm afraid to say. Just keep your poo soft.

CycloTron wrote:May I suggest daily or twice daily salt baths?


And salt baths don't work. They simply amuse the patient trying to find salt, and then a bath. One fellow I knew used to make them up in his wheelbarrow. On the balcony of his unit as he didn't have a bath.

Most GPs can't tell the difference between a fissure, haemorrhoids, haematoma, dermatitis, warts or a cancer. :oops:
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Trevtassie
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Re: Fissure

Postby Trevtassie » Fri Apr 07, 2017 7:34 am

Just found out I've got one, after going to the bum doc and being turned into a human egg cup in the special chair... first line of treatment is something called Rectogesic, basically a cream to relax your bum muscle. Apparently spasms cause the tear to keep opening up. It is over the counter from the pharmacy...and has some interesting side effects, like initial dizziness and headaches, because it's got a nitroglycerine derivative in it. I've only been using it a few days and already notice a massive improvement. Best talk to your GP first though, there are some contra-indications with various aliments and medicines. Doctor reckons it has a 50% success rate, so worth a try.
The surgical option involves doing the same mechanism as the cream, cutting a bit of the muscle so it can't squeeze so tight.
Since I'm about to spend 5 weeks riding in Japan I went the cream option... surgery might not heal in time.

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ValleyForge
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Re: Fissure

Postby ValleyForge » Fri Apr 07, 2017 7:57 am

Trevtassie - You know more than most GPs about fissures! The nitrate cream works really well but in needs to be three times a day strictly, and kept going for at least 3 weeks. Which is a PIA for most people.
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Trevtassie
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Re: Fissure

Postby Trevtassie » Fri Apr 07, 2017 9:40 am

ValleyForge wrote: Which is a PIA for most people.

To the uninitiated, PIA does not stand for "Pain in the Arse" it's actually "Poke in the Arse" , think little rubber finger glove and some soothing cream....noice, and I've got a month of it, according to the quack.

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ValleyForge
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Re: Fissure

Postby ValleyForge » Fri Apr 07, 2017 10:55 am

Trevtassie wrote:
ValleyForge wrote: Which is a PIA for most people.

To the uninitiated, PIA does not stand for "Pain in the Arse" it's actually "Poke in the Arse" , think little rubber finger glove and some soothing cream....noice, and I've got a month of it, according to the quack.

Still better than putting teeth marks in the toilet door....
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AUbicycles
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Re: Fissure

Postby AUbicycles » Sun Apr 16, 2017 5:32 am

Cycling is good because it us normal and healthy activity. Pain wont suddenly get resolved because of saddle selection so any change to your setup is about moving towards comfort (e.g. Double knicks and chamois creme).

For bowel movements, avoid strain (no reading books or checking the smart phone) and a truely effective option (in addition to suggested solutions to counter immediate or subsequent pain) is laxatives that contain macrogol. Over the counter and no prescription required and makes it easy for bowel motions.

Of course get advice from medical professionals as it is worthwhile identifying your situation and best remedies for you but also get advice from more than one doctor if extreme 'solutions' are recommended.

One thing you will find is that your state of being (e.g. Stress) will play a significant role in your wellbeing.

kenwstr
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Re: Fissure

Postby kenwstr » Sat Apr 22, 2017 8:45 am

A lot of people suffer from related conditions that result in this and other symptoms and it usually gets worse with age. the pain of fissures is usually associated with sphincter cramps which is a reaction to stress. The stress is exacerbated by rectal pressure, sitting, worry, tension...... it goes on. Mucus discharge can irritate the fissure itself also triggering cramping. It is often not sufficient to take just 1 action. Constipation, IBS, SIBO etc can cause internal pressure and therefore the fissure itself and continual re-injury. If you are getting inconsistent bowel movements, abdominal bloating, particularly high up, and this is not relieved by your current fiber based strategy, then the fiber itself may well be just adding to the bulk and making matters worse. Another strategy in to flood the bowl with water for a softer, more consistent motion, gets things moving better to relieve pressure. If you are drinking a reasonable amount of water or as much as you can reasonably handle, try movicol (an oral salts based preparation) instead of the fiber. This will take 2 or 3 days to take effect so be cautious about the dose. You can use paracetamol to assist muscle relaxation. Epsom salt baths to sooth the area. You can use a rectal cream to help sooth and heal the fissure itself. Doctors are often less helpful than pharmacists on this topic. Relieving pressure can be helped by: do not eat unless you are actually hungry, do not eat until upper abdominal bloating has subsided, do not over eat, stop before you feel full, do not eat within 2 hr of bed time. Cut back on starch. We generally eat way too much of it and it is a prime cause of abdominal fermentation and bloating pressure. Starch is grains potato etc. Wheat, bread, pasta, pastry, biscuits, noodles, rice, porridge etc There are many other things with starch but these are the main sources of blank starch, that is starch without much nutritional value. The 2 aims of all this is, relax the cramping muscle and relieve the pressure in the colon.

Rectogesic is an effective cream but the aplication is painful and can tear the fissure again.
The surgery can cause permanent loss of bowel control, requiring a colostomy bag.

Ken
Last edited by kenwstr on Sun Apr 23, 2017 7:04 am, edited 4 times in total.

Trevtassie
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Re: Fissure

Postby Trevtassie » Sat Apr 22, 2017 12:00 pm

Or don't eat a can of cheese in a day when you are dehydrated, bored and in a blizzard in Antarctica...

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ValleyForge
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Re: Fissure

Postby ValleyForge » Sat Apr 22, 2017 5:50 pm

kenwstr wrote:A lot of people suffer from related conditions that result in this and other symptoms and it usually gets worse with age. the pain of fissures is usualy associated with sphincta cramps which is a reaction to stress. The stress is excebated by rectal pressure, sitting, worry, tension...... it goes on.

Actually, fissure becomes less common with age. The older a patient, the less likely it's a fissure. And stress is not a risk factor.

kenwstr wrote: ...Constapation, IBS, SIBO etc can cause internat pressure and therefore the fissure itself. If you are getting inconsistent bowel movements, abdominal bloating, particularly high up, and this is not relieved by your current fiber based strategy, then the fiber itself may well be just adding to the bulk and making matters worse....

Constipation is the risk factor. Stool softeners are the first step of treatment

kenwstr wrote: ...Another strategy in to flood the bowl with water for a softer, more consistent motion, gets things moving better to relieve pressure. If you are drinking a reasonable amount of water or as much as you can reasonably handle, try movicol (a salts based preparation) instead of the fiber. This will take 2 or 3 days to take effect so be cautious about the dose....

Water consumption on its own does not improve outcome. Stool softeners do.

kenwstr wrote: ...You can use paracetamol to assist muscle relaxation. Epsum salt baths to sooth the area. You can use a rectal cream to help sooth and heal the fissure itself. Doctors are often less helpful than pharmacists on this topic....


Baths and over-the-counter creams do not improve outcomes. Stool softeners, topical nitrate cream, botox, and surgery do.
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kenwstr
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Re: Fissure

Postby kenwstr » Sun Apr 23, 2017 7:47 am

ValleyForge wrote:
kenwstr wrote:A lot of people suffer from related conditions that result in this and other symptoms and it usually gets worse with age. the pain of fissures is usually associated with sphincter cramps which is a reaction to stress. The stress is exacerbated by rectal pressure, sitting, worry, tension...... it goes on.

Actually, fissure becomes less common with age. The older a patient, the less likely it's a fissure. And stress is not a risk factor.


I intended to indicate the causative conditions like IBS and SIBO tend to get worse.

ValleyForge wrote:
kenwstr wrote: ...Constapation, IBS, SIBO etc can cause internat pressure and therefore the fissure itself. If you are getting inconsistent bowel movements, abdominal bloating, particularly high up, and this is not relieved by your current fiber based strategy, then the fiber itself may well be just adding to the bulk and making matters worse....

Constipation is the risk factor. Stool softeners are the first step of treatment


Hard stools cause pressure in the colon and cause the fissures. I agree the stool softeners are the 1st treatment as others indicate. However Inconsistent motions indicate an underlying condition is likely. For many people, fiber based products don't soften the stool, just increase mass. Products like Movicol are much more effective at softening which is the strategy below.

ValleyForge wrote:
kenwstr wrote: ...Another strategy in to flood the bowl with water for a softer, more consistent motion, gets things moving better to relieve pressure. If you are drinking a reasonable amount of water or as much as you can reasonably handle, try Movicol (a salts based preparation) instead of the fiber. This will take 2 or 3 days to take effect so be cautious about the dose....

Water consumption on its own does not improve outcome. Stool softeners do.


I am only trying to indicate that baseline hydration should be adequate as it is the 1st issue a doctor will ask about. I agree stool softeners are the effective treatment which is why I mentioned Movicol might be a better treatment than fiber. It's commonly preferred for bed ridden patients in hospitals.

ValleyForge wrote:
kenwstr wrote: ...You can use paracetamol to assist muscle relaxation. Epsum salt baths to sooth the area. You can use a rectal cream to help sooth and heal the fissure itself. Doctors are often less helpful than pharmacists on this topic....


Baths and over-the-counter creams do not improve outcomes. Stool softeners, topical nitrate cream, botox, and surgery do.


By cream, I was referring to something effective like Rectogesic, just couldn't recall the name off hand. In my experience, baths do give some relief and help to relax and destress. Physical stress held in the body over extended periods is a factor with repeated cramps and spasms IME. I don't see any problem advising someone to take action that will make them more comfortable while waiting for effective treatment to take effect. It certainly reduces the incidence of re-injury IMO. Surgery is an option but can go very very wrong surely it is better to try less obtrusive options 1st.

Ken

jpgibson
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Re: Fissure

Postby jpgibson » Sun Apr 23, 2017 9:54 am

If it's not healing with conservative treatment, ask your GP for a referral to a colorectal surgeon.this is their bread and butter ( sorry, couldnt resist).

thatmdee
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Re: Fissure

Postby thatmdee » Tue May 02, 2017 6:55 am

Thanks for the feedback. Not sure why the GP didn't suggest rectogesic, which I have been trying for the last few weeks in combination with movicol.

I've adjusted my diet slightly, which seems to have helped (vegetarian, but trying to go entirely plant based). The trickiest part I've found is not just balancing soluble and insoluble fibre, but determining what insoluble fibres to take.

As an example, I was eating nuts on a daily basis, which are known to be quite a 'scratchy' insoluble fibre -- and made matters worse. I've since stopped that, which has helped a significant amount, and replaced with pitted dates.

I have a referral, and believe there's something further up responsible (I've had issues there before) -- so I'll keep up the diet changes, and go see a surgeon.

For now, I've been finding cycling hasn't been much of a problem thankfully. I've had days where I've been in considerable pain the entire day which has stopped my riding, however since removing mixed nuts from my diet and replacing with other sources of insoluble fibre, I've found that this has helped substantially.

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