Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.
Hi I'm Dr. Phil
Can I ask your first name?
Hi Dr Phil, my name is Lin.
Nice to meet you
How often are you having a bowel movement?
That depends. At the moment it can vary between 2 - 5 times a day. I am trying to reach a happy balance but it's just not working. Then I become constipated for some unknown reason and the whole cycle starts again.
Have you tried a daily stool softener like metamucil or miralax?
At the moment I am taking Macrogol (My GP prescribed) and Dulcolease but I'm not sure how long I can take these for.
I would go with miralax
you can take it forever if needed
That will help regulate the bowel
As for the fissure itself, the rectogesic is good
have they considered surgery?
I don't think I have ever tried that one, as I just need something to help me with bowel movement on a regular basis. I thought that you couldn't take medication for too long!
nope you can take miralax forever
and it works!
I have been told to use the rectogesic for six weeks only? As for the surgery, my GP dismisses that as a 50/50 success rate, which I am obviously not going to accept.
Yes, that is not ideal
Try the miralax Lin
It works quite well
I don't want to end up with a "bag".
I hear ya
I will certainly take your advice. So are you saying not to take macrogol or dulcolease?
Brilliant. Is it to be taken at night?
no, I would take in the AM
Ok and only once a day?
Would you know why this hasn't been suggested to me before, seeing that I have been suffering for so many years.
I'm not sure
It is the first go to med in the U.S.
Thank you! Once I finish the rectogesic, how long would I have to wait before I can use it for another six weeks?
I would give it a couple weeks off
Thank you. Is there any other advice you can give me that I don't seem to be covering at the moment?
One last thing is that sometimes you can take oral medicines that can help
or calcium channel blockers like nifedipine or diltiazem
*oral calcium channel blockers like nifedipine or diltiazem
also, topical nifedipine is better than topical nitroglycerin (what you are taking) in most studies
I will try anything to stop this pain. I have also been recommended to take Ortisan cubes. They are natural cubes. What would your opinion be of those?
those seem okay
you can take them with miralax
That's good. You think that rectogesic is the best ointment I can use at the moment. Is there anything else?
Like I said, nifedipine seems to work better
I'm not sure what the name is XXXXX XXXXX UK
Thank you, XXXXX XXXXX certainly take your advice. I will do a search on the internet and see what pops up for topical nifedipine.
you're welcome :)
glad to help
Did I do excellent work for you today Lin?
Many, many thanks. You certainly have. Have a good weekend!
thank you :)
please don't forget to click the excellent face before leaving
I greatly appreciate it
I won't and thank you again.
you're very welcome