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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 53184
Experience:  GP in the United States
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Can anybody help me with a persistent fissure that I have

Resolved Question:

Can anybody help me with a persistent anal fissure that I have been suffering with for nearly 8 years. Back in 2010 I had two procedures (the first one in Feb 2010 didn't work) and the second procedure, Botox, was used (in July 2010). Unfortunately, I am now suffering badly again and have been prescribed Rectogesic rectal ointment. I have good days and bad days and cannot see this healing on its own.
I drink at least 3 pints of water a day, eat bran, fruit etc etc, everything I should do to help the bowel movement.
Is there anything else I am not doing that I should.
It is so sore and very debilitating!! Any help would be greatly appreciated.
Many thanks.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 2 years ago.

Dr. Phil, MD :

Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Dr. Phil, MD :

Hi I'm Dr. Phil

Dr. Phil, MD :

Can I ask your first name?

Customer:

Hi Dr Phil, my name is Lin.

Dr. Phil, MD :

Hi Lin.

Dr. Phil, MD :

Nice to meet you

Customer:

And you!

Dr. Phil, MD :

How often are you having a bowel movement?

Customer:

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.

Dr. Phil, MD :

I see.

Dr. Phil, MD :

Have you tried a daily stool softener like metamucil or miralax?

Customer:

At the moment I am taking Macrogol (My GP prescribed) and Dulcolease but I'm not sure how long I can take these for.

Dr. Phil, MD :

I would go with miralax

Dr. Phil, MD :

you can take it forever if needed

Dr. Phil, MD :

That will help regulate the bowel

Dr. Phil, MD :

As for the fissure itself, the rectogesic is good

Dr. Phil, MD :

have they considered surgery?

Customer:

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!

Dr. Phil, MD :

nope you can take miralax forever

Dr. Phil, MD :

and it works!

Customer:

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.

Dr. Phil, MD :

I see

Dr. Phil, MD :

Yes, that is not ideal

Dr. Phil, MD :

Try the miralax Lin

Dr. Phil, MD :

It works quite well

Customer:

I don't want to end up with a "bag".

Dr. Phil, MD :

I hear ya

Dr. Phil, MD :

http://www.amazon.co.uk/Miralax-Powder-Doses-4-1/dp/B000NIAZMM

Customer:

I will certainly take your advice. So are you saying not to take macrogol or dulcolease?

Dr. Phil, MD :

correct

Customer:

Brilliant. Is it to be taken at night?

Dr. Phil, MD :

no, I would take in the AM

Customer:

Ok and only once a day?

Dr. Phil, MD :

correct

Customer:

Would you know why this hasn't been suggested to me before, seeing that I have been suffering for so many years.

Dr. Phil, MD :

I'm not sure

Dr. Phil, MD :

It is the first go to med in the U.S.

Customer:

Thank you! Once I finish the rectogesic, how long would I have to wait before I can use it for another six weeks?

Dr. Phil, MD :

I would give it a couple weeks off

Customer:

Thank you. Is there any other advice you can give me that I don't seem to be covering at the moment?

Dr. Phil, MD :

One last thing is that sometimes you can take oral medicines that can help

Dr. Phil, MD :

or calcium channel blockers like nifedipine or diltiazem

Dr. Phil, MD :

*oral calcium channel blockers like nifedipine or diltiazem

Dr. Phil, MD :

also, topical nifedipine is better than topical nitroglycerin (what you are taking) in most studies

Customer:

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?

Dr. Phil, MD :

those seem okay

Dr. Phil, MD :

you can take them with miralax

Customer:

That's good. You think that rectogesic is the best ointment I can use at the moment. Is there anything else?

Dr. Phil, MD :

Like I said, nifedipine seems to work better

Dr. Phil, MD :

topical nifedipine

Dr. Phil, MD :

I'm not sure what the name is XXXXX XXXXX UK

Customer:

Thank you, XXXXX XXXXX certainly take your advice. I will do a search on the internet and see what pops up for topical nifedipine.

Dr. Phil, MD :

you're welcome :)

Dr. Phil, MD :

glad to help

Dr. Phil, MD :

Did I do excellent work for you today Lin?

Customer:

Many, many thanks. You certainly have. Have a good weekend!

Dr. Phil, MD :

thank you :)

Dr. Phil, MD :

please don't forget to click the excellent face before leaving

Dr. Phil, MD :

I greatly appreciate it

Customer:

I won't and thank you again.

Dr. Phil, MD :

you're very welcome

Dr. Phil, MD :

take care

Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 53184
Experience: GP in the United States
Dr. Phil, MD and 2 other Medical Specialists are ready to help you
Expert:  Dr. Phil, MD replied 2 years ago.
I appreciate the excellent rating.

I would be happy to help you in the future. Just ask for feedback. Thank you. :) Dr. Phil in your question opening or bookmark this page http://www.justanswer.co.uk/medical/expert-irondoc/

I greatly appreciate a positive rating in the customer satisfaction survey that you will receive via email. It is important for me to get your feedback. Thank you. :)

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