At the end of my tether.

[Lamly]

does anyone that has IBS have rectral problems, fissures piles etc apart from suffering from constipation I have very painfull and dibilitating rectrum problems.

[Blearyeyed]

Before I had more control of my IBS- C , and when I have flares I do get minor splits or fissures in the rectal area , itching , some minor bleeding and pain and sharp spasms. My IBS appears to be linked to my Autonomic nervous condition ( Dysautonomia) and Fibromyalgia.

I take Buscopan to relax the nerves and reduce the spasms. I eat soluble fibre and not insoluble fibre which often made bowel movements more painful or harder for me. Drink the recommended water each day which helps the constipation symptoms.

Even when things are not moving because I have bowel dysmotility I don't strain to go which has reduced the times I would get cracks or fissures , I've luckily not had piles.

An NHS tip I learnt to help make your bowel move without straining, which works after a surgery, is to sit , breath deeply then keep repeating the word , " Idge" out loud , a few times between big breaths . Oddly , it does make your intestines and anal muscles clench and release and helps movement without causing more damage. Even if you don't go at first , it does seem to help the movement of things through your bowel until it is possible to have a bowel movement.

Stool softeners can often help as long as you can take them , it's best to check with the GP before buying any over the counter.

Pelvic floor exercises and Kegle exercises created for Men or Women done each day strengthen the muscles making it easier to go and reducing the chance of piles or a prolapse.

You can access these exercises on a PDF available via the NHS website.

A cool , not cold bath or cool damp flannel can take the pain and heat from it.

Paracetamol can also help reduce the inflammation in the lower bowel and improve the chance of a bowel movement.

You can get creams prescribed by the GP to treat the entry to the rectal passage.

It would be a good idea to see the GP and gave it properly examined if you have these symptoms and they aren't clearing up after a few days , or if you see any fresh blood or blood in your stool. You may need a colonoscopy, or some treatment for piles.

[Lamly in reply to Blearyeyed]

Thank you for your reply, I have had a colonoscopy last year and I was clear , thank God.

[Blearyeyed in reply to Lamly]

I see in another reply that you are tapering Amitriptyline and wonder whether the IBS could be linked to it.

If you think back to when you started the drug do you think that the constipation did start soon after that?

IBS - C is often drug or supplement induced , and more often missed as such because the effects of constipation can be slower to occur than drug induced diarrhea.

In many ways , you hope that it is induced by a drug , especially if you don't have to keep taking it as it is one of the easier ways to get your IBS back in control a few months after you stop taking the drug that triggered it.

I was put on Amitriptyline for migraine and insomnia , but I didn't tolerate it at all . It made my migraines and insomnia instantly worse , and increased my palpitations instead of decreasing it. I have a Tachycardia induced form of Chronic Dysautonomia, so it really wasn't a drug that could work for me.

Although , Amitriptyline more often causes diarrhea because if it's relaxant effect on your nerves , everyone is different so it might have effected your system in reverse.

Interesting, since going on a drug to improve my circulation and Dysautonomia, all of my various problems have improved to some degree especially the constipation.

Autonomic nerve dysfunction effects all your involuntary body responses like eating , temperature , heart rate and bowel movements but hardly any consultants know anything about it or test for it which seems crazy as every illness causes some level of Dysautonomia at some point. Long COVID is basically an acute , or short term , form of Autonomic nerve dysfunction because if the way an infection can effect your body responses.

Nerve dysfunction and its effect on your bowel muscles and muscle strength is a more common cause for IBS - C than IBS- D.

I didn't notice a big effect on constipation but I only took it for two weeks. I have had to change various drugs because it increased my constipation and IBS over the years. Do you take any other medication or supplements that might be making the constipation worse?

Ferrous Iron is particularly bad for causing constipation , if you take a multivitamin with iron and have IBS-C it's better to swap to one with no iron . If you need iron after a blood test to confirm it take , Gentle Iron by Solgar on alternate days instead.

[Lamly in reply to Blearyeyed]

Thankyou for your reply, I am not on any other medication, that’s what is making me think that it is withdrawel from the Amitryptiline, I will shortly find out as I am nearly off the pill. The pill is known to be quiet addictive.

[Nikon1972]

Hey Lamly. Sorry to hear you're in so much pain. I know this will be no help or consolation to you, but you are not alone, and yes this rectal pain can be completely debilitating, draining you both physically and mentally. I've had IBS since my late teens, and the symptoms I had originally (abdominal swelling and pain) changed over the years, these days it's more flare ups of diarrhoea on a regular basis, with various influences from no understandable reason at all to spicy food, anxiety or even just warm weather bringing on problems.

I first had piles and bleeding around 7 years ago. It made it very painful to sit down, drive, etc, for a couple of weeks, then got better, and it returned regularly since for short period of times. A few months ago again the piles (external) got painful, and I got heavy bleeding from them and got to the point where I couldn't sit comfortably any time, and painkillers didn't help. I eventually saw a GP who just coldly told me my case wasn't bad enough for the NHS to care about and I should just go home, take more painkillers, and put some linseed in my diet to help with the diarrhoea. I got rather angry and did ask her if she'd hold the same opinion if SHE felt like she was sitting on knitting needles all day but she seemed to just dismiss me as a drama queen. It was extremely upsetting for me to have someone tell me that hurting so much all day was not 'serious enough'. I went home and took more painkillers, but the constant pain in my rectum ended making me feel sick, my anxiety spiralled out of control and that made me feel sick too, I would sweat constantly, not be able to eat, and feel utterly week and unable to function. The painkillers on empty stomach made it a lot worse too.

I finally called the doctors again recently and filled their online e-consult form (our practise has this facility, not sure if most have it or not) and got a call from a GP within a few hours, who organised blood tests and a face to face appointment.

Blood tests came back with nothing major except slightly elevated liver results (wine helps with the pain more than paracetamol - time to stop using that as a crutch now), but this time the GP was actually listening and paying attention and being sympathetic. Examination confirmed mild external piles but the intensity of the pain suggest a fissure that doesn't heal because of the constant diarrhoea. She prescribed uniroid (prescription only - the previous GP said there were creams available but I wasn't considered as needing them!!), and said to give it 6 to 8 weeks to help the piles and fissure and pain. She said if things weren't better after that I'd be referred to surgeon. The cream is taking the edge off the pain, and this made everything spiral the other way this time, less pain, and pain only for a while after a bowel movement rather than all day, eased my anxiety a bit, made it easier for me to eat a proper diet, which in turn helped with all the nausea, diarrhoea and so on.

It's only been 10 days so no 'healing' yet, but it has helped, and seems as I said to make all other symptoms fall into place and get better too.

It really is worth insisting and going back to GP (or whichever team in the medical system is looking after you) and getting help with the pain. It is not 'mild pain' someone can live and function with, it's sharp, deep, unbearable pain which make sitting, driving, and in my case even basic housework (anything that involved any pressure or tension in the pelvic area, even washing up, leaning forward for anything, hoovering) unbearable. I got to the point where I had to stop anything I was doing every five minutes to lie down for 10 minutes. That is serious enough, and impacts life enough, to be considered as 'serious' (not in a life-threatening way, of course, but in a life quality way) and not be brushed off by medical staff. The GP I saw last understood that and said 'oh no, that sounds so painful, we must do something' and insisted on me having another appointment after 6 weeks to consider referral. It really helped my morale and my anxiety to be treated kindly and seriously.

Keeping stools soft is important (though I realise not always easy for people suffering from constipation) and treatments for fissures are available (uniroid or GTN ointments) though they don't always work apparently as fissures tend to reappear if the constipation or constant diarrhoea keep reappearing too. Anything that could help with the pain though will make your life so much more pleasant!

I hope you get the help you need and deserve very soon. You have all my sympathy!

[Lamly in reply to Nikon1972]

Thank you so much you have helped a lot, and yes the pain is constant and horrific, there is not much help at my surgery, it is almost impossible to get an appointment, I am tapering down from Amitryptiline 10mg per day, (which I have taken every evening) to 2mg per day I am almost off it, this pill is extremely addictive and i have often wondered if all this is due to withdrawel, all this began when I came down the dose, I am going to approach my surgery once more to refer me to a colorectal general surgeon on the NHS. if not when I am completely off this drug, if not I will end up paying private, but it will take what bit of money I have managed to save.

[Arpin]

Oh Lamly it’s such a vicious circle So I’m not giving advice just to let you know I’m supporting I understand the whole horrible situation Have a hug and lots of love from me to say your not alone in this Not much compensation I know

🫂🧡 xx

[Lamly]

Thank you.

[301246]

I have lavata ani for which I've had Boxox injections. Hurts to sit on your rear.

[binks]

I can absolutely sympathise. I seem to have some pelvic floor dysfunction following a hysterectomy years ago which means I have to strain sometimes - coupled with the IBS it's all a perfect storm for fissures and piles. I use the brace and breathe technique, and a little yoga block to lift my legs a bit but even then it's a struggle. I go through bouts of intense rectal sensitivity where even wind cause a spasm and it feels like I have something sharp stuck in there! I use a sitz bath when it's really bad, which helps. You can do a search for IBS and rectal sensitivity and read about the trials that have been done. I had a digital rectal exam last week which was so brutal it's made things even worse! When it's flaring up I don't want to get out of bed.....but I do!

[IBSsucksallthetime]

yes! Antibiotic ointment helps me heal much much faster than anything. If you are straining too much than what helps me is liquid glycerin. Using glove, spread on fingertips and lubricate internally and externally. Also the only thing I can get any relief when this bad is (Fleet) liquid suppositories. This works to help me go. A lot of the problem may be that you’ve just pushed so hard that your pelvic floor is no longer working correctly. Pelvic floor therapy can help, also pelvic floor surgery. Chronic constipation can cause a lot of problems! I have had all of these treatments unfortunately. Feel better soon