Seeking Guidance on Persistent Fissure Symptoms and Future Actions
**Overview:** * 40-year-old male, of South Asian descent, residing in Australia for the last decade. * Overall good health, without significant medical issues. * No hereditary cancer risks; however, my mother had an ulcer in her upper abdomen. **Current Concern:** Around eight months ago, I began feeling a severe stabbing pain during bowel movements, likely linked to periods of constipation due to an inadequate diet. My general practitioner identified it as an anal fissure and suggested a topical ointment available over the counter, which provided only temporary relief and did not completely resolve the problem. Subsequently, I was referred to a specialist who also suspects a fissure. While he expressed minimal immediate concern, he mentioned that if the situation doesn’t improve, we might explore a colonoscopy. He has prescribed Diltiazem cream, which I intermittently use along with Metamucil and some laxatives like Coloxyl. Most of the time, my symptoms are manageable, but when my stool is even slightly firm, I experience discomfort at the onset of a bowel movement and occasionally notice a small amount of bright red blood. There’s no abdominal pain or cramping; however, I tend to feel a persistent discomfort in the rectal area, particularly on days when there is blood. **Request for Guidance:** 1. **Colonoscopy Scheduling:** Since my private health insurance won’t cover a colonoscopy until April of next year, I’m pondering whether I should wait or opt for a private payment. Given my current symptoms, is it advisable to expedite the process, especially with public health services having long waiting times? 2. **Identifying Food Triggers:** As my constipation is not a daily occurrence and tends to fluctuate, I’m curious if there might be specific food intolerances or allergies at play. Would pursuing a food allergy test be beneficial? 3. **Nutritional Guidance:** I am considering consulting a dietitian to evaluate and enhance my dietary habits. Would this be a prudent approach at this juncture? 4. **Usage of Metamucil and Laxatives:** I’ve been taking Metamucil and, occasionally, Coloxyl, but I’m unsure about the frequency of use. Should I continue with both, switch to just one, or discontinue them entirely? I’m becoming concerned that my digestive system may become too dependent on these aids. I welcome any recommendations on managing this issue or steps I might take moving forward. Your assistance is greatly appreciated!
Answers (1)
6/22/2025, 12:30:47 PM
OpenHealth AI
Key Points:
You are dealing with a persistent anal fissure that causes pain during bowel movements. You have tried topical treatments and fiber supplements but haven't found complete relief. You are looking for guidance regarding a possible colonoscopy, food triggers, dietary improvement, and management of your medications.
Explanation:
Anal fissures can be quite painful, especially during bowel movements, and often result from hard stools. The bright red blood you see is a common symptom of fissures but should still be monitored closely. Given your description, it appears that you're managing your symptoms reasonably well, but there are still challenges, especially with occasional discomfort and bleeding.
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Colonoscopy Scheduling:
- If your symptoms persist and are affecting your quality of life, especially with blood on stool, it's reasonable to consider expediting a colonoscopy. This procedure will help rule out any serious underlying conditions. Although it may come with a cost, if the waiting period is significantly long and you are experiencing discomfort, private testing could be worth it for peace of mind and management of your symptoms.
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Identifying Food Triggers:
- A food allergy test can be helpful for identifying potential intolerances, especially since your constipation fluctuates. However, keep in mind that food intolerances don't always show up on standard tests. You might also consider keeping a food diary to track what you eat and when your symptoms worsen, as this can give insight into specific triggers.
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Nutritional Guidance:
- Consulting a dietitian is a great decision, particularly as you're seeking to enhance your dietary habits. They can provide tailored advice on increasing fiber intake, hydration, and managing the constipating effects of certain foods, which may help in healing the fissure.
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Usage of Metamucil and Laxatives:
- Continuing both Metamucil and Coloxyl is generally fine as they serve different purposes; Metamucil (a fiber supplement) increases stool bulk, while Coloxyl helps soften stools. However, consider using Metamucil regularly as your primary fiber source while limiting Coloxyl to occasional use when needed. It's essential to increase water intake to support these supplements effectively and help prevent dependency.
Next Steps:
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Decision on Colonoscopy: Weigh the symptoms you experience against the potential cost and urgency. If discomfort persists or worsens, consider booking a colonoscopy without delay.
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Food Diary: Start writing down your daily food intake and any symptoms, focusing on bowel habits. This will help you or a dietitian identify possible food triggers.
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Dietitian Referral: Schedule an appointment with a dietitian to assess your current diet and get personalized recommendations tailored to alleviate your constipation and manage your fissure better.
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Monitor Medication Use: Continue with Metamucil daily (as directed) and limit Coloxyl use to when you feel particularly constipated, ensuring adequate hydration throughout.
This structured approach should help you manage your symptoms effectively while exploring underlying causes. You’re taking important steps toward addressing your health concerns, and it’s okay to seek further assistance when needed.
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