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.
-
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.
-
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.
-
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.
-
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:
-
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.
-
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.
-
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.
-
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.
Related Questions
Blood in Urine: Seeking Guidance
A 20-year-old female weighing 140 pounds has not been taking any medications or supplements, and has no prior or current medical conditions. Her menstrual cycle last occurred two weeks ago. While at work, she observed blood in her urine, which appeared light red but darker than pink. Accompanying this symptom, she has experienced some abdominal discomfort. Notably, there was no evidence of blood on her underwear, only when she urinated. Additionally, she felt a moment of lightheadedness upon noticing the blood, which has since subsided; she attributes this feeling to her anxiety about the potential seriousness of the situation. Given these symptoms, what could be the likely cause? She is uncertain whether to visit the emergency room or to wait until urgent care is available tomorrow for a consultation. As she recently relocated and does not have a primary care physician yet, her anxiety is heightened.
Exploring Endolymphatic Hydrops: Could This Be My Condition?
34 years old / Female Current weight: 165 lbs Navigating the challenges of motherhood In early December 2025, I caught a cold. By mid-December, my right ear felt blocked, but I attributed it to the cold virus. As New Year approached, I experienced another cold, which coincided with an onset of ringing in my ears. Disturbingly, sounds started to seem altered from the affected ear, accompanied by a persistent fullness in that area. Additionally, I noticed twitching of my eye and swelling in the salivary gland on the same side. My primary care physician prescribed a decongestant and Flonase; however, because I am currently breastfeeding, I hesitated to take the medications as directed. On January 27, I was evaluated by an ear, nose, and throat specialist, who requested a hearing assessment the following day. The results indicated that I had sensorineural hearing loss affecting my low-frequency hearing range (250 Hz to 500 Hz). The doctor prescribed a steroid with the hope of addressing the issue promptly. Now on day 10 of steroid treatment, I have experienced significant relief. Remarkably, I've noticed a substantial amount of thick, putty-like mucus clearing from my nasal passages. The pressure in my ear has subsided, and sounds are returning to normal, though I still perceive a slight ringing — possibly just a touch of hearing loss remains. What concerns me is whether ongoing sinus congestion could be the root of these symptoms or if I might genuinely be dealing with endolymphatic hydrops. Notably, I have not experienced any episodes of dizziness. In the evenings, I tend to feel considerable pressure building on the right side of my head, almost as if my sinuses are becoming blocked once more. I would greatly appreciate any insights or advice on this matter, as I find myself in a state of uncertainty regarding my condition.
Experiencing Occasional Hematuria: Seeking Guidance
Greetings, medical professionals. I appreciate your assistance with the following situation. **Patient Overview:** - **Age:** 47 - **Gender:** Male - **Height:** 6 feet - **Weight:** 202 pounds **Symptoms Overview:** Approximately three months ago, I began to observe small traces of blood in my urine. It's a minimal amount, usually just a couple of drops occurring at the end of urination. I do not suffer from any pain, fever, chills, or urinary difficulties. Initially, I suspected that this could be linked to kidney stones or exercise-induced hematuria, as I maintain a rigorous exercise routine spanning two hours daily, seven days a week. My workouts alternate between strength training 3-4 times a week and cardio exercises, including rowing, treadmill use, the elliptical, stair climbing, and jump rope. After several weeks, I also observed tiny tissue-like fragments in my urine, prompting me to consult a doctor, as I suspected a urinary tract infection. Although I have an enlarged prostate, my physician considered it a benign issue, attributing the swelling to the potential chain reaction of a UTI leading to bladder infection and subsequently causing prostate inflammation. **Diagnostic Tests and Outcomes:** I underwent a comprehensive metabolic panel, which included tests for glucose, BUN, creatinine, and various electrolytes. All results fell within normal ranges, with the exception of a low BUN/creatinine ratio (8). Additionally, I received a Creatine Kinase (CPK) test, which returned normal results. A complete blood count (CBC) with differential was conducted, showing all parameters, including WBC, RBC, and hemoglobin, to be normal. Urinalysis reflected negative findings for GLU, BLO, NIT, and LEU. However, it indicated a small amount of bilirubin, a ketone level of 15, a specific gravity of 1.025, a pH of 5.5, and a protein level at 30. Uric acid levels were 8.1, within normal limits, though an inflammatory marker was mildly elevated. A sedimentation rate (Westergren) displayed a slight elevation at 19 (normal range is up to 15). A CT scan of the abdomen and pelvis with contrast yielded several findings: - **Lung Bases:** A few small pulmonary micronodules were noted, but otherwise clear. - **Liver, Spleen, and Pancreas:** All appeared normal without lesions. - **Kidneys:** Normal with no stones or masses. - **GI Tract:** The stomach was mildly distended, but otherwise normal with stool presence noted in the colon. - **Pelvis and Vascular Structures:** Solid organs and vessels appeared normal. - **Other Findings:** Prominent inguinal lymph nodes were potentially reactive, alongside a small left inguinal hernia. **Follow-Up Treatment:** Following these evaluations, my physician prescribed sulfamethoxazole for a duration of 28 days. I adhered to the regimen fully, and while undergoing treatment, all symptoms subsided completely. However, this occurred about a month ago, concluding in late December. **Current Situation:** This evening, after my workout, I noticed the return of blood traces in my urine. While I do not experience pain, I have difficulty with bowel movements, feeling persistently constipated regardless of food intake. This change coincided with a mild tearing sensation during exercise on the adductor machine. Additionally, I have developed a reddish rash on both arms, which had resolved during the antibiotic treatment but has now reappeared. Previously, this rash was effectively treated with prednisone, leaving me unsure if this is connected to my earlier symptoms. **Concerns:** I worry that standard medical tests might overlook a significant issue affecting my prostate, colon, or urinary system. My insurance policy does not cover colonoscopy or prostate evaluation, and I have been advised to consider these procedures, though they would cost nearly $7,000 out of pocket. While I understand the necessity of these assessments if needed, I prefer to seek a second opinion before committing to such expenses. It's important to note that there is a family history of cancer, primarily lung cancer. I welcome any advice or insight into my case and will provide any additional details you may require.
Gene Testing Outcomes Suggest Elevated Risk for MPN
A 27-year-old male of Irish heritage recently conducted a commercial gene analysis, and here are the findings: - **Rs12340895 (C;G)** Result Interpretation: "Doubles the likelihood of developing V617F-positive MPN." - **Rs3780374 (A;G)** Result Interpretation: "Significantly raises the probability of V617F-positive MPN manifestation." Based on my research, it appears that having these two genetic markers indicates a strong predisposition to this particular form of cancer. What steps should I consider taking to either prepare for or potentially postpone the onset of this condition? Should I discuss these findings with my healthcare provider? My studies suggest there isn’t a definitive cure for this condition.
Understanding Preseptal Cellulitis in Children
Hello everyone. I'm reaching out for assistance. My 6-year-old son recently experienced a concerning issue. He woke up on Friday with significant swelling around his eye, nearly closing it entirely. We quickly took him to the emergency room, where doctors diagnosed him with preseptal cellulitis. They prescribed antibiotics, specifically cephalosporin, as part of his treatment. However, after approximately 30 hours on the medication, I’ve noticed that his condition seems to have deteriorated. We’ve been applying warm compresses, which help reduce some swelling temporarily, but he now has a noticeable bump right in the center of the affected area. This morning, he woke up again with his eye completely shut. I’m uncertain whether I should return to the ER for further evaluation. I appreciate any advice or insights you can provide. Thank you!