Mom 5

Date: Fri, 18 Apr 2003 16:07:30 -0400
From: "Wendy" wlabronrcn.com

Hi- Please add the following to your fissure website. Feel free to include my e-mail address. THANK YOU! Wendy

Botox Surgery and the Nursing Mom.

Thank you for this very valuable website. I wanted to share my experience in the hopes that it might help pregnant/nursing moms like myself. I had horrid hemorrhoids and a VERY painful fissure after the birth of my second child. I tried Colace, Tucks, fiber, lots of water and all the rest but I couldn't seem to get the constipation and pain under control. I finally found a surgeon who recommended Botox for the fissure and removal of a few external hemorrhoids. He said he usually doesn't like the procedure of cutting the anal muscle of women since women have less muscle there than men so are more likely experience incontinence later in life. He also made the Botox option sound easy-discomfort for 3-5 days following the surgery but nothing like the pain I was experiencing. Desperate for relief, I scheduled surgery for the next week.

Recovery from the surgery was NOT pleasant and, ultimately, the surgery did not help. I had IV sedation and local anesthesia (no problem with nursing), then Percaset (sp?) for pain relief, and directions to take mineral oil 2 X's a day. I was VERY constipated for a few days following the surgery due to the meds, and I had excruciatingly painful muscle spasms on the opposite side of the botoxed area. While the Botox helped one side, my body seemed to compensate by moving the tension to the other side and creating a new fissure. Into the second week after surgery, I would spend 5 hours or so after a movement in intense pain from both the movement and the spasms (Thank God the grandparents helped with the kids!). It took me 4+ days before I was able to combat the constipation and 9 days before I was able to leave the house shortly after a movement. Six weeks after the surgery, I still had pain following a movement, but got a handle on the constipation and the muscle spasms somewhat. At my 6 week follow-up appt., the dr. noted that I had yet ANOTHER fissure and recommended surgery to cut the muscle.

Fortunately, I didn't jump into surgery again. I found another doctor who recommended NIFEDIPINE ointment which worked and, according to my OB, is safe for pregnant and nursing moms. Three times a day I would do a warm sitz bath to relax the muscle and then insert the ointment. After a few weeks I felt much better and now, 3 months later, I feel I can FINALLY say I've healed.

Here are my recommendations for nursing moms:

1. I'd try Nifedipine before surgery. It relaxes the muscle to allow for healing, the same thing that Botox does. (One dr. explained it well? When your muscle feels pain, it tightens. This tightening contributes to constipation. Both the constipation and the tightening keep the fissure from healing). Keep up the sitz baths, especially after a movement, but otherwise keep the area dry.
2. Do whatever you can to keep your stools soft. Colace is safe, as is prune juice. I found that a mild dose of Herb-Lax (see shaklee.com), which contains senna, helped break the cycle. Senna can show up in breast milk but I took a low dose (only 2 tablets whereas 4 produces a laxative effect) and my baby had no side effects. In addition to 2 Herb-Lax, I took a cup of prune juice and a Colace before I went to bed to get a soft, predictable movement in the morning. For the pain, Advil was the only thing that seemed to work. I slowly weaned myself off Advil, Herb-lax and the Colace. Now I just do the prune juice before I go to bed and give myself a very occasional dose of Nifedipine at the slightest hint of pain, plus an occasional sitz bath. When I travel or eat poorly, I add a Colace to my regime for a few nights as a preventative measure.
3. Surgery may not be as simple as it sounds. If you decide to have surgery, have plenty of support in case you need it after the surgery (a spouse with a good sense of humor helps too!). As for info on the safety of anesthesia and certain drugs while nursing, I'd recommend 'The Nursing Mother's Companion' (or if you're pregnant, 'The Natural Pregnancy') which reviews meds, fibers, herbs, and so on that do or don't pass into breast milk. I nursed throughout my entire ordeal (no pumping, no bottles, no formula) and neither I nor my baby had any issues.
4. As for diet, lots of water and greens. I had no luck with fiber. Once my baby started solids and my hormones started to stabilize, my constipation lessened.

While I think my fissure came about from hormones and not drinking enough water, I don't feel as if I did enough to combat the constipation early on. I thought that even taking Colace would affect nursing. I probably could have avoided a lot of pain if I had been even more aggressive early on in treating myself. If any suffering moms out there need more information, please feel free to contact me at wlabronrcn.com.