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Chronic constipation, fissure, taken Ciplox and Flagyl, blood in stool, flatulence. What went wrong?

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Gastroenterologist, Surgical
Practicing since : 1984
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I am 27 yrs old unmarried girl , suffering from cronic constipation since september-2011. Earlier i did not know about hard stool or constipation and i thought stool would get soften itself but then after few days i got suffered from fissure. then i went to doctor and without checking on the basis of symptoms she prescribed me 1 tablet daflon (for one week) and lactulose solution and proctosydyl ointment and sitz bath etc..and also isabol and i followed it 2 months continuosly execpt daflon that took only for one week (not taking sitz bath and using proctocydyl during periods ) and also was doing 4 km morning walk one month but blood again come with stool at the end plus pain was there in anal part through out that 2 months (oct-nov-11) ..
Then i referred other doctor , he checked fissure and told me it is mild fissure/spasm and don't need to take sitz bath. He gave me ciplox with flagyl twice in a day after brkfast and dinner for one week and applying xylocline gel before bowel movemnt plus isabol in the morning after bowel movement. after one week it got reduced but little bit blood was still going so he told me continue flagyl only for one more week along with using xlocline gel. At that same time i also concernt gastroenterologist for my constipation (since lactulose solution was stopped showing effect which i was taking 2 spoons and sometimes three spoons for 2 months continuosly) he along with fliud and fruits intake gave me "Lactifibre" for continuous 14 days. Earlier i find it effective but later it again stopped showing effect even after taking 2 spoons after 30 min of taking dinner. Meanwhile my first fissure got healed but 2 fissure appeared and wen it got healed again third one appeared (because of thick stool which was many times very dry)...When i use to take flagyl blood does not come at the end of stool but when i stopped taking it, after one week it again comes at the end with stool but quantitywise its not that much but also can't neglect that quantity also. I took flagyl continuosly 2 weeks then after one week gap again took for 3 weeks continuosly then i find blood is stopped and no pain is there in anal area while walking. But now again constipation has occured and some times along with thick stool (not that much hard i guess but many times dry ) blood comes in traces in outer surface of stool not at the end and when i eat cabbage or cauliflower white fluild also comes along with stool. I had a routine stool test two times but repots are normal and other reports blood, urine .thyroid ..everything is normal.. .. that fissure specialist told me don't eat raw food always eat cooked and take isabol in every morning and that gastroentolosist told me eat raw food , salad and take Lactibre after 30 min of dinner. But i had suffered from sideeffects of lactulost like bloating, flatulence etc. i fear that lactibre fibre show same side effect and also i have heard intestine get dry by taking lactulose for longer time ..pls suggest ..because i think if i ll have thin soft stool my fissure problem ll go away but i dont know...I am not able to concentrate on my personal life as well as professiona;l life... i am unmarried ..i don't know anyone will marry me or not because of this problem ?? :(.. i am eating fibre diet and plenty of water around 4 ltr per day since october-2011 till date .. and even today in lunch i ate ladyfinger with chappatis and fruits like papaya, chiku and sweet citrus and then butter milk, and i passed stool in night around 8:30pm with traces of lady finder seeds. i don't know what went wrong?.. i am sending some of my reprts also. Pls help
Posted Thu, 26 Apr 2012 in Constipation
Answered by Dr. Ajit Naniksingh Kukreja 1 hour later

Thanks for Posting your query

I would like to congratulate you for the elaborate description of your complains, this will help me come to treatment part straight away

First a word of reassurance - This is not a major problem we see around 500 patients of fissure every month and all get married and enjoy a good life - so keep yourself relaxed as anxiety adds to all gastrointestinal problems

Coming to your treatment - Fissure in any form is a treatable disease by medicines in some cases and by surgery in most

All your reports that are attached are normal

But before you go ahead get your problem of constipation resolved

Few tips : Continue with lot of fluids and XXXXXXX leafy vegetables to add fibre

If raw doesn't suit you you can use cooked high fiber diet

Your problem is with the consistency of stool and not the propulsion[Movement of intestine] so I would suggest you go for Liq Paraffin atleast 20-30ml at bedtime for atleast 6 weeks to 6 months in a gradually reducing doses

White fluid which comes out with stools is mucus - is common with hard and dry stools nothing to worry as your stool reports are normal so the mucus is not of infective origin

The blood that comes out in traces is because of fissure - If the constipation is controlled the fissure won't reoccur - for the present fissure use an ointment called Diltigesic and apply it twice a day after stools and before going to bed

Continue sitz bath till the fissure heals and do not take ciplox and flagyl without advice from the consultant

Hope I have replied to your satisfaction, if yes accept my reply or else post a followup query

Get well soon
Above answer was peer-reviewed by
Follow-up: Chronic constipation, fissure, taken Ciplox and Flagyl, blood in stool, flatulence. What went wrong? 21 hours later
First of all thanks for your reassurance for marriage. Sometimes i feel like i should get marry a doctor so that he made me to feel relaxed everytime because only doctor can understand problem of mine. It is quite embarrassing to tell about this problem to any other person who is not doctor. I am getting proposals from IIM and ISB studied guy. I don't know how i ll tell them about my this problem. And 'll they marry me after after this or not ?

I am just requesting you pls read all what i have written below carefully and suggest me. I ll be very much greatfull to you. I am loosing all my confidence and zeal in my life because of this.

Just want to know which liq parrafin (pls specify name) because i had already took lactulose solution for 2 months continuosly with sometimes 2 or 3 spoons in the night which stopped showing effects later after 2 month. Are you talking about same laxative?
Wheather i start taking lactifibre or not ? because that doctor suggested me take lactifibre 1 spoon, if it does not work then go for 2 spoons and if it ll not work then go for 3 spoons but not more than this and continue this regularly till you come out of this cronic constipation.

Is there any sideeffets of lactulose / lactifibe ? because i have heard some where that these laxative dry the intestine if it take for longer period of time and intestine/ colon stops doing it own function . Is it so?

And if i go for surgery for fissure but still i will be suffering from constipation then again fissure reoccur. Is it so?

I never ate junk/baked food much like pizza, burger.etc then why it happened to me i don't know :(

Also i am eating papaya and sweet citrus/ orange everytime along with breakfast , lunch and dinner so that stool become soft but after one week it stops showing effects. I used to eat cooked vegetables everyday like spinach, then peas., then cauliflower, sem along with chappatis. I also stopped eating rice since oct-11 (although through out my whole life i used to eat rice only not chappatis because rice was my favorite).

I ll use diltigesic gel that u suggested me after stool and in night but should i use xylocline gel before stool? koi reaction tou nahi hoga dono gels ke beech?

I ll also start doing sitz bath but when? Although i cant do this during periods. Is that ok??

And .i don't use to take ciplax now (took only for one week initially). But i am taking only flagyl.Earlier when i used to go to doctor .. he use to give me flagyl only and once he told me " if blood ll not stop even after taking this u have to go for operation since i can't prescribed this flagyl for longer period of time". Although i use to have pain at that part everytime if blood goes daily but its not that much that i go for surgey.

I use to take flagyl when blood goes because i think doctor will tell me for surgery so i don't have any other option except to take flagyl. I don't know what to do if blood goes daily? because if i give strain during stool or stool is hard then blood comes along with stool daily and hence pain ll be more. I don't know what to do in this case.

I am just keeping patience since 3 and half months so that i can come out of this problem without surgery but i don't kab tak rakh sakti hun.

Thanks, Regards
Answered by Dr. Ajit Naniksingh Kukreja 49 minutes later

Thanks for posting your followup query

Let me clear one thing I am a Qualified proctologist with 25 years of experience, I see around 500+ patients of anorectal disorders every month but have yet to see a guy who would not marry a girl because of this problem so go ahead and get married to a good prospective candidate

Secondly Lactulose is different from paraffin, you need to take anything like Softner 2-3 tsf before going to bed

No reaction will occur between xylocaine and diltigesic

You can continue sitz bath for rest of the days of the month
You cannot avoid surgery with ciplox and flagyl, so do not take without medical advise

Junk food does increase the problem but it is not the only cause of constipation

You need to control constipation as per my advise in first consultation, if constipation is under control fissure will not recur

If surgery is essential as per your doctors advise go ahead there are so many new procedures available, we usually discharge the patient in one hour after fissure surgery and nothing is cut

Hope I have replied to your satisfaction if yes do accept my reply

Get well soon
Above answer was peer-reviewed by
Follow-up: Chronic constipation, fissure, taken Ciplox and Flagyl, blood in stool, flatulence. What went wrong? 22 hours later

Thanks for reading my query with patience and giving me advice again.
I have started using your prescribed gel and ll keep continuing with proper diet and water.

Only Last two questions i have...

1.1 ) please prescribe me "names of liq parrafin" that you are talking about so that i can directly go to medical store and purchase otherwise again i have to go to doctor only for this particular thing and may be he ll start his own treatment. Last time that gastroenterologist was saying 'if fissure reoccurr u have to go for colonoscopy'. So Keep taking lactifibre. Now it has again occured , may be he ll send me for colonoscopy.( I don't know how terrible it ll become colonoscopy in fissure :(..)

1.2 ) Most of the time the initial part of stool is hard and only back part is soft. Does this softerner help me in this ..making initial part of stool softer also??

and 2 ) pls tell me "name of other options that can be done without cut" if you feel comfortable or OK by sharing these option that i can talk to my colonrectal surgeon because last time he was only talking about only one option in operation and telling me about the adverse effect of other options.
and i guess he was talking about cut wala option for this mild reoccuring fissure :(

Please note that i am consulting two doctors one for gasteroloenterologist (who told me for lactifbre) and other is fissure surgeon (who use to give me flagyl) because in that hospital there is no doctor with combo of both. I have to consult them seperately.

And Once again thanks for marriage reasurance.. I don't want to live alone through out my whole life thats why become more concernt for this.

Earlier when i was not mentally prepared for marriage i was completely healthy. I never had any problem (except fever and cold thats it) and when i have mentally prepared myself for marriage this embarrassing problem happend to me..

Thanks , Regards.. and i am sorry if i would have irritated you..
Answered by Dr. Ajit Naniksingh Kukreja 3 hours later
Hello again Ms. XXXXXXX

Thank you for writing again and thank you for appreciating.

I am happy that I could help you and ease your pain somewhat with my answers,

Softner is a brand of Liq Paraffin it will help you soften the stool. You can visit your nearest pharmacy and request for a bottle of liquid paraffin. Any brand will do the job so do not be worried about the brand. It is available as an over the counter medicine in India so you wouldn't require a prescription to procure this.

No you do not need colonoscopy, it is a very tedious procedure.

You can check hospitals such as Apollo or Fortis and any teaching hospital for the available options other than surgery. Even the surgical procedure is a very minimal and simple thing. So there is nothing to be worried about.

Anyway all that I have suggested should help you now and in case it recurs revert back.

Hope I have replied to your satisfaction, do accept my reply.

Get well soon.


Above answer was peer-reviewed by
Follow-up: Chronic constipation, fissure, taken Ciplox and Flagyl, blood in stool, flatulence. What went wrong? 21 hours later
Thanks a lot doctor i am going to purchase this tomorrow and start taking this softner.

Answered by Dr. Ajit Naniksingh Kukreja 43 minutes later
I am happy to see you relaxed
Keep up the spirit and you will be able to overcome the disease
Again : Get Well Soon
Above answer was peer-reviewed by
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