BrownBagger wrote:... The whole soluble fiber thing was a revelation to me. In addition to their other benefits, soluble fiber sources like white rice are digestive system lubricants. They keep it all moving. I noticed when I had the ileostomy that after eating rice, I'd always get a nice clean slide when draining the bag. I didn't figure out until later that it was the soluble fiber slicking things up.
On a different thread, Eric made reference to the soluble/insoluble fiber distinction, which I think is one of the main keys to avoiding butt pain in the first place. To deal with butt pain, I think the preference would be to prevent it from happening at the outset if at all possible so that you don't ever have to focus on what kind of treatment to apply.
From my point of view, prevention involves four primary dimensions, all of which have to be dealt with at the same time. These dimensions are:
- Acidity of stool: The acidity of the stool must be minimized to the greatest extent possible. A lot of this is under the control of the patient by avoiding foods and condiments that are acidic or spicy in nature. This means focusing on a very bland diet. There are various leaflets available to help the patient identify foods, beverages, and medications for minimizing acidity of the stool output. I think that pain is likely to occur in the rectal, anal, or anastomosis region whenever acidic stool content passes through.
- Bulk/hardness of stool: The stool needs to be small and soft, not hard, because large, hard stools will expand the anastomosis junction and/or the anal canal and cause severe pain. Large stools can also cause anal fissures, which will cause even more excruciating pain. This is where the soluble/insoluble fiber issue comes into play. The softness of the stool is largely under the control of the patient if the patient pays attention to what is put into his/her mouth. This includes medications, since some medications can cause constipation as a primary or secondary effect. This means that the patient needs to focus on diets that have the right kind of fiber and the proper proportions of other ingredients. There are various leaflets available in this area to help patients identify which combinations of food/beverage/medication/supplements will reliably yield a soft stool. You will want to avoid a hard stool at all cost because this can cause an anal fissure, which will then take a long, long time to heal. A large, hard stool might even cause a rupture or leak at the anastomosis junction, which is an even more serious problem. You will also want to avoid large stools due to eating large meals. This is why the standard recommendation is to eat 5 or 6 small snacks per day and to never eat a very large meal.
- Method of wiping/cleaning: I would say that the preferred method of cleaning oneself after a bowel movement is to use water spray (e.g., bidet or small hose with nozzle). The worst practice is to use rough toilet paper with a scraping motion or wet wipes containing noxious chemical moisteners. Some problems with surface butt pain are exacerbated by patients using an inappropriate method for self cleaning.
- Exercise/physical movement: The normal functioning of the intestine is facilitated by normal body movement, such as walking. For good intestinal motility, it is bad to be horizontal in bed all day or in 'couch-potato' mode. The body should be in a vertical position a majority of the time to prevent extremes in digestive function (i.e., diarrhea, constipation). To facilitate regularity of bowel movement and to facilitate the reliable production of soft, semi-solid stools, physical exercise is an important component.
So, I would recommend focusing on preventing butt pain first, rather than waiting until the only option left is to treat butt pain or seek its relief in various creams or preparations.
Keywords: butt pain, butt burn, proctitis, rectal pain, radiation pain, sore bum hole, sore bottom, painful anus, anal pain, sore butt, anal fissure