Some background: I am a 32-year old male and in otherwise excellent health; I am vegetarian and get 40-50 grams of fiber a day, which is normal for me. I also drink 3-4 quarts of water daily and exercise 3-4 times per week or more. I have never experienced issues with constipation before, at least not that I can remember. I have one cup of coffee on most days and usually a cup or two of green tea. There have been no dietary changes whatsoever that should have precipitated issues with constipation, at least not that I can imagine.
This began three months ago almost to the day, when I developed a very painful external hemorrhoid inflammation combined with an even more painful anal fissure due to an unusually difficult bowel movement. My doctor initially prescribed stool softeners to relieve the pressure of bowel movements until the hemorrhoid issue healed-- he did not initially suspect a fissure. The stool softeners proved ineffective, so I was prescribed Milk of Magnesia. I took about half of the recommended daily dosage (1-2tbsp), and it worked wonders. Stool quickly became soft and passed easily. After about three weeks of this, the hemorrhoid resolved, but I continued to deal with extreme burning pain associated with bowel movements, walking, standing for long periods, etc. I continued taking the Milk of Magnesia and treating with sitz baths and topical ointments as though it were a hemorrhoid problem. By the end of the second month, my doctor finally recommend a GI specialist, and it was he who diagnosed an anal fissure; he gave me a steroidal ointment to aid in healing, and after about 10 days, all symptoms had disappeared.
At this point, I tapered down the MOM for a few days and then stopped it completely. Within 3 days, I was once again having very hard stools, and this brought back the symptoms of the anal fissure and put me right back where I had been before. I immediately resumed taking the MOM and used the remainder of the ointment I had been prescribed; after another week, the pain and discomfort was again gone. That was a month ago; twice since then I have tried stopping the MOM, but within a couple of days the hard stools return and I immediately go back to taking it.
The symptoms of the fissure (if it is that) are so painful and debilitating that I am unwilling to risk an extended period without MOM or some kind of laxative. Before I spend $200 on another visit to the GI, I had really hoped to be able to come up with a solution on my own. I have never dealt with anything like this before, and I would think that my diet and exercise would largely eliminate the risk of constipation. The only risk factors I can think of are 1) I am a wine drinker (2-3 glasses a day,) which could theoretically cause dehydration, but I have been for years, and without issue until now; 2) that I very infrequently will take 1/2 of a capsule of Vicodin ES (prescribed by my doc) for pain associated with hard bowel movements. I know that a narcotic such as this is a recognized cause of constipation, but I take it very rarely, and have also experienced hard stools during periods when I hadn't taken it in a long time.
Please reply if you have had similar experiences or can identify something I may be overlooking.