pain in the ass.

Where has Madame been? She had to take a little hiatus and unfortunately not a fun one.

I have been on a pain vacation.

There are different levels of pain. Different kinds. Some pain is mental - your heart aching when someone you love moves far away; your heart breaking as you watch your baby suffer (from their own teething pain, for example). Some pain is a bother but you can mostly ignore it - your tooth after biting into ice cream; that ankle that bugs you sometimes as you as you miss the bottom step. Some pain has purpose and you can push through it - your legs burning as you climb that mountain; your uterus contracting as you squeeze out a baby.

And some pain is just unbearable.

This is graphic and it is personal, but that's what this is all about, isn't it? Sharing the most intimate parts of life because they make us who we are? Consider yourselves warned.

I thought giving birth to two babies would be the hardest, most physically painful experience of my life. At the time it may have seemed that way, but I was wrong.

Five weeks after having my beautiful boys, I got mastitis. Now that was pain. Fever of almost 104, chills, vomiting, hallucinating and feeling like shards of glass were embedded in my breast. It was the worst pain I had ever experienced. 

Ten days later I got mastitis again. Boy, that first time I had had it easy. I was hospitalized for five days. Five days for a breast infection. I was hooked up to IVs and filled with pain meds. I don't do pain meds and I was begging them for more. I was the small percent that gets it really bad, the percent we all ignore because that won't happen to me. There was talk of taking a giant needle and draining the infection because the antibiotics just weren't seeming to work as fast as they should have. It was that bad.

Now that was pain.

Until they realized the reason I was still spiking fevers and vomiting three days in was no longer the mastitis. I was so hopped up on narcotics and so dehydrated from the fever and vomiting and no one had noticed I hadn't used the bathroom in three days. For a girl who usually goes three times a day, that is a serious backup. Who knew narcotics are constipating? The doctors, obviously, but no one felt the need to fill me in. Like I said, I don't do pain meds. I don't even do Tylenol. How was I supposed to know these things?

The next few days were filled with doctors doing everything they could to, how shall we put this delicately? Alleviate the problem. I crossed off many things on my anti-bucket list. Stuffing myself full of laxatives? Check. Having someone else insert suppositories? Check. Mineral oil enema? Check. None of it worked. When they threatened to resort to manual extraction, which is exactly what it sounds like, I took matters into my own hands, so to speak.

After a sizable dose of pain meds and a tube of numbing lubricant, it was time to give birth yet again, except this time the baby wasn't so cute. In the process, I did what no one ever wants to do: I tore my anus.

Now let's go over a little anatomy, here, because bottom talk seems gross and is usually off limits at the dinner table; most people don't know the specifics and that is crucial. You have your rectum, which is essentially the lower part of your large intestine. That ends at an internal sphincter, which is the beginning of your anal canal. The anal canal is lined with muscle and nerves and terminates at your external sphincter, commonly known as your butt hole. Such lovely terminology, no?

As you digest food, the liquid mush goes into your large intestine where vitamins, minerals and water are absorbed. By the time it reaches the internal sphincter it is a nice, solid mass. The reason you need to drink lots of water and have fiber in your diet, specifically the insoluble fiber found in fruits and vegetables, is because insoluble fiber absorbs water as it passes through your intestine, adding bulk and making the mass soft.

Why does it need to bulky? Because of a reflex called the rectoanal inhibitory reflex (RAIR).

When your rectum (that upper part of the above diagram) fills with stool, electrical stimuli induce your internal sphincter (that part with the tentacle thingies) to relax, and your external sphincter (the end of the track) to contract; the upper sphincter opens and the bottom one closes, allowing the stool to start making its way down into the anal canal without exiting the body completely. You can't control or feel your internal sphincter contract or relax, but you can feel the stool (or alternatively gas) in your anal canal and that feeling, the fact that you have sensation there is very important.

The amount of relaxation directly correlates with the mass of the stool. The more bulky the stool, the more your internal sphincter relaxes and the bigger it gets to allow the stool to pass through. You can't control this, so in order to relax and let the stool out, it needs to be bulky enough to trigger the RAIR.

Drink your water and eat your fiber, boys and girls. Trust me on this.

Enough science. Back to the story. So I got the mass out and in the process literally tore myself a new one. But I didn't know this yet.

After being discharged I was in more pain than when I had been admitted, and that is saying something. For weeks after coming home I was bed-ridden. I could not stand. I could not sit. I could not take care of my babies. I could not eat or sleep or think. I spent my days in tears between the toilet and the bathtub. I cried and I cried and I cried and I asked the universe how it was possible for someone to be in so much pain. I did not want to go back to the hospital because in my mind they had done this to me. Every time I went in I seemed to come back out worse for wear.

Luckily, a dear friend convinced me I needed to be seen by someone. My primary care physician was on maternity leave, so I went to see one of her colleagues. One quick look and her face told me it was grim. It's like the Grand Canyon down there. I had torn my external sphincter.

"At least I didn't really tear while giving birth," I mused. "That must be awful."

"Um, not so much," she replied. "You give birth once. You poop every day."

What can one do to heal a torn sphincter? Not much. If you tear the corner of your mouth it hurts like a b-word, but you keep your mouth closed for two or three days and it heals. If you tear the corner of the other end of the human gastrointestinal tract you can't just keep it closed for two or three days. The goal is to eat your fiber and drink your water and make those stools nice and soft so when they do pass through they don't keep ripping off the scab and starting you back at painful square one. Sitz baths became a two- or three- or four-times-a-day affair. I was going through post-partum herbs and Ibuprofen like it was going out of style.

Slowly, slowly, the pain started being more manageable. Then I was in pain for only a few hours after going to the bathroom. Then only while on the toilet. And then magically, a few months later, I had my first pain-free BM in what seemed my entire life. I still cried, but this time they were tears of joy. I was out of the woods! I was into the magical land of reading magazines and checking my email on my phone and not wishing and praying for a colostomy bag!

Don't count your eggs before they are fully hatched, people.

A few weeks later the pain returned and became progressively worse every day. We were back in the woods and it was dark in there.

Fast forward to last week. The pain was so intense I found it hard to do anything other than lie around and wish I were dead. Going to the bathroom became so intense that sometimes it took me over an hour to finally manage. And then one morning I found myself in so much pain that I was using birthing techniques, screaming and moaning as I had been in labor while squatting in the bathtub. Have you ever pooped in the bathtub? As an adult? Cleaning your own poop out of the tub is possibly one of the greatest practices of humility possible. I was by myself and still I was blushing. How devastatingly embarrassing.

It was time to call a surgeon.

After a fiber-optic anal probe, probably one of the least fun experiences out there, I finally discovered why I had been in so much pain for the past six months. That fateful January day I had not just torn my external sphincter, but my entire anal canal as well. Remember before how I said your anal canal having sensation was very important? Ah, yes. I have a tear in the muscle in there and I can feel it. My whole rectum has been traumatized as a result. Attempting to avoid the intense pain that comes with stool passing anywhere near the anal canal, my RAIR has ceased to function properly, leaving my internal sphincter in permanent spasm. This keeps stool out, but also causes the torn muscles of the anal canal to spasm, as well, meaning they can't relax enough to heal and meaning I am in constant pain. When I do need to go, my sphincter refuses to relax, hence the hours I spend in pain trying to coerce my bowels to cooperate. It is a vicious and painful cycle.

So what is the solution? Well, I can try to increase my water and fiber intake and take it easy and try to let my body heal on its own. Painful. Or, alternatively, they can surgically remove the tear and the surrounding scar tissue left over from six months of improper healing, essentially creating a new, bigger anal fissure for my body to heal. Painful. The difference would be that this purposeful fissure would be cleanly cut and properly stitched up which might entice my body to heal faster.

Hm... Rock... Hard place... Me. Which one to choose?

This is why I have not been posting pictures of my babies and sharing recipes and drawing comic-versions of my life as of late. I have been trying not to convince a surgeon to sew up my sphincters all together and give me one of those poop bags reserved for people who have parts of their colon removed because honestly I don't ever want to use my anal canal ever again for the rest of my life. I have been trying to convince my body, despite all this damn pain, to relax and to heal; and all the while somehow take care of the two tiny humans I created while smiling through the pain and feigning normalcy on the rare occasion that I venture out in public. I have been trying like hell to decide between the rock and the hard place and I have no idea what to choose.

This whole ordeal is a giant pain in my ass, and it's slowly wearing me thin. I'm at the end of my rope and unsure what move to make. I've lost all sense of humility here. I pooped in the tub, for god's sake! Don't be shy. Don't pretend like you didn't read this. If I had torn a muscle in my hand we wouldn't be blushing here. It is what it is and I need your help. Tell me, please, I'm begging you, if it was you, what would you do?