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I have been chronically constipated for almost twenty years. The bleeding started nine months ago. Every single time I went to the bathroom. Last Thursday I checked into a surgical center to have the muscle around my anus cut so the tear could finally heal. A colorectal nurse stopped me at the pre-op door and said one sentence. That sentence cancelled the surgery. It is now twelve weeks later and I have not bled in eight. I am writing this from the same desk I almost gave up at. --- I am forty. I am a freelance writer. I live alone in a one-bedroom apartment in a Midwestern city I will not name, because the surgical center is here and the nurse still works there and I do not want to make her life harder than I already have. I work from a small desk by the window. I am paid by the word. That last detail matters more than you would think. When you are paid by the word you sit. You sit for nine, ten, eleven hours. You feel everything that is happening under you. --- I have been chronically constipated since my late twenties. For most of those twenty years I managed it. Magnesium. Fiber bars. A glass of Miralax on the bad weeks. It was a quiet companion. Annoying but loyal. About eighteen months before everything I am going to tell you, it stopped being quiet. Stools got harder. Sits got longer. Then the blood. --- The first time was a streak on the paper. I told myself it was a tear. A one-time tear. I was eating too much oatmeal. I was straining too hard. I would drink more water. Two weeks later. A streak on the paper. Then a streak in the bowl. Then every single time. For nine months. --- Let me tell you what nine months of bleeding every time you go to the bathroom does to a person. It changes the way you eat. I stopped having coffee in the morning because I knew what coffee did. I stopped having salad because the fiber I had been told my whole life was the answer was, in my body, the bullet. I ate small dry plain things. By six o'clock I was lightheaded. By bedtime I was hungry. I lost four pounds I did not want to lose. My jeans, the ones I used to be able to button by 2 p.m., I could no longer button at all by the end. Not because I was bigger. Because my lower belly was so distended that by mid-afternoon I looked, in the mirror, sideways, the way the women in those Reddit threads describe it. Heavily pregnant. A maternity photoshoot belly attached to a body that had been losing weight for three months. --- It changes the way you sit. The chair. My beautiful ergonomic writing chair that I had saved up for and bought used off a graphic designer in 2019. The chair was now an enemy. The pressure radiated forward and down into the fissure I did not yet know I had. I would write a sentence. Shift. Write a sentence. Stand up. Standing up was its own calculation. You cannot just stand up when there is a fresh tear in the wall of your anus. You have to brace. You have to roll forward off the chair the way old people do. I am forty. I was rolling forward off the chair the way old people do. --- It changes the way you sleep. I would wake at 3 a.m. with a brick of pressure low in my pelvis and a ceiling fan I was suddenly very angry at. I could not go. I could not not-go. I would lie there and count the slats of the fan. Then I would stop counting and start crying. Quietly. So my neighbor through the wall would not hear. --- It changes what you carry. I started carrying a small zip pouch in my bag. Witch hazel pads. Ibuprofen. A folded square of paper towel. Just in case. I have an old college friend who carries an EpiPen. The pouch in my bag was my EpiPen. I had never told her about it. I had never told anyone about it. The pouch is what made me realize how alone I had become inside this. --- Now I want to tell you what I had tried. Because if you are reading this, you have probably tried most of it. And every doctor I had been to had given me the same prescription. More water. More fiber. See the colorectal surgeon. --- **More water.** The first thing every GP said. I drank a gallon of water a day for three months. I peed every forty minutes. My stools were maybe five percent softer. The bleeding was unchanged. **More fiber.** Metamucil first. Then chia in my oats. Then a "high-fiber breakfast" I read about online. Oats. Flax. Berries. Eighteen grams of fiber before noon. The bloating got worse. My stools got *bigger* and *harder*. Which is, if you think about it for ten seconds, the worst possible outcome for someone with a tear. Harder stool through a tear that never got to close. I figured this out about six months later than I should have. **Magnesium citrate.** Worked for ten days. Then my body got used to it and I had to double the dose. Then the rebound cramping started. I stopped. **Miralax.** Daily, with my coffee, for four months. My doctor had told me Miralax would be my new best friend. For the first three weeks she was right. By month four I was having what my GP later called "a purge like a colonoscopy cleanse" once or twice a week. Off it. **Probiotics.** Three brands. One of them was the one with the famous Instagram ads. You know the one. I bought into the ads. I admit it. I am a copywriter and I bought into the ads. Nothing measurable. Three months. Fifty dollars a month. Down the drain. **Prune juice. Smooth Move tea. Warm lemon water with cayenne pepper.** Each one worked for about a week. Then stopped. **Suppositories. Glycerin.** Emergency only. Made the fissure worse every single time. **Witch hazel pads. Sitz baths. OTC hemorrhoid cream.** Managed the surface. Did nothing for the cause. **A steroid cream and topical lidocaine from a derm walk-in.** Numbed the moment. Did not change the next morning. --- I had a drawer. A whole drawer in the cabinet under my bathroom sink. Half-used Miralax. Three brands of magnesium. Two probiotics. The Smooth Move tea. The lidocaine. A graveyard. Fifty dollars at a time, for two years. My GP's last appointment with me lasted six minutes. She said: "More water, more fiber, see the colorectal surgeon." I cried in the parking lot. --- I saw the colorectal surgeon two weeks later. He looked. He prodded. He said: chronic anal fissure. The sphincter muscle has gone into spasm. The spasm is keeping the tear from healing. Every stool re-tears it. He gave me topical nitroglycerin first. Six weeks. No change. Then a Botox injection. Eight weeks. Some healing, then it tore open again at week seven. Then he said: I can fix this surgically. He scheduled a lateral internal sphincterotomy. It is a procedure where they cut the internal muscle around the anus so the spasm relaxes so the wall can heal. It is, he told me, very routine. It is also irreversible. You do not get the muscle back. He told me there is a small risk of permanent incontinence. Small, he said. Small. I signed the form anyway. I was nine months past being able to negotiate. --- The pre-op was on a Tuesday in late autumn. Seven fifteen in the morning. I had not eaten since dinner the night before. I was in a paper gown over my own socks because the surgical center is cold in the autumn and I am not above bringing my own socks. The procedure was at eight. A nurse came in at seven twenty. Her name was Carol. She had been a colorectal nurse for nineteen years. I will tell you in a minute how I know that number. --- Carol wrapped the blood pressure cuff around my arm and the cuff sighed. She clipped the oximeter onto my finger. She looked at the chart on her rolling stool. She glanced at me. She glanced at the chart again. Then she paused. She did not pick the chart back up. That pause is what I want you to remember. I have replayed that pause every day for twelve weeks. Carol asked me: "How long have you been bleeding?" I said: "Nine months." She asked: "How long have you been chronically constipated?" I said: "Probably twenty years. Worse the last eighteen months." She set the chart down. She rolled her stool a foot closer. She leaned forward. She said: "Honey. Can I tell you something I am not technically supposed to tell you while you are already in the gown?" I nodded. --- She said: "This isn't really a wall problem. It's a stool problem." "The bleed isn't the problem. The bleed is what happens when a dehydrated stool grinds the tear open every single time you go." "We can cut the muscle around the tear today. That is what the surgeon is going to do in thirty-seven minutes. And it will heal for a while." She paused. "But if your colon is still producing concrete stool every morning, the tear comes back. I have seen patients come back for the same procedure twice. I have seen them come back for it three times." I sat up a little. The paper gown crinkled. I said: "What's the upstream fix?" --- Carol said: "Why your colon is producing concrete in the first place." She said: "Most people with chronic fissures don't have an anus problem. They have a colon-signaling problem." She said: "Your colon pulls water back out of the stool faster than it should. There's a chemical signal that's supposed to tell it when to stop pulling water — butyrate. Plus a couple of others. Short-chain fatty acids. Those chemicals aren't being made in your gut anymore. Without them, the water keeps getting pulled out. The stool keeps grinding harder. The tear keeps reopening." I said: "Where do those chemicals come from?" Carol said: "Normally, gut bacteria make them from fiber. Yours don't have the bacteria to do it anymore — depleted years ago, probably antibiotics in your twenties, probably Western diet, probably stress. Doesn't matter at this point. The chemicals aren't being made." I said: "More fiber?" Carol almost laughed. She caught it. "No, honey," she said. "Fiber is the raw material. Without the bacteria to process it, fiber just sits there and bulks. You don't need more raw material. You need the finished chemicals." --- I asked the question I had wanted to ask for nine months. I asked: "Why hasn't a doctor told me this?" Carol said: "Surgeons fix the wall. That is their job. The wall is what they have a scalpel for." I said: "What about laxatives?" Carol said: "Laxatives flush. They don't seed." She glanced at the clock on the wall. It read seven thirty-one. She said: "I am not telling you to cancel the procedure. I am telling you that if you do the upstream fix for eight weeks and the bleeding does not stop, then come back and we cut." "But if I were you. I would call the surgeon out here right now. And I would ask him for eight weeks." She stood up. She straightened the chart. She walked toward the door. Then she stopped with her hand on the door. She turned around. She said: "Last spring a patient brought me a small pouch of a fermented gummy. She had cancelled the same procedure six weeks earlier. She came back to my pre-op room to thank me. I will not say a brand to you. But the word you want to search is *fermented*. Not probiotic. Fermented." She opened the door. She left. --- I sat in the paper gown for a full minute. Then I asked the next nurse who came in to please call the surgeon out. --- The surgeon was annoyed. He stood at the foot of the table in his scrubs and listened to me explain that I wanted eight weeks. He looked at the ceiling. He looked at the floor. He shrugged in a way that said *I have seen this before, it usually does not work, but it is your body.* He signed the cancellation. He told me he would keep my chart open for ninety days. He told me to call if the bleeding did not stop. He told me good luck. It was the kindest thing he said in the whole eight-week relationship. I walked out of the surgical center at seven forty-eight in the morning. In my own jeans. In the parking lot. Without the procedure ahead of me. I sat in the car for ten minutes before I started the engine. I was shaking. --- That afternoon I sat at my desk by the window. I typed into the search bar: *fermented kombucha gummy butyrate* The third result was a small brand called Jevawell. A raspberry kombucha gummy in a soft pouch. Berry Bliss flavor. The page said: kombucha culture, slippery elm bark, dandelion root, soluble fiber, a prebiotic-probiotic-postbiotic stack. One gummy. Ninety minutes before bed. The page said: the colon does most of its water-reabsorption work overnight. That is when the crew needs to be seeded. Sixty-day money-back guarantee. I ordered the pouch. It arrived on Friday. --- I want to be honest about week one. Nothing dramatic happened in week one. By day five my stools were maybe slightly softer. I was still bleeding. I almost stopped. I sat at my desk on the Sunday of week one and I held the pouch in my hand and I thought: I am about to throw fifty more dollars on the pile. I took the next gummy anyway. I took it because Carol had said *eight weeks.* Not five days. Not one week. Eight. --- **Week 2.** A small thing happened in week two. The first morning I sat down on the toilet I did not grip the towel rail. I had been gripping the towel rail every morning for nine months. I had not consciously known I was gripping it until I was not gripping it. There was still some blood on the paper. Less. The bloating, by mid-afternoon, was measurably down. My jeans buttoned at two o'clock. I cried in the bathroom for reasons I could not explain. **Week 3.** Three bleed-free days in a row. I wrote the dates on a Post-it note and stuck them to the side of my monitor. I had not had three bleed-free days in nine months. I read the Post-it once an hour like it was a fragile thing that might fly off the screen. **Week 4.** The dread around dinner lifted. I ate a salad. I did not do the math first. I ate it the way a regular person eats a salad. I ate it because I was hungry and the salad was there. I went to the bathroom that night. There was no blood. I sat on the bathroom floor afterward in the way you sit on the bathroom floor when something has been not-happening for the first time in a year. **Week 6.** The first fully bleed-free week. Eleven months since that was true. I drove to the grocery store on a Saturday morning. I bought ground coffee. I bought broccoli. I bought a small bag of clementines. The clementines were a test. I would have been terrified of clementines four months ago. I came home. I sat in the car in the driveway for ten minutes. I cried the way you cry when something is finally not happening. **Week 8.** I emailed the surgeon's office. I told them I would not be rescheduling. I thanked Carol by name in the message. I do not know if anyone passed it on to her. I hope they did. **Week 12.** I cancelled the procedure permanently. I went to a follow-up at my GP. She asked me to lie on the table. She examined the area. She sat back on her rolling stool, the same kind of rolling stool Carol had been on twelve weeks earlier, and she said: "The fissure is healed." She asked me what I did. I told her about Carol. I told her about butyrate and the missing signal. She wrote something down. I do not know what she wrote. I hope it was the word *fermented.* --- I am not the hero of this story. I tried everything I knew to try. I was about to let a surgeon cut the muscle around my anus because I had run out of ideas. A nurse in a pre-op room rescued me. She broke protocol by twenty seconds. She named the missing chemical. She told me about the fermented gummy a patient had brought her last spring. She did not say a brand. I want to say the brand now. It is called Jevawell. It comes in a soft pouch. It is a raspberry kombucha gummy. Berry Bliss flavor. One gummy. Ninety minutes before bed. It has slippery elm bark, dandelion root, soluble fiber, kombucha culture. A prebiotic-probiotic-postbiotic stack. Sixty-day money-back guarantee. They will refund the pouch if it does not work. I am twelve weeks in. I have not bled in eight. My fissure is healed. I cancelled the surgery permanently. I am not telling you it will work for you the way it worked for me. I am telling you it is the upstream fix Carol pointed me at. --- My anus wasn't built wrong. My colon just stopped sending the signal that keeps the stool soft. --- If you are sitting at your own desk by your own window with your own pouch in your own bag of witch hazel pads and ibuprofen and a folded square of paper towel, I do not want you to wait the eighteen months I waited. I want you to skip the parking-lot cry. The pouch is on their site. Sixty-day money-back guarantee. One gummy ninety minutes before bed. Read the page. Decide for yourself. If you decide it is not for you, close the tab and I will not be offended. If you decide it is, the pouch will arrive on a Friday like mine did. P.S. I went back to the surgical center six weeks ago to drop off a thank-you note for Carol at the front desk. The receptionist asked me what procedure I was checking in for. I said I was not. I said I had cancelled my procedure twelve weeks ago and I wanted to leave a note for the nurse who told me to. She smiled. She said: "You're not the first." I asked her how many. She said: "I shouldn't say." I asked her again. She said: "More than you'd think." jevawell.com/products/kgcc