Volans
I'm pretty much like you. Tightness, pain when sitting and minorly after bm. The similarities of our symptoms and as I've noticed with a few other people in this forum would indicate to me there should be some pathological or psychological cause. Something other than typical fissure related issues. I don't recall your history but in my case doctors haven't even seein any fissures or hemmoroid!
Anyways, please chime in if you're interested in talking about this ailment to see if we can find some root cause. Correct me if I'm wrong, but you reside in Canada? If so , it'd be nice if you could introduce some good CRS as well. You can PM me as well/thanks

I’ve just seen my CRS (18 months of fissure pain) He is my third opinion CRS and seems the most knowledgeable and sensible of the doctors I’ve seen. He noted very high pelvic pressure in me and says this is the main issue and my fissure is a side show. He told me to dilate for 6 weeks and return (I returned today) he said my fissure is barely visible now but the pain remains due to partly the pressure (which we are improving with dilation) but also because of the pain memory system in the anus which is very unique (great!) so even when the fissure heals the anus remembers trauma for a long time. Sometimes a course of low dose Amaltryptiline (no idea how to spell this) can interrupt the pain/nerve signals - it’s basically a type of chronic pain management. So I’m to continue dilating but maybe the pills might be the next step…but the pain has definitely lessened a little with dilation

*Amitriptyline

Hi Hazey122,
So happy for you for having a plan in place. Do you reside in Canada? and do you have pain when sitting? My turmoil started about the same time as yours but for the majority of it, I don't have a localized fissure pain, instead a dull muscle pain/pressure that starts when I sit and gradually build up. I'm truly exhausted by it all the time

Hi Hazey123,

Thanks for the update. That's wonderful news fissure is barely visible!! Keep working on the dilation loosening muscles so you do not get another fissure (tho I seem to recall you got from AT removal?). FYI, when my GP first examined me couple years ago and said I had hypertonic pelvic floor (same thing high pressure); wished I knew then what I know now what happens when you leave tight muscles too late until excruciating pain; that's how I got bad fissure dealing with now. The drug is antidepressant also used in migraine; check side effects you may or may not experience. In addition to dilation, work on belly breathing and awareness when you exercise you not tightening your bum. I hope I receive good news from CRS in couple weeks.

Hi Fred55
I’m in the UK and yes I have a lot of pain while sitting. The irony is I was a road cyclist before this all happened and now I can’t even sit on a soft sofa let alone a bike seat! Driving a car seems to be the worst because of the position. The pain tends to build throughout the day. It started early last year following skin tag removal op and has been awful ever since. My original surgeon last September after six months of pain gave me an EUA and sigmoidoscopy to see what was going on and declared everything looked perfect (other than some small internal hemmies that exist in most people anyway) but the pain was terrible. Roll on to Jan this year I got a second opinion who said I had a fissure. I’d assumed the first doctor missed my fissure but maybe it had healed. The EUA and scope really made things much worse so maybe I acquired a new one during that. The weird thing is the pain has been there all along even when no fissure declared. Yesterday my CRS said “today I can’t really see your fissure” but he said it in a way that might suggest it might be visible another day!!! Goodness knows. The pain I have is a burning pain all day that gets much worse by the evening. Mornings I feel my best even after a BM (which definitely sting a bit every time despite Movicol which is amazing!) pain is not too bad in early morning but gets worse as day progresses. Only way it feels ok in the eve is in bed. Since I started dilation the general pain has eased. No where near gone but at least going the right way. However I can’t ever imagine feeling normal again. But my doc did spend ages talking about the pain signalling in the Anus and how it’s very over reactive after any trauma to the area. It keeps ringing alarm bells long after the trauma is over. My CRS is listed as a specialist in “Anal Pain” so someone like this could benefit you if you can find him/her near you?? My CRS assures me it will get better in time!

Hi GrrrAF
Aww thanks for your message. I’m happy it’s going the right way, although it still does hurt a lot despite being not very visible!! Interesting you found this pelvic tightness out before you got your AF - I was blissfully ignorant but have spent years doing squats etc during exercise where you squeeze hard as you come up. I’ve stopped doing that! Apparently if you’ve had natural births you won’t have this issue. I had C sections so my pelvic floor is rock hard still (I thought this was a good thing lol) I find it’s quite hard to relax everything without needing to have a wee!! But the breathing advice is good thank you I’ve been trying to do more of it just generally (I think I’m tensing most of the time) Also my CRS is obsessed with this and tells me to meditate and breathe during my dilation sessions. In order to retrain my body to relax and release the muscles. I completely agree re the migraine medication. I don’t think I want those side effects. Altho he said it would be a tiny dose but we are not going down that route yet. I’m hoping to heal naturally. I really don’t want more drugs. Taking Movicol is enough for me. I struggled for ages trying to soften my stools naturally but some days it worked and some days it didn’t so I’d end up in horrible pain after a tiny bit of hard BM. With Movicol I’m guaranteed soft altho it’s pretty gentle (no extra frequent BMs). I got this from this forum as was using stool softeners before which don’t work too well. Wishing you a pain free weekend (wouldn’t that be lovely:)) and very good luck with your CRS check up. Keep me posted xxx ps I’ve almost given up caffeine as I read this can elevate your internal pressure? Decaf coffee and tea not the best… my last pleasure!!

Hazey123,
Thanks for the description and sorry for your indeed long period of suffering. I'm pretty much in the same boat. It started in Jan 2022 with a couple of classic fissure incidents. I had colonoscopy 2-3 months later to find "nothing". Other tests and scans were the same too. My main problem is pain with sitting. I'm good in the morning and pain gradually build up towards the evening. If I don't sit, I probably wouldn't have much problem except minor burning/stinging/itching. You want to give PN a thought as it's common among cyclists.
Anyway, your post is encouraging me to give dilation a serious thought. Hope we all improve (or even fully heal I dare to say?!)

Hey Hazey123, Fred55,

I don’t currently have pain sitting but did before with anal spasms and any position even lying in bed! Back then I also recalled sometimes pain worse at end of day was related to external hemorroids not spasms; makes sense gravity more blood flow as day progresses you spend more time upright then maybe busy and your mind is also in overdrive (breathing shallow). You can use a mirror down there to look if anal area more swollen end of day. The swelling went away overnight at least for me which makes sense since you are off your fit and bum and just lying in bed; starts all over when you get up next day! Have you tried ice packs if you must sit? I used ice a lot in those days especially sitting and on occasion still do if there are external hemorroids it helps. I try to alternate between different positions all day. Another factor unfortunately if you mid-age your blood vessels are just weaker and nothing can reverse that:(

GrrrAF
Yes indeed, sitting worsens everything but sometimes is really unavoidable, especially in social occasions and at work. I've come to near conclusion though that my main problem is not fissure. I might have sensitivity down there and it might well be how it started, but right now I believe my problem is tight and over-reactive IS and pelvic floor muscles. When sitting, I feel a burning anal pain, but also a deep muscle pain radiating to pelvis area and sometimes feels like pressure to my buttocks, perinum and lower abdomin. The more I sit the more the pain.Truly awful and am sick of it!