My usual cycle is: bm, pain free for 1 hour, bad spasmic pain for 1-2 hours, residual bedridden pain several hours beyond that. I don't know if it's just luck or what specific factor(s) helped, but I wanted to share some stuff that helped me go from crying, level 8-9 pain the past couple days to level 1-2 pain today.

Yesterday bm: some constipation and trouble passing the stool. No measures taken but sitz bath before and after bm, some vaseline, and lying down. = still had horrible pain

Prep for today and starting usual routine: Yesterday I mostly ate fruits, veggies, some prunes, a bit of fiber supplement, and plenty of water. And last night I took half a cap of miralax. This morning, my bm was pretty soft. I did my usual sitz bath before & after bm, and vaseline to lube it up.

New helpful measures today: when I felt the usual pain flare coming, I ran around the house for a few minutes to stimulate circulation (inspiration: Your Friendly Proctologist on Youtube https://www.youtube.com/watch?v=xfzzyIAMF_I), and then did these pelvic floor relaxing exercises: https://www.youtube.com/watch?v=2yx0_PK0Q-4
As I did the exercises, I definitely could tell there was tension in a pelvic floor muscle because of the flare (that isn't usually there outside of a flare). I believe the exercises helped me stretch the muscle out and cut the spasm before it got too bad.

I haven't done formal physio yet, but even just this youtube video was probably one of the most helpful measures from today.

Besides this I did some diaphragmatic breathing and just took it easy relaxing especially for the first ~2 hours after the bm. Plus regular strength ibuprofen + tylenol right after bm.

Hope this can help someone else. I know it can feel tedious to have to go to all these measures just to feel OK, but we gotta do what we gotta do to take care of ourselves.


Fissures since March 2021 (on & off, mostly on)
Likely Levator Ani Syndrome since late 2021
Botox in December 2021, made the pain worse or it was getting worse already, not sure
Tried 2 sessions of electro-acupuncture, didn't help
Next step: pelvic floor physical therapy, biofeedback, muscle relaxants, I'll try it all

How have you been doing lately?

Well I haven't had that level of pain since (which the scary part was, it was even when I was lying down, which is the position that minimizes pain the most for me). It could just be luck, and my period is approaching so that'll be a bigger test, probably.

For now, mostly if I lie down I'll be OK except for post-BM the pain can reach level 5-6 for about 20-30 mins. After that I'm fine but I have to be lying down. If I do anything other than lie down (and it can be many many hours after a bm) it can hurt. So I'm pretty much bedridden still.

Doctor is trying to schedule me for a manometry test and I guess we'll see from there. She recommends another round of botox injections, maybe to the sphincter /and/ pelvic floor. And maybe if that doesn't work then LIS.

What is the link between the manometry test and the fissure?

I'm not an expert or a doctor, but this is what I understand:

- The manometry test tells you how much muscle tension/pressure there is in the sphincter.
- This is good to know, because excessive muscle tension (like what happens with spasms) can make it difficult to heal the fissure because it keeps pulling the tear apart.
- One way to heal a fissure is to get a LIS surgery, which involves cutting some of the sphincter muscle. But, this surgery comes with risks, such as incontinence (I think usually it's not major, but the risk is higher in women). Incontinence could happen if the cut in the muscle made the whole sphincter too loose.
- So one of the reasons doctors will do the manometry test is to see if your muscle can withstand cutting. If it's very tight it'll probably be OK. If it's too loose, they'll know an LIS is riskier because it would make the whole area even looser.