While looking through Karl Monahan's Chronic Pelvic Pain Syndrome (CPPS) website, I began to wonder if a lot of the problems associated with Anal Fissure are actually problems of chronic pain. The stories one reads here on the AF Support Forum often tell of anal fissures that were healed or removed but then later recurred, and went on recurring, even after surgical procedures like LIS. It's possible, I suppose, that the strictly medical and/or surgical approach only deals with part of the trouble - once the perianal region is disturbed, it's very hard to restore it to normality, and psychological and physiotherapeutic methods like Karl's may be essential in that regard.

This is also the message that comes from books like A Headache in the Pelvis, which I think was groundbreaking in opening up a holistic approach to pelvic pain and dysfunction.