I'm scheduled for Botox to the levator ani muscles later this month, and the doctor wants to do an anal exam while I'm under twilight sedation, not general anesthesia. I'm pretty concerned that this could cause some kind of injury (since the muscles won't be fully relaxed) and I don't want to walk through fissure hell again. She wasn't clear on whether she would use a scope or retractor.

Has anyone here had this exam under this type of sedation? I'd be interested to hear your experience and if everything went off well for you.

I share your concerns and hope that someone has some experience to share with you. I had to just give up my power of choice by having my gallbladder removed last night. I don't like taking "chances" with my health anymore, so it was a difficult decision to make. Good luck with yours.

Ugh, that sounds so painful! How is your recovery going? I hope your digestion will be all right without a gall bladder.

I did some more reading and found that the sedation that will most likely be used (propofol) will relax the sphincter muscles. I'm also going to be very clear with the doctor that I don't consent to use of a retractor, and only want a small anoscope to be used. She did say it was all right to use a valium suppository before the procedure to help with the muscle relaxation.

Very good to hear that the propofol will relax the area. And yes! Make sure that the doctor knows what you want, and only what you want.

It was very painful, but the recovery has been good so far.

I'll definitely be very clear about it to her. I'm going into this procedure because I've tried plenty of other things which have helped but not cured the pain.

I'm glad to hear you're doing better! Hope you'll feel like yourself very soon.

Best of luck to you Patience. Please let us know how you go.

I had twilight sedation 4 years ago for a sigmoidoscopy and anal dilation

The drugs used were Fentanyl and Midazolam (Versed)

I was awake sort of but felt nothing, and was given a reversal drug when procedure was finished

I didn’t feel a thing

Thanks for the reassurance. I spoke to my PT as well and she assured me this is the best step to take next. I'll update this thread when the procedure has been completed.

I had the Botox for pelvic floor and anal exam today. What a day. Started off pretty badly with severe pain upon starting the IV. I hate those things anyway and today's was the worst ever. They had to switch to my other hand and disconnect the first IV point. I'm still not sure why it hurt so much.

I spoke to the doctor about my concerns and told her to avoid hitting the scars I have in the area from old skin inflammation. For once she wasn't in a hurry and listened patiently. After that the anesthesiologist gave me some Valium and I don't remember a thing till I woke up in recovery. I was pretty startled because I didn't have any warning about going under. Every other time I've been in hospital I remember being wheeled into the OR. Maybe they put me out early because I was in so much distress from the previous IV site. I apparently spoke to my husband but don't remember that either. I had severe nausea and sweating upon getting ready to leave despite being given zofran earlier, and then I needed more through IV. Not sure which was worse to experience, pain or nausea.

So in the end they didn't use a scope or anything, just a visual exam and no sign of a fissure. They did Botox injections at three different points around the perianal area. I do have a small point on the anal area that looks as if it was nicked by mistake, not happy at all about that. I've applied some ointment and hope it'll heal without issues.

I finally had a BM after getting home and could already feel the relaxation being caused by the Botox. Honestly I was worried my butt would prolapse, it feels so loose, so I used a finger for support. Hoping that will get better with time. A decent amount of soreness internally from whatever manipulation the doctor had to do, but it's subsided. Mostly I'm keeping the weight off it and keeping the area clean using a bidet. Fingers crossed that I finally find pain relief from this procedure!

My fingers couldn't be more tightly crossed for you!

And I can commiserate with you on so many other fronts. I hate when I put out like that without warning. I have very bad veins and often have 10 or so sticks before they find a good vein. It can really hurt! And having a nick is NOT something you need! I'm glad that she at least listened to you patiently and that you can already feel the effects of the Botox.

Keep us posted.