Good grief. I visited the drs a few weeks ago after a painful spasm and he prescribed me Amitryptiline in an attempt to relax things down there. I'm also using rectogesic and fybogel and lactulose. I thought I might finally be getting somewhere because despite still being in discomfort, the muscles down there were def starting feel a little more relaxed. That was until today. It wasn't even a large BM, but it was followed by a radiating pain which I assume is a spasm which is only just subsiding now an hour later. I've been noticing a bit of a sting after applying rectogesic which I'm assuming means there is a small fissure in there somewhere (even though the drs and specialists can't find it). When is the dam thing going to heal. It's been two months now and I'm just getting nowhere. The only positive I can draw from this is that if the fissure is so small that the drs can't find it, then surely it must have a good chance of healing by itself at some point. The thing is it feels like it's about 5cm inside, and because of where it is it's obviously just not healing. What should I do

Moogdog...

hmmm... Can you describe your symptoms a little more? Do you have bleeding or pain when having a BM, like the feeling you're passing something sharp out of your anal area? If you're having pain that you feel is that far up inside, it might not be a fissure. The anal canal itself only measures 2-3 cm in most people, and skin receptors to pain (which does not include spasms) only occur in the lower third or so of that distance. Do your doctors think the spasms could be due to something besides a fissure? Has anyone ever mentioned levator ani syndrome to you, for example?

The stinging from the nitro. could just be a reaction to the cream itself. Can you locate a specific spot when you apply it where it stings, like you're on a cut, or s it a more general stinging that you're feeling?

Hi, thanks for the reply. No bleeding and generally no pain when having a BM, just afterwards. The stinging feels localised, like it could be a small cut, but I'm unsure. The pain is always in that area though. Without being too graphic when I apply rectogesic I insert my index finger all the way in. The sore area is somewhere round about after the canal widens out (I'm not sure what this part is call) after the anal sphincter. If you imagine the canal was ur right index finger, the pain would be somewhere on the left of your nail (does this make sense?). Some folk on here have mentioned levator syndrome, but so far none of the specialists. I just find it so frustrating. It's one thing knowing what's wrong with you and treating it accordingly, but not to not know for sure is really quite depressing. I should say that this has been going on since last May (2012), but I did have along period this summer (JUne to end of September) when things were generally Ok. Any thoughts?

If your pain is that high up (a finger inserted all the way in) and I assume doctors have looked in there with some kind of scope and haven't seen anything), it really doesn't sound like a fissure. (Of course, anything is possible). Levator ani syndrome would be one possibility.

Here's an interesting article you might want to check out.

http://www.theiaforum.org/Article_Folde ... l-pain.pdf

I don't know what country you're from or what access you have to medical care, but if you can, you might want to consider trying to find a doctor, either a colorectal surgeon who specializes in pelvic floor problems, or a pain specialist who includes pelvic floor pain as part of their practice, to see if you can get anywhere. One way to go about it is to look up physical therapists in your area who specialize in pelvic floor dysfunction and call them up and ask them for a referral to a doctor who treats pelvic floor pain. Pain up that high into your rectum is much much less likely to be due to a fissure than it is some kind of pelvic floor muscle issue.

Hi, thanks for replying. I live in the uK and have seen two colorectal specialists now (and numerous doctors) and none have been able to locate the source of the pain. I didn't realise it wasn't possible to have fissure that high up. Hmm, now I am intrigued. The pain comes from the left hand side (the 9 o clock position as I'm facing forwards). All the specialists have said it could be a fissure which has healed but which gets aggregated from time to time, but I'm starting to wonder whether they are def looking in the right area?

Well, of course, anything is possible, so it could be a fissure, but it's just not sounding highly likely, and even more so if your pain is lateral rather than on the midline top or bottom of the anus. (The majority of fissures occur at the posterior or anterior midline, not on the side). The more you describe it the more it sounds like something other than a fissure, and since the pain is lateral (on the side) it sounds even more suspicious for something muscular going on.

It's very frustrating really. I have no idea how to make myself feel better or if I ever will This has been going on so long now I'm beginning to lose hope that I will get better. I guess the only positive to come from this is that hopefully the specialists can't start to narrow things down and work out what is actually wrong with me.

Hi guys, I thought I'd post a quick update. I've been on the Amytriptoline for 5 weeks now and the dr has doubled my dose to 20mg per day. I don't want to tempt fate but I am feeling a little better. Don't get me wrong I don't feel 100% but for the past fortnight I have at least been able to enjoy my life a bit more without worrying constantly. I've also got my date through for my specialist consultation which is late January so hopefully I can go that a bit better informed, and finally get to this bottom of this pain.

Good to hear that things have improved some for you and that you have a consultation booked to help pinpoint a diagnosis! It can really help a lot when you feel like you're at least moving in some direction toward answers.

Keep us posted on how you're getting on!

"It's very frustrating really. I have no idea how to make myself feel better or if I ever will This has been going on so long now I'm beginning to lose hope that I will get better. I guess the only positive to come from this is that hopefully the specialists can't start to narrow things down and work out what is actually wrong with me."

I'm in the same boat as you were months ago...and wanted to check in to hear if you are doing better today.