Thanks. Yes, that set of NHS pages is useful - but I still don't see any reference there to scar tissue and related problems. You mention a jigsaw puzzle, and that's indeed how I've seen the condition these past few years. During them I have consulted at least 5 different colorectal surgeons, four on the NHS and one privately, but none of them has been able to give me a clear view of exactly what I am up against. Also, perhaps surprisingly, none has suggested surgery, not even Botox. The last CRS I saw examined me, told me that my fissure had almost healed, and then put his finger on it, reopening it.

Perhaps, like you, I need to see the same CRS over a period of time - the difficulty for me is finding the right CRS, one whom I trust. There's also the question of my age, 72, which seems to make some colorectal surgeons nervous.

For the time being I'll continue to talk to my GP now and then. But at some point I will probably have to go further and find a specialist.