for the last several months my pain patter is as follows:

bm (good or often not so good with incomplete emptying) around 8 am

burn in rectum and pelvic area starts around 10:30 am and builds to its peak around noon. At this point my day is over. I hit the painkillers, hot and cold packs and pray to get through the day.

Pain starts to decrease around 6 pm

rinse and repeat tomorrow

I am not nuts but what the heck is going on it's like my pain and brain are connected like an alarm clock.

Is it anything like what this article describes?
https://www.sciencedirect.com/topics/me ... lgia-fugax.

Yes it is similar although with proctalgia the pain is brief but recurring. My pain is constant, never lets up for hours.

So it must be something else then. Have you got a date for the colonoscopy yet? Perhaps that will turn up something important.

No date yet for colonoscopy

Going for X-ray guided pudendal nerve block July 17

I hope it will be a successful procedure!

You still have your fissure right? This sounds pretty "typical" fissure behaviour to me. Is there any chance you could have a warm to hot sitz bath at around 10.15am to stop any spasms before they begin? If not, another trick that has helped me is to do cardiac coherence breathing exercises with relaxing music (search for them on YouTube) and consciously focus on relaxing my sphincter. This helps it stop going into spasm, or calms it down once the burning begins. If you find your sphincter is contracting, you'll need to check back every minute and re-relax it until it stops clenching. This could take a while but it really does help, especially if you are in a place where you can't have a sitz bath.

thank you I will try your recommendations

The last crs I saw in November said he didn't see anything up there.

Hedgehog I have noticed after I have a bm that my external sphincter is tight and contracting. I can feel it on the outside of my skin when I press my fingers against it. it feels hard and lumpy and it spasms contracting and relaxing. I get almost a numbing tight squeezing feeling at my anus. Thank u for mentioning it didn't know if in was the only one to experience this.

Hurt, good luck tomorrow really hope you get positive results.

How did things go hurtinend? Have you recovered from the procedure?