Hi, i dont know yet if what i have is an anal fissure but i think you guys can tell me due to your experience with it.

i will try to make the story short
i am 34 years old male
6 months ago i started having anal itching and skin around anus was a bit red but no bowel movement pain, no dishcarge or blood, went to a colorectal surgeon he did a DRE said there is nothing there and asked for a stool analysis which came negative, he asked me to do hot sitz with salt and tell me not to worry.

the itching was gone for like a month, then came back as an itching,burning and a pain inside anus just 1 or 2 cm on the right side of the canal again no bowel pain ,no blood or discharge, i visited a general surgeon who also did a DRE and said its totally normal there and he didn't even prescribed any thing.

the pain was gone again for like a month, then came back the same, feeling confused i went to a urologist to role out any urinary problem he checked the anus (no DRE this time) he just had a look while me pending down, and he made something like ultrasound on the lower part to check the bladder,prostate and kidneys and it also came back negative, he said this is probably just a skin reaction and gave me an anti fungal cream.

this time the pain gone only for like 10 days and came back, since last Dr said its a skin reaction so i decided to see a dermatologist, who also checked (no DRE) and said he cant see anything wrong but he can see the skin inflamed around anus, he gave me anti inflamatory, and a hydrocortizon cream to use , also the pain is gone for like 10 days,

the itching is now 90% gone , when i have a look with a mirror the skin around anus looks as if nothing wrong. but the problem now is that the pain inside which is 1 or 2 cm inside is still there and i always feel pressure on that side that sometimes shot to my right upper legs, its very bad while sitting, but very mild while laying or standing.

i am really stressed, depressed and want to know whats wrong because i started to worry what is that thing that 4 doctors cant find a clue about, and started to freak out about anal cancer. i am really tired of going to doctors who cant seems to find anything

could this be an anal fissure that is deep inside the anal canal that the doctors weren't able to see? and if true is it normal symptom of fissures to not be painful on bowel movement and cause this amount of pressure.

please let me know your opinion
Thanks

Hi Kilmer,
You symptoms don't sound like a fissure. A fissure is typically very painful on defecation, often like passing broken glass or gravel. After defecation, there is often a pain caused by spasms, that can go on for hours. There is sometimes blood.
You don't describe any of these symptoms.

Does this passage from Wikipedia ring any bells?

http://en.wikipedia.org/wiki/Levator_ani
Levator ani syndrome (also known as levator syndrome and proctodynia) is episodic rectal pain, caused by spasm of the levator ani muscle.[5] The etiology is unknown, however it has been suggested that inflammation of the arcus tendon is the possible cause of levator ani syndrome[6]
Symptoms include a dull ache to the left 2 inches above the Anus or higher in the rectum and a feeling of constant rectal pressure or burning. The pain may also be felt in the low pelvis or perineum.[citation needed]
The discomfort may be relieved by walking or pelvic tightening exercises similar to Kegel exercises. Other treatments include massage of the muscle, warm baths, muscle relaxant medications, therapeutic ultrasound and biofeedback. Electrical stimulation of the levator ani muscle has been used to try to break the spastic cycle. Injection of botulinum toxin A has also been used.
Variants of levator ani syndrome include proctalgia fugax (fleeting pain in the rectum) and coccydynia (pain in the coccygeal region). Proctalgia fugax and levator ani syndrome have not been found to be of psychosomatic origin, although stressful events may trigger attacks.[5]

Thanks Scientist2516 for your reply, i read about Levator ani syndrome before it has some similar symptoms, i think i excluded it before because at some time there was a skin inflammation around anus which didn't seemed muscular at that time but i will keep reading on it as i am familiar with Pelvic floor problems since i had a pelvic floor pains last year

a new update is that i had an appointment with a surgeon yesterday (i told him i am not going to leave the clinic without knowing whats wrong :) ), he did a DRE asked if i feel pain on any spots i said no, then he said try to describe the area where the pain is coming from i told him like 2 cm on the right side of the anal canal , he didnt feel anything with his finger and i didn't feel pain until he pushed hard and i screamed, he then had a look on that spot and said there is a very small internal hemorrhoids and he is surprised that this small one causes this pain but may be due to the pressure from sitting.

i do believe the problem may be double sided, i do think there is a small problem in anus which was exaggerated by a a muscular problem like levator ani or just my muscles down there are totaly contracting due to stress, i am a person who worrys alot and usually have problems that end up to be stress related, i have been thinking and worrying about my anal pain for the last 4 months so i think my mind is totaly locked down there which would of course make the muscles tense down

so i will start reading about levator ani, take the medications for hemorrhoid the doctor prescribed, and do some yoga stretches that helped me last year with my pelvic pain, i also need to fix my terrible diet.

thank you so much Scientist2516 i will keep you updated.

It's funny how often people write in saying they have a lot of stress and a terrible diet. I think the two are related. People deal with stress by eating and drinking things that comfort them but are bad for the body. Do work on your diet. By increasing your water intake and eating more fruit and veg, you will feel better all over, and your anus will thank you. Internal hemmies are not supposed to be painful, but the evidence on this forum is that they are in fact painful. You need to get to where you have soft stools that slip out easily. Never, never, never strain on the toilet. Hemmies can only get worse if you do that.

As for tension, certainly when I get stressed I hold a lot of tension in my anus. I never realised that until I got a fissure. On a few occasions I'd get stressed, then notice my anus was stinging and feeling bad. I'm learning to consciously relax my bottom. It's hard to remember to do it.

But with diet, relaxation, and special exercises, I bet you can beat this thing. Do keep writing in, let us know how you are doing. Even though your pain is not fissure-related, it's still anal pain and we can all relate to that. Good luck!

Thanks Scientist2516, i will try to follow this although its hard while i still fail the pain all day which leads my mind to stay locked down there, i started the muscle relaxation yoga i used to do with pelvic floor pain, increasing my water intake, i have been very good yesterday and today until i started feeling the pain again couple of hours ago, i am generally in a low mood lately probably should start working on that by any means. will keep updating you.

"fail the pain" - interesting typo!
Are you blaming yourself for the pain? Could be a major source of stress if you start beating yourself up for not relaxing enough.


Well, I'm no psychiatrist, so I'll stop with the amateur armchair diagnosis.

really interesting typo, No i am not blaming myself, i just know my self i am a person who is obsessed with illness always worry and these stuff, and the funny thing that the first time i decided not to worry about an illness i ended up in a hospital because i ignored symptoms that looked like normal cold but it was collapsed lung , this that i totally get very worried when i feel a slight itch anywhere in my body

3rd day on the medications for hemorrhoids and no pain relief , today the pain suddenly moving to the left side and back to right side again , any ideas ?

Hi kilmer406,

What you described was my part of my daily life several years ago. I thought it was an anal fissure or hemorrhoids. I went to four different doctors, three of them GP's and one a specialist who did a sigmoidoscopy on me which was normal and couldn't tell the reason for my pain. I finally got a diagnosis from a very experienced doctor who was very near of retirement. He pressed hard on with his finger and I screamed in pain. Funny how similar our experiences are. His diagnosis was Diaphragma pelvis spastica or Levator Ani syndrome as it's called today. He suggested things like warm baths and prescribed me a muscle relaxant.

I didn't do the baths and muscle relaxants make you sleepy, but I had bottle of magnesium supplements I hadn't really used. I started taking two per day(350mg magnesium oxide) and the pain disappeared in few days and has returned briefly only a few times. Mind you, this was four years ago. I remember having it for few weeks back in summer of 2011 during an extreme heat wave. Must have been dehydrated and low on electrolytes. Nowadays I get most of my magnesium from food. Occasionally I have this sense of pressure and fullness in rectal area but the pain is long gone.

If magnesium oxide doesen't work for you, try better absorbing magnesium citrate. Or if the pain is really bad, you could try rectal suppositories if you already haven't. I tried ones containing prednisone when I thought I was having hemorrhoids and found a relief for couple weeks, even after discontinuation. That pretty much nails the inflammation hypothesis, doesen't it?

My levator ani syndrome was very probably caused by Ankylosing Spondylitis where inflammation of tendon insertion points is very common. I actually wrote that part to Wikipedia about arcus tendon inflammation. I found this thread because I wanted to check has anyone quoted it

Thanks Toni for your detailed reply, this is exactly what i was diagnosed with by the 7th doctor :) he said this is a muscular/nerve problem and he mentioned levator ani, my medications was anti-inflammatory, Multivitamins (i use Centrum) and an additional B-Complex to help the nerves i got much better after less than 1 week on the medication, now it comes an goes from time to time and is very mild and not disabling as it was before. the most important thing is to eliminate all the other causes and have a right diagnose at least this will give your mind some peace which will help in the muscular and nerve cases.
Thank you so much Toni