So I had an appointment with a CRS today. We have only 2 CRS' where I live and I've seen them both several times. The other CRS, who has diagnosed me with anal fissures on 3 different occasions over the past 5 years, has told me that he will not do LIS because my fissures heal. He has also diagnosed me with Levator Ani Syndrome, but says that there is no treatment for it and it usually gets better with age. The CRS I saw today has never diagnosed me with an anal fissure, but is aware of my history. He said today that he thought I was getting anal fissures and Levator Ani confused and that he didn't really believe that I have suffered with fissures, since he's never seen me with one. Although he does LIS routinely, because he has never seen proof of fissures with me, he would not consider it. He said that, for my condition, which he believes is Levator Ani and/or pelvic floor dysfunction, there is no treatment that will fix the problem. He basically had nothing to offer me. He did do an "exam", which consisted of pulling my cheeks apart and said that I had no fissures or hemorrhoids. I asked him how he could tell without a scope and he said that he is trained to see fissures without a scope, so he would be able to tell. I am also scheduled for an anal manometry test tomorrow, but this CRS said that he didn't think it was needed, because regardless of the results, the treatment options wouldn't change from what I have already been offered. I'm feeling pretty discouraged right now. Not just because of this visit, but because I have now had two local CRS' and one at Mayo tell me that there really is no good treatment for my condition. Now if I presented with an anal fissure, then they would probably do something, but because mine are recurrent instead of chronic it's hard to get in to see a CRS when the fissure is active. I do believe that I do now have a fissure, but of course the CRS didn't see it, so it must not be there.

I just wanted to say that I'm sorry about your situation.
It has to be very frustrating but you know your body better than anyone else and if you think you have a fissure they aren't seeing, You keep going until you find a doctor who will help you. It took me several trips to doctors and hospitals before I got a diagnosis.

Personally I would travel to see a different CRS, it's always going to be worth getting a 3rd or even a 4th opinion from different CRS'.
I'm a bit puzzled at how your current CRS is trained to see fissures without the use of an anuscope etc, I know that some fissures can be seen at the anal verge but what about the ones that are hidden in the folds of skin or are further up the rectum, he can't see them without a proper examination.

That is a real bummer. I would also find another doctor. I have seen a total of 3 CRS's(all in the same office) over the years and all of them either used a scope(to visually see) or digital exam(to feel) for a fissure.
I would keep searching for answers - even if this means going to several doctors.