Is it a fissure, or something else?

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Postby dmcff » 15 Feb 2023, 04:32

It seems that sufferers from anal or rectal pain are commonly diagnosed with 'hemorrhoids', or 'fissure', without a proper examination having taken place. When such an examination does occur, the results are often ambiguous or vague, and the recommended treatments ineffective.

Two conditions - proctalgia fugax and chronic proctalgia - are frequently suggested as the cause of anal or rectal pain. Of the latter, an NIH publication has the following to say, inter alia:
no organic disease explanation will be found in approximately 85% of patients presenting to gastroenterologists with chronic anorectal or pelvic pain.
No single treatment has been reported to be consistently effective in chronic proctalgia, and management can be a frustrating endeavor for both patients and physicians.

the minority of proctalgia patients affected by unspecified functional anorectal pain are still left without a satisfactory treatment option. In this regard, depression and anxiety are both frequently reported in non-responsive proctalgia patients.

The subject of pelvic, anal and rectal pain is apparently shrouded in relative mystery, and one wonders why, in the 21st century, this should still be so. Is it because of the absence of an 'organic disease explanation'? And why are gastroenterologists consulted about these conditions? Should not colorectal surgeons have the last word, although such specialists often appear uncertain when asked to determine the source of the pain?
2014 Anal fissure
2015 CAT, EUA, sigmoidoscopy, 2 MRI
2016 Pain severe then moderate to low
2017 Moderate pain
2018 Physical therapy, pain management
2019-20 Just living with it
2021 Better, but still have AF
2022 Therapy, meditation
2023 Onward and up
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Re: Diagnosis

Postby WhatTheFistula » 24 Apr 2023, 21:02

The truth is that the multiplicity of causes probably requires a multi disciplinary team approach. However, the way in which resources are managed in UK means that is unlikely unless patient ends up on cancer pathway.

Interesting to read posts from American authors here who seem to have similar issues in respect of specialists.

When my fissure returned, my GP was clear that I had two options: (I) cancer pathway on NHS, or (II) referral to a CRS on my health insurance. I chose the latter and my GP was adamant that I must see a CRS to lead on treatment.

It would have been lovely to see a dietician, psychologist and pain consultant too!
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