I've had fissure-like pain over several years, I put it down to poor technique and stress. Seen docs here and there that thought it was haemorrhoids and treated with prednisolone cream (Scheriproct). It would come an go, I'd use the cream and be fine for a few weeks and the cycle went on.
About 18months ago it got worse and just wouldn't get better, went to a doc and confirmed it was a small fissure at 6'oclock. Burning, scratching sensation and muscle spasms. Was worse after a BM and just sitting down for any length of time would make it worse too.
Tried Nifedipine cream for 2 months, didn't clear up so had botox injections.
The botox helped the spasms, but the burning pain stayed. I was booked in for a LIS, but the doc examined and said there was no sign of the fissure - it had healed. Very surprising as I felt the pain hadn't gotten any better. I've since confirmed with another doc that there is no sign of the fissure.

I still get a burning sensation and particularly after sitting for longer periods, in the car, at work etc I get a deeper aching pain.

I've seen a pain specialist and tried a ketamine/amitriptyline cream and also a nerve block at the base of my spine, neither had any impact.
I've seen two pelvic floor physio's and they identified my hypertonic pelvic floor and did some tests to confirm. They offered some exercises and floated the idea of gentle stretching - But I just don't make any progress with the physio.
I've had 3-rounds of botox during this time and it does provide some help for a few months, but doesn't take away the pain and discomfort.

The burning, scratchy uncomfortable feeling is the same now and when I had an active fissure. It feels like there is a fissure, it's uncomfortable all the time - particularly when sitting down.
It seems I have exhausted treatment options and to be told there doesn't appear to be anything physical wrong, while still being in the same pain....it's hard.

Hi there,
I'm very similar! Pain/burning particularly with sitting while there's no physical trace! How're you doing these days? Found any answer?

Hey, thanks for the message.

Unfortunately no improvement. I had another round of botox in mid-September, but I haven't found that particularly effective. Actually quite disappointing as I thought I could at least rely on the short-term, but reoccurring help. Perhaps diminishing returns each time.

I do struggle with IBS/incomplete evacuation and I find I often have to push a bit to get things moving. Not strain a lot, but definitely a push. My pelvic floor is hypertonic and I guess it's just a circle...I push, which further strains the muscles and the burning pain is the result.
I've tried movicol (I think that's our version of miralax) but I get very bloated and uncomfortable. My stool seems to be soft usually, albeit thin, so I don't feel that's the problem solely.

Some sort of mix between the IBS and pelvic floor tightness that I can't make inroads with. Can't seem to find anything else to try

I have the same issue. My IS is tight and I have to always strain during BM. My main complaint is pain when sitting, which gradually builds up the more I sit. I get a deep ache. I also get burning pain. The skin at 12 o'clock spot is also inflamed, itchy and sensitive. All tests have been negative and I've been dealing with this for the past 3 years. I had burning sensation problem many years ago (+16 years) but it cleared after a few months. I always had moderate IBS issues. When it started 3 years ago I thought it's the same issue I had 16 years ago but then it turned to this chronic permanent ailment that never left me!
Have you done a manometry test? How did they diagnose your hypertonic pelvic muscle issue?

Wow sounds exactly like where I'm at, even the history - It's rough.

I haven't had any bleeding in 2 years and the CRC confirmed the fissure is healed - So I have to believe it isn't an active fissure. Which either leaves skin irritation of muscular issue with the pelvic floor.
Again, visually the CRS says things look fine - So I currently believe it's muscle tightness and disfunction, with the tightness causing the burning sensation.

I've seen a physio and tried various stretches, but nothing seems to make a difference. The stretches if anything seem to aggravate so I don't have much motivation to keep trying that route.

I did do a manometry test with the CRS, she seems to be one of few certified in the area. I didn't get much from the tests but she did say they weren't as bad as expected given my pain. But also not good, as I'm an otherwise health 34yo.
The hypertonic diagnosis was first just a surgery note after the 2nd botox I had. Confirming the hypertonic pelvic floor and that there is no visual sign of a fissure. So the manometry didn't provide anything new or change treatment plan...

The CRS has been very nice and helpful, but at the end of the day she's stumped as to the pain. Happy to repeat botox as I like, but between the expense, discomfort and now less alleviation of the pain, I'm not sure how I will handle it going forward.

That sucks! I had a manometry test and even that was normal! But I don't buy that all this pain I'm experiencing isn't caused by anything! The thing is we have a broke health care system that tests, appointments and second oponion specialists takes for ages and at some point one might lose the drive and learn to suck it up! But it ain't good at all! There was a time I was suspecting my prostate might be the culprit! Ive thought about any possible cause which has took a significant mental toll on me especially with all the horrible things you read on the internet! I'm tired of self diagnosis!