having been referred by my GP, I was examined (anoscopy? - large 6-inch long clear tube with camera inside) by an experienced anorectal surgeon this morning.
She said that any fissures have healed - and where not chronic enough to produce scar tissue. She also ruled out any LIS because there's no fissure to relieve pressure on.
She suggests that any pain (I still feel a level of pain equivalent to a stone in the shoe when walking every day) is due to 'residual tenderness of tissue post healing'
Advised me to cease all Rectogesic/Diltiazem - the side-effects outweight the benefits (not disappointed to hear this) - but to avoid constipation.
Anyone had similar? I have no reason to doubt her view as she was very thorough and professional. Just surprised as the pain is persistent, if not agonising.

Hi BlueFizz, i had a similar problem as in my case after following the regime given by doctor i did not feel any pain while BM, but throbbing pain post BM and the reason was over tight sphincter muscle. As a result of which i underwent Anal dilation and have felt no such pain ever since only mild itch occasionally.

Blue,
I would be very very careful! I am only up to my crs offering me botox at this stage. I do think I need LIS.
My worry for you is that if you stop creams then use vaseline before a bm? The last thing you need is a re-tear and we all know in the UK at least, how long we have to wait to see a CRS.
Then, also vital is of course the stool softeners. I use movicol/miralax. If my CRS tells me what you have been told I will be most upset! She/he aint with you day after day with the painful bm and then the spasms that follow! Never mind all the other symptoms we suffer. I really feel sorry for you!! So, be careful and be sure ur crs isn't copping out??? Please tell me she advised you and gave you painkillers at least for the pain ur still in????

Could you get a second opinion??

I would get a second opinion. Healed and still having pain doesn't make sense to me. :roll:

I had that pain after my Fissure healed.
In my case it was a lack of magnesium absorbtion which relaxes my muscles.. I was still having Levator Ani spasms after bowel movements.. I thought that I still had a fissure because it gave almost the same kind of inflamation and irritation symptoms.
Once I started taking magnesium suppliments I noticed a immediate improvement..
I think in my case the levator was almost trained to tighten up like it had been doing for years to protect the fissure from more damage.. You could almost call it a development of a nervous twitch except in a bad place..

Oh Ouchtear how awful a nervous twitch! I can understand that completely! I have given my bowel a nervous disposition too!! Ooo the Joys of it all

Interesting comments - thanks guys.
On the one hand I'm relieved to learn there's nothing more sinister going on; on the other as a couple of you point out: being healed doesn't quite equate with ongoing pain.
I'm particularly interested in the magnesium thought and dilation. Anoscope was very uncomfortable - but oddly, afterwards for the rest of the day I felt tender but relaxed down there! Pain returned when everything felt tensed up 24 hours later after sitting and concentrating at desk all day.
I do notice that when pain is there, even massaging myself with a little oil to 'open up' helps quite a lot.
Might look into magnesium - didn't know it had potential to cause muscle tenseness if lacking, or indeed to relax muscles if taken in supplement.
My plan is to give it 10 days or so then go back to GP.
I value your advice. Thanks.

Dear Blue FIzz, Have ever heard About anal Steno-sis. It is case when the anal cavity becomes very narrow and hence makes an individual put additional pressure during BM, which can further lead to either Piles or create fissure. A typical symptom for Anal stenosis is that your stools are pencil shaped and not like a typical torpedo. If it is Anal stenosis then Anal Dilation is the Ideal Solution. However Anal dilation should be done only when an extremely skillful Surgeon is available because if it goes wrong then the repercussion are quite bad. I do not mean to scare but only intend to make you aware of the facts associated with Dilation. In any case unless you find a way to relax those Sphincter, it will be extremely difficult to achieve a complete recovery from pain. Hope you get well soon.

Gi said same thing tenderness and to use zinc oxide along with biofeedback exercises. May try the magnesium. I know diazepam seems to help
Muscle relaxants I agree