In my - admittedly limited - 2.5 years' experience of AF, I haven't been convinced that many doctors know what to recommend as remedies for this painful condition. Pain management will probably be of more immediate use than suppositories, but that's just my rather disenchanted take.

thank you... I'm going on year 10, on and off.

Spent countless dollars, many many thousands, on herbs, ointments, naturopaths, acupuncture. Gone through endless tubes of diltiazem. Recently trying pelvic floor physio therapy.

Have not gone the surgery route.. Mostly because no doctor will refer me to a true CRS that does the surgery. I just go from Doctor to Doctor - have seen 2 specialists....diltiazem and "you're fine"

I'm far from fine. My life has ended as I once knew it. I cannot sit because it hurts horribly. When the pain is at its worst, it affects my ability to urinate. This is a nightmare.

I'm sorry for the negativity. I've tried in the past to be supportive and suggest help here. I've gone past the end of my rope.

I believe I am a "tight ass"....somethings going to give until tight ass syndrome stops. But I can't stop it.

Most of the CRS I've consulted have been quick to tell me that surgical intervention is the very last resort - "I really hope you won't need to have an operation, Mr. X" - and have then gone on to prescribe the usual ointment or cream, with Botox the maximum therapeutic action.

I think the pain management/lifestyle adjustment aspect of the disorder is the crucial one, and the one where patients can possibly make most progress. After all, there's a big psychological factor in no longer being able to move about freely, in having to think hard about accepting invitations to events where one will need to sit on a hard chair, in having to make sure that one's bladder is empty before venturing outside, etc. etc. So any medical or social care professional who can provide some sort of scheme and support for dealing with all that is going to be more effective, IMO, than a surgeon who isn't really interested in the condition to start with, and doesn't want to operate.

excellent points...surgery down there is risky and invasive. Some have been completely cured by it, others, not. Strange thing is doctors in my city never refer me to a true colorectal surgeon. I get passed to a proctologist or gastroenterologist, they have a standard therapy....water, fiber, ointment.

The pelvic physiotherapist told me I was tight down there, sigh, yell, scream. I am doing the pelvic exercises, was told a minimum of 3 months to see results. $ 160.00 Canadian dollars per visit.

Pelvic floor therapy doesn't seem to be all that popular here in the U.K. At any rate, no GP or CRS I've seen has suggested or recommended it as a treatment for my AF. The consensus appears to be to let the condition subsist quietly if uneasily without much intervention, treat it with non-invasive topical therapy like GTN or Diltiazem, hope that it settles down and reserve any hospital treatment like LIS or Botox for extreme cases, as a last resort.

Which leaves the field of pain management open for GPs, psychologists and psychotherapists, who can at least help to defuse some of the fear, anxiety, resentment, anger and frustration their AF patients and clients feel in the face of such an intractable and socially problematic disorder. For not all of the pain is physical - IMO a fair part of it is emotional and psychological.

I have had many days thinking that I was literally insane or crazy, imagining most of the pain.

The walk in clinic Doctor I saw yesterday said after his brief "examination"..." Ouch, you have hemorrhoid and what may be a fissure, just based on a quick look"

So, I guess I'm not nuts. But I don't
know what to do anymore

Hurtinend, it doesn't make sense that they haven't referred you to a colorectal surgeon! Would it be possible to look up the information of one at a hospital near you and bring the info to your doctor or walk in clinic for a referral? May call the crs's office beforehand to see if they will take you as a patient if you get a referral? And from everything I know, LIS is not a risky surgery as far as surgeries go - but talking to a CRS would give you more info about that and your situation!

Dmcff - I don't of a situation where physio was prescribed to heal a fissure - but it may help with the cause or outcome of the fissure - tight musculature, pelvic floor dysfunction, etc. That is why my CRS suggested it, since a tight pelvic floor and anal sphincter was clearly part of the problem.

If a fissure becomes chronic (lasts longer than 4-6 weeks) and then treatment with GTN or Nifedipine is unsuccessful, the consensus actually is that surgery or Botox is the next step. For sure doctors would rather treat the problem than prescribe pain medication while the wound remains unhealed indefinitely...but in the meantime for sure we deserve some option of helping our pain. You're so right that it is so much easier when the psychological aspects can be lessened with pain relief. in this situation I think they're particularly hesitant to prescribe pain medication because they tend to be constipating - which is never good for the fissure! Another option is to see a pain management psychologist. I did so - it did not provide the pain relief that opioids did but it sure made the journey easier.

thanks again for great advice...I have been referred 3 times in the last several years. Best I got was a sigmoidoscopy, and more diltiazem and you'll be fine.

I wil do it, I will seek out a CRS and demand a referral.

ended in emergency at hospital, general pelvic pain hell, originating from Ano rectal area, also now causing urinary retention. Doc had a quick look down there, didn't see anything obvious. Said it felt like my general pelvic area was in spasm, also recommended pelvic floor physio.

Doc is referring me to colo specialist at the hospital...should get scope within 3 weeks. Also prescribed Cipralex which is anti depressant/anxiety, few side effects. Also given a few days of Ativan to settle me down a bit.

Hurtinend - sorry you ended up in emergency...I've been down that route also, difficulty urinating etc and it's just awful.

Are you feeling like the cipralex will help you? I was on a low dose for a long time for ibs and it did have quite a few side effects for me - but everybody is different. I take Ativan now as needed and find it much better.

I felt just like you with full pelvic spasm and have always been told my CRS that it's a fissure, even when other doctors could not see it. She said she could see that it looked much better, but that it could still cause lots of pain. Are they really sure there's no fissure? Maybe the physio will have more insight.

-GG