Hi all.

First off ... so sorry for the pain all of you experience.

My name is Nico, 38 male, graphic designer from Namibia, Africa.
My history is outlined at the end of this post.

Currently I do not suffer from fissures or hemorrhoids, 'just' spasms, needle-like pain after BM. While this can hardly be compared to what most of you go through, the impact it is having on my life is nevertheless moving me to attempt to sort it out now.

My spasms seem to come from the traumatic time of 2009 - 2012 (see below), so there is definitely a psychological/memory part to this.

We have tried Diltiazem ointment, which only worked for about 2 weeks.
One doc has proposed physio treatment, but the idea of being massaged ... internally ... simply not doing that!

Now he is proposing Botox injections in sphincter muscle and puborectalis. Both specialist surgeons I go to agree with this course of action. Both docs are very conservative!

If that doesn't help, I am considering finding a surgeon in Germany who will do an incision of the sphincter muscle to weaken it.

You guys may not be Doctors, but would you agree this is the best course of action? On the one hand I agree with using the most conservative measures for as long as possible, but on the other hand I think 6 years is plenty enough!

Thanks in advance!
Nico



2009 - after an unusual case of constipation = external hemorrhoids!

2009 - 2012 - terrifying pain after each BM, blood, in bed for 16+ hours/day. My business crashes due to this, leaving me without money to pay for an op.

2012 - Hemorrhoidectomy, traditional = tying off blood vessels, leaving skin tags on, small cut in internal sphincter to make passing stool easier.

2013 - great year overall, one 2-week bout of spasms that passed without treatment.

2014 - spasms, spent a small fortune on standing desks - too afraid of sitting, helping but not curing.

2015 - spasms, Diltiazem oinment works for about 2 weeks, anal manometry = appears normal.
2015 - inserting middle finger in shower after BM, massaging muscles a bit is the only thing that seems to work to a degree.

2015 - having lost faith, I drive 1500km to Cape Town, South Africa, to see a Gastrointerologist. Ultrasound, another manometry, colonoscopy. He wants to remove skin tags and do stapled Hemorrhoidectomy - but I decide to consult my surgeon back home firts and he says the results from Cape Town do not warrant an op.

2015 - past 3 months have been quite good, without doing anything except showering after BM, had lots of work and less time 'thinking about this condition'

2016 - spasms, not as bad as 2014/2015 but enough to give rise to fear, teetering on edge of depression again.

to the group! Read through your post and as you can see from my history, I 'cured' myself with dilation, very gradual, with pediatric dilators. Have been where you've been (to the wretched hell of fissure pain). Also I use a Sitz Bath to soak my bum after each BM too, and that helps me. Am careful in the extreme about what i eat too.

Did you see a colon and rectal surgeon (or does a GI doctor cover the lot in SA?)? CRS really know the most about this condition, more than a GI doc and definitely more than a GP. The number of times I was told the wrong thing by a GP...

Our search on here - the one above between FAQ and Portal - is excellent. You can search by topic there.

Hopefully others will give you some ideas. We know how you feel, believe me, as so many of us have been and know where you are.

Hey thanks, Savaici! Good on you for curing yourself!!!

There might be CRSs in South Africa, went to the GI mainly because he can do the various tests (manometry, colonoscopy and ultrasound) - simply wanted hard proof there was nothing physically out of place down there.

Will look this up, thanks for the advice.

My one doc actually mentioned dilators ... and since the finger technique works to a degree, this might be worth investigating before going the Botox route.

Thanks again!

Hi Nicolay...sorry to hear you have been through the never-ending butt problem routine....hopefully you will get it sorted out in 2016.

Please note that I am no doctor...so take my thoughts accordingly.

You mention in your post that diltiazem only worked for 2 weeks -- how long did you use it for. I was told that a minimum amount of time to use a cream is 8 weeks and i had surgeons tell me that they would not operate until a patient had used for 12-16 weeks with no measured success. Perhaps you stopped too soon?

Do your spasms come on after each and every bm...or just those that are hard? Are you perhaps pushing too much?

Are you doing anything else to help calm the area down? I found applying heat (sitting on a heating pad and taking warm baths and/or sitz baths) was very soothing for the pain and the spasms...perhaps add that to your routine.

If you are not in serious pain you may want to explore those very conservative options for a week or two and see if it helps at all...if it does then continue, if not then on to the next step.

Best,
Canadabum

Hi Canadabum, thanks for the reply.

Took the Diltiazem for about 4-5 months, even after it didn't work no more. Even now I apply it every now and then. Hope can be a strange thing.

Spasms happen after every BM. Might not sound believable, but I never have hard BMs, no matter what I eat. Always drink enough. That incident in 2009 was a freak case, the water where I was staying had too much calcium in it. Add frozen pizza and coffee ...

- after BM, warm/almost hot shower, cupping one hand over that area to direct the warmth
- have tried applying warmth/heat afterwards (sock + rice -> microwave) but it seems to make it worse
- move around as much as possible afterwards, running errands, etc. - not always possible due to job
- sit for max 1hour at a time, stand 80% of time at work (as an artist & graphic designer, this has reduced my creative output to 30%, a real shame)
- anything that takes my mind off it
- relaxation technique (visualising the muscles in that area to be 'melting') 20 - 30 times a day

One thing that has not been investigated is a possible neurological aspect to this - I get these sciatica nerve pains in bum cheeks and coccyx from sitting, like a nerve being pinched - once that starts it travels 'there'. Maybe an MRI would not be wasted money.

Sorry for rambling on and on.

Sounds like you have been very thorough in your approach to dealing with this.

The sciatica is a possible clue and may. E related to the needle like pain. Have you ever gone for deep tissue massage to deal with sciatica -- friends of mine swear by it.

Aside from that...from your previous post sounds like self dilation worked to some extent for you...may work again.