Hi, I'm hoping someone out there can help me. I've been suffering with anal pain for the last year and a half now. I've visited my GP numerous time and since the specialists twice, but none of them have been able to find a fissure. Yesterday I suffered the most excruciating spasm after a BM so went straight to the Drs to have them look at it sure that they would finally see something, but again he could find/see nothing. The spasm came on immediately after the BM and was so excruciating. I'm already using rectogesic so would have thought that this would prevented this from happening, but alas no I've now been prescribed Amitryptline which over time is supposed to relax the nerves down there and prevent the pain. That's the theory anyway. In the meantime I'm terrified of using the bathroom in case I have another spasm, and I'm sure this is making more tense and therefore more likely to cause another spasm How on earth do I break this vicious cycle?

When I googled Amitryptline, it came up as an anti depressant. So perhaps it WILL help you relax during your BMs. I think I've read on this forum that some CRS's prescribe valium because it relaxes the anal area as well as reducing the anxiety brought on by pain and fear. So maybe Amitryptline will help you in both these ways.

The rectogesic should help the spasms, but you really need to attack this thing on all fronts:

1) soft stools - lots of water, plenty of soluble fibre in your diet, maybe a stool softener and/or a laxative. Whatever it takes to make your stools consistently soft. You don't want diarrhoea though.

2) not too many BMs. It's difficult to find the right balance here, but if your diet/laxative regime causes you to have more than 1 or 2 BMs a day, that's probably too many. The dreaded 2nd BM is often worse than the first one.

3) deaden the pain. This could be with ibuprofen, topical lidocaine..........it's really hard to find a pain killer that actually does anything to ease anal spasms, but personally I lived on ibuprofen for 2-3 months. It didn't stop the pain but it took the edge off. You need to break that cycle of pain causing spasms, which cause more pain which causes more spasms.

4) ease the spasms with heat. You can take warm baths, use a sitz bath, sit on a heat pad or hot water bottle. The heat does ease the pain and also increases blood supply to the area, helping you to heal. I like a hot water bottle because you can sit on it all day long, and put it under your bottom at night. Just don't make it too hot, because if you burn or overheat, you'll get spasms from that, too.

It does sound as if you've got a fissure, but even if you haven't, all those things should help. You are right that you need to break the cycle, because the spasms are hindering your healing - reducing blood flow and making you tense.

Re-reading your post, I wonder if you need to pay careful attention to your diet. Keep a diary and see if you can see if any foods cause you to have BM pain. Try cutting out some of the obvious suspects like gluten, dairy, nuts.

I am NOT a doctor, so please take these pieces of advice as suggestions only. If you keep suffering, do keep going back to the doctor.

Hi Moogdog,

So sorry to hear about the pain you're having. Anal pain is so debilitating to live with, and even more so when it's tough to figure out what's causing it. In addition to the great advice above, it is possible that you are experiencing levator syndrome without a fissure being present. It is also possible that you do have a fissure but it isn't easily visible on examination. Do you feel pain when you have a bowel movement, a feeling like something is scraping or that you are passing glass or razor blades through your anal area? Do you have any blood when you have a bowel movement? Amitryptyline is actually a pretty good place to start when it comes to pain, but just be careful about constipation, as this is one of the main side effects people complain about when taking it.

Have you seen a colorectal surgeon? They are the specialists who are best at finding fissures. A colorectal surgeon who also specializes in pelvic floor dysfunction and is familiar with levator syndrome would be ideal in narrowing down your diagnosis further. You may need an examination under anesthesia to get a complete view of the anal canal to inspect for fissures. While the treatment for fissures and levator syndrome can have some overlap, there are also differences in how they are treated so it is important to try to get things sorted out.

Wishing you relief and some clearer answers too!

Hi guys, thank you so much for taking the time to reply. I have seen two colorectal specialists now, and neither could find anything wrong with me. I've thought long and hard about what has caused this - I don't get any obvious burning and stinging after a BM, it just feels bruised/sore and this can linger all day some times. I am concerned about the Amitryptyline giving me constipation, but I eat a lot of fibre and take two doses of fybogel a day so hoping that won't happen. I had a small haemorrhoid a year and a half ago which healed, and I haven't felt quite right since. My theory is somehow this has aggravated the area which makes it more prone to irritation. Or maybe it didn't heal properly? Also I wonder whether using haemorrhoid creams etc when I didn't have a haemorrhoid somehow weakened the area. I've never known anything like this discomfort. I bling domed my finger a few years ago needed stitches etc, but at least that healed in time. I think you are rig about keeping a diary - try and work out if there is anything I'm doing which is aggravating this.

Hey Moogdog!

Got any answer on what is causing your spasm? I'm in similar situation where my fissure is almost healed but spasm doesn't decrease proportionally.

Thanks

Hi bgd, sorry to hear your suffering No updates yet, but I've got an appointment with the specialist next Friday (17th) so will post an update then. I really hope they can get to the bottom of it this time - it's driving me crazy.

Hi, sounds like you may have levator ani syndrome. It's a painful condition that can cause sudden and excruciating pain. Are your bms a normal size and easy to pass? I used to get the most awful charlie horse up the butt feeling with my fissure and stenosis. It was enough to bring me to my knees in tears. Sitting on a very warm heating pad helped tremendously. I finally had surgery. It's hard to pinpoint how levator ani starts because all your pelvic floor muscles are so close together. When I was having the spasms I never knew when it would happen. Sometimes valium helps but usually the spasm goes away before the pill even kicks in. Some people find relief with physical therapy too. Hope your doctor can help you, Suzy.

Hi Suzy, thanks for your post. Did you have surgery for levator ani syndrome? If so what did it involve? If not do you still suffer? I'm on Amitryptiline at the moment, and between that and the rectogesic it's just about manageable, but I have good days and v bad days. There doesn't appear to be any rhyme or reason to it which is v frustrating. One day I can be fine, then the next I feel dreadful.

Hi, no there is no surgery for levator ani syndrome as far as I know but I did have surgery. I suffered from severe anal stenosis. This was a result of hemorrhoid surgery years ago. It happened slowly so I didn't really understand what was happening to me. I got my first fissure about 7 years ago but it healed on its own. The next fissure was 6 years ago and it did not heal. It would heal for a few weeks and tear and heal and tear and on and on. In the process it was creating more and more scar tissue. When my fissure was active it would burn and I'd get this tightness like spasming. I had LIS and it failed but it did create more scar tissue. After that surgery I started to get this awful charlie horse up the butt feeling every so often. It was the worst pain I've ever felt. I would go weeks sometimes months before it would happen again. When it did happen it would last for about 15-20 minutes and it was awful. The rectal pain was consuming my life and I didn't know what to do. After 5 years of struggling I went back to my CRS and told him what was happening. I had narrowed so much having a bm was scary. He told me that the narrowing was what was causing the spasms as much as the fissure. When you're body tries to stretch in an area that can't stretch anymore it send the muscles into spasms. The only option I had left was to have the scar tissue around the opening removed and new tissue sutured into place but because I was too narrow to even get an instrument in there I would need it done on both sides. I can't even explain the thoughts that ran through my mind. It still took me a few weeks after that visit to make up my mind and do the surgery. I could't do the normal prep so they had to be creative ( I couldn't even get an enemas in). Because of the wonderful people in this group I got through my prep and did the surgery. I did have to be in the hospital a few days but they managed my pain well. When I went home I had to have help because they didn't want the skin to stick together on my butt. Keeping everything clean and dry was hard but we did it. I had a few setbacks but for the most part it just took a long time for recovery. Since the surgery I'm able to go to the bathroom normally again ( I still take a small amount of miralax at bedtime). I dilate every other day, (that's part of my recovery). I've had a few minor discomforts here and there but a warm bath or just walking makes that go away. I'm 8 months post-op and I wish I would have done the surgery sooner. You don't have to have an anal fissure to get spasming in the anal region. Hemorrhoids can cause them, anal stenosis and pelvic floor dsyfunction can cause them too. I still remember those spasms and hope I don't ever have to go through that again. One tip my doctor gave me was if I feel a little tight just lubricate a dilator and dilate. I've done this a few times and it really works. My recovery will take about 2 years for everything to settle down but that's okay. The only advice I can give you is to make sure you have a good CRS who listens to you and explains to you what you can and can't do. I got lucky. My doctor has a wonderful bedside manner, a good sense of humor and he sits down and tells you everything you need to know. He even drew me pictures of the surgery I needed to have done. I never found any medicine that helped with the spasming very much. A warm heating pad helped the most and nitro helped a little. I hope you find what will work for you but please be persistent.. Don't give up. It may take a while but one day you'll find yourself on the road to recovery too. All the best Suzy.

Suzy,
Thanks for posting your story and updating. It's amazing to see how well you are doing! I love your current mood " Very Optimistic" - I just hope you get better and better!
Moondog & everyone else on this thread - Be inspired! - & stay strong. You will get there in the end too :)