I have a history of getting anal fissures going back a few years. I would usually see some blood and have some mild pain but they would resolve naturally within a month or two. At first I thought I had hemorrhoids and didn’t get a proper diagnosis until after I already had a few of them.

I also have a history of frequent urination caused by tight pelvic floor muscles. An anal manometry test and two PTs have confirmed that my resting pressure is much higher than it should be.

About five months ago I started having persistent rectal pain but no bleeding. The pain is indicative of a fissure because it gets much worse after bowel movements. I thought this fissure would resolve naturally like they had in the past but here I am 5 months later still in a good deal of pain. I went to see my CRS who confirmed that I had a superficial anal fissure. He gave me some topical creams which did not provide much relief and after a few months of pain I tried Botox which still did not provide any relief. I followed up with my CRS last week and when he examined me he said there was no visible fissure but he observed a muscle spasm that was indicative of fissure. He told me that if I did not feel better in 2 to 4 weeks I should see him again to discuss the pros and cons of surgery.

The fact that I have not bled once during these 5 months and that the CRS saw no visible fissure has me worried that the pain could be caused be something else. Is there anyway to confirm that I have a fissure just so I can have some peace of mind? If there is a fissure present I will opt for LIS but my biggest fear is that I will still be in pain post surgery because there was no fissure in the first place. I’m a little paranoid that the pain could be caused by something more serious like pudendal neuralgia or a pelvic floor problem where the treatment options are less straight forward.

If anyone has any similar experiences or suggestions I would greatly appreciate them. Sorry for such a long post.

I have had hems since I was 14 I have crohns also. When I first got my fissure every doctor I saw said it was hems, now I have had hems for over 25 years and never experienced pain like I was feeling, the spasms were beyond horrendous I didn’t know pain like that existed, and I have a high pain threshold. The fissure stopped me eating when my crohns never did, it stopped me working and being a good mum.
Now I persisted and was treated for a fissure with creams even though by this point I had been examined by three different CRS’s and not one had seen a fissure. I went to a private CRS who specialises in IBD patients he examined me asked me to bear down as if having a BM and he saw the very end of my fissure hiding behind one of my hems. He did Botox and after the procedure said it was one of the worst fissures he had seen in 22 years.
Now I’m not saying you have a fissure but I am saying it can be missed, could you tell your surgeon that when you have the op if he sees no fissure or evidence of previous fissures then you would prefer it if he didn’t do the LIS.
Really good luck in whatever you decide