Hi,

I have been experiencing pain for months, saw a doctor who thinks it could be a fissure and have been on 2% Diltiazem for 6 weeks. The 'fissure' has healed about 85% but there has been zero reduction in pain, maybe the pain has slightly increased.

I saw another doctor who seems to think its not a fissure, but a small ulcer that is healing. The reason he thinks this is because the 'fissure' is not painful to touch, you can poke it and no pain whatsoever. He has suggested Pelvic Floor training and physio.

The pain I experience is severe tightening of the sphincter muscle just after a BM (not during) that can last a long time. I can also get it during the day and I also get occasional spasms.

My question is are fissures usually painful to touch or poke ? I don't feel any pain there whatsoever there. Its more of a general sphincter pain ache and tightness. Also, I have read those with fissure can have sharp pains, almost like passing glass - again I have never had any sharp pains


Thanks for the feedback

If you have no pain on touching the area it's probably not a fissure. I second the recommendation for pelvic floor physio.

I saw the CRS again and he has changed his mind, he also now doesn't think its not a fissure but a ulcer that healing.

He indicated that the pain and the wound are two separate issues.

He suggested that the fix for my sphincter tightness and general pain (occurs especially after BM and also throughout the day) is Botox.

He suggested that Pelvic Floor Physio is generally only for those who have the opposite problem to me - their muscles are too 'loose' and need strengthening.

The doctor said that it relaxes the muscles and that its effects wear off after 3 months - but will that not mean after It wears off I will be back in the same position ?

Or does Botox do some kind of reset; trains the muscle to work properly and again and will resolved my tightness ?

The doctor said that there is little to no side effects, is that true ?

Thanks

Botox is fairly low risk. How many units and injections did he say he would do?

Your doctor is off base about what pelvic floor physio is about. It is used to help people who have both types of problems with their pelvic floor, too weak or too tight. It's not surprising though, a lot of doctors don't know much about the pelvic floor and its importance.

Hi

Thanks for the update.

That's what I thought too, physio can help with tight as well as weak pelvic muscles. I was thinking to give physio a month or two first and then consider botox, sounds like a plan ?

The CRS didn't mention does but I thought he said 6 injections ! I hope I misheard

I have noticed that the bottom half of sphincter is much tighter, the upper half is almost normal.

Should I insists on the anal pressure test thing ? It may show normal pressure at the top and too tight at the bottom and the CRS could adjust his dosage (or it doesn't work like that)

If I don't have a fissure, and the botox is only required for a 'reset', then do I still need the standard dose which takes an average of 3 months to wear off ?

I'm not sure what the anal pressure test would show in your case. As far as I know it only measures overall pressure. My advice is to ask your doctor as many questions as you want. It's your health after all. You may need physio even after the Botox, so better to go get an evaluation from a physio first before declining Botox.

I feel Botox is a band-aid and may not help long term. What about stress? Is there anything causing you a lot of stress these days? Hate your job? Bad relationship? Financial issues? Do you have anxiety or a lot of worries? These things caused my muscles to lock up after BMs for 18 months until I quit my job and POOF - instantly gone. I had no idea.

Is the anal pressure test the anal manometry test? If so, I had that before my LIS to make sure I could tolerate the incision. I was off the charts too strong and I broke the balloon during the test.