Levator Ani?

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Levator Ani?

Postby mike1971 » 27 May 2018, 19:10

Hello everyone. New here. Mike, Toronto Canada, 47 year old male.

Looking for some answers to questions I have. I understand this is not a doctors forum and issues like this require medical attention, but there are many here whom I believe have experience and knowledge regarding my symptoms.

Just had fistulotomy surgery 9 days ago. I have two fistulas that were cut open (low superficial near anus) and left as is with no stitching or packing. The perianal skin abscess I have is also still active and draining pus (it's not huge but still alive) and the surgeon lanced it.

It seems I have also acquired a couple thrombosed external hemorrhoids after the surgery (my luck). Surgeon says they should eventually go away and "get better". Ok.....

Question; since my abscess spontaneously erupted late last February, I have been experiencing a dull, aching, burning pain on a daily basis. It can vary in intensity. Most of the time it comes on subtly over a couple hours. Tightness, a pressure in the anal area, somewhat of a burning or inflamed sensation. This feeling can build in intensity and peak at 4 or 5 hours when I feel a coming down period for another hour or two and then it's as if my anus what released from the grip of the pain. I've had this pain last anywhere from 5 to 10 hours a day, everyday since. I don't have this pain before, during, or after a bowel movement. The pain is generally starts in the late afternoon, evenings, or late night but it can also come early mornings.

When I probe around my anal area with my fingers I feel the pain and burning where the abscess and fistula surgery was (left butt check). I don't feel any pain on my right butt check, on either rump or in my outer hips, tailbone or leg area.

I never experienced this pain prior to coming down with this infection. Could it be the abscess or fistula area causing the pain, maybe the hemorrhoids? I feel the hems they are tender and hard but do hems flare like this for hours and then pretty much no pain whatsoever (other than when I sit down). Do active perianal abscesses still flare and cause pain off and on?

Or could this be lavator ani I'm experiencing?

Thanks for any opinions.
mike1971
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Re: Levator Ani?

Postby patience_and_healing » 29 May 2018, 23:08

I'm sorry for the awful time you're going through right now. I don't really have any input other than to ask if you've had abscesses in the perianal region before, or if this was a completely new thing for you? It's possible that the infection in the area is causing the pain and burning. The sensation of pain leads to muscle tightening, resulting in a vicious circle.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
On and off in pelvic physical therapy
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Re: Levator Ani?

Postby mike1971 » 30 May 2018, 16:56

Thanks Patience.

Yeah it is my first perianal abscess. I've been to numerous doctor Apts and hospital ER visits. Had a couple digital rectal exams (not that I'm proud of them), multiple physical exams by different doctors, sigmoidoscopy, blood tests and an EUA in which the surgeon said he did not see any evidence of perianal spasm, anal stricture, or Crohn's disease.

All my blood tests keep coming back good. I'm told by many things don't " look that bad as I think". And although I'm sure more invasive examination such as a colonoscopy, biopsy of intestinal tissue and additional blood tests for Crohn's can provide a more thorough diagnosis, I don't feel I suffer from any intestinal issues now or in the past. I pretty much eat and drink anything and don't have vomiting, naseau or diarrhea. No stomach cramps or pains. I did experience fatigue, loss of appetite, and abdominal discomfort while on 5 weeks of Flagyl and Cipro prescribed by the surgeon pre-op. The antibiotics really messed me up and I really didn't want to take them. It's easy for the doctors and people around you (family and friends) to tell you to take your medicine because a doctor prescribed them and they will do you good. Then these same people want to question you why you lose your appetite, lose weight, and you seem tired, lethargic, weak, dizzy and confused while on the medication. Upon stopping the antibiotics , my skin color, appetite , and energy levels have slowly come back.

Back to the possibility of Crohn's , I could remember twice in the last 10 years when I had diarrhea multiple times a day for 3 or 4 days straight. The first time may have been a virus or food poisoning, the second back in January of this year ( 2 months before getting my perianal abscess) was diagnosed as rotavirus by my family doctor.

I atribute my recent health woes to my type 2 diabetes, or just plain bad luck or my lack of personal hygiene , diet, and neglect of physical activity ( being overweight but that's dropped from 280 lbs before abscess to currently 220 lbs dealing with abscess and fistula issue for last 3 months).

Which brings me to the point of my long winded explanation.....yes, maybe it is all in my "head". Maybe the pain I'm experiencing pre and post-op is from the abscess and fistula site. It definitely feels more tender and inflamed when I'm experiencing this other weird pain. Maybe I'm subconsciously thinking ( or even more so conciously thinking ) to tense my anal opening when I get this pain , or maybe since the abscess and fistula are so close to my anal opening I'm really confusing the pain in that region to possibly something else.

Reading all the "horror" stories online ( and asking myself wether many of them are true or simply made up....because c'mon.....some of them are truly outrageous and in imaginable......like people going for 5 mile jogs or 20 mile bicycle rides a week after their fistulotomies.....or working a 9 or 10 hour physically demanding job.....or driving a car or truck for 100 miles.....just sounds so absurd to me).

The Internet can really mess with your head. It can create negative, unnecessary, and unneeded stress.

And after spending days reading much of this stuff online, those closest around me tell me I'm stressing myself out.

Maybe some of it really is "all in my head". "I really do need to change my attitude for the better and take control of my situation.

Sorry for the rant.
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Re: Levator Ani?

Postby mike1971 » 30 May 2018, 19:10

Ok so today I dropped into the local ER at 10 am with the help of my girlfriend (we planned this 2 days in advance and she had to adjust her work day schedule) to see an ER doctor and hopefully get an answer as to why I'm experiencing this rectal pain on a daily basis. After waiting for 2 hours I was escorted to a private room and met with the doctor shortly thereafter. I am currently 12 days post-op from fistula surgery. I had 2 tracks laid open and the active superficial skin abscess slightly cut open where one of the fistula tracks were to allow it to continue to drain pus (which it still is). So worried about this as I'm not sure how long the healing process will take.

Anyhow, the ER doctor looks at my wound and I immediately get the sense she doesn't know much about these things. Concerned about a couple of thrombosed hemorrhoids I had seen she said she didn't see any, and that she can see the small fistulotomy incisions and it all didn't "look that bad".

She mentioned she will call the surgeon on duty to have her take a look but suggested I take a blood test there to "analyze my white blood count".

So another nurse takes my blood (she was s smooth it was completely painless) and we wait in the waiting room for another hour for the results.

The ER doctor calls me in and explains my blood results are even better than my pre-op blood test. In addition, she stated the surgeon on call did not want to see me at that time because "it could take up to six weeks" for the fistulotomy to heal. Ok, yeah, sure.

When I asked if the pain could be associated with the active abscess and fistula cuts she said it was possible, but couldn't say for sure. She didn't want to do any further CT scans as I had a prior one 8 weeks earlier which showed the abscess and fistula but nothing more. She didn't want to expose me to any further "radiation" but maybe this was more a time and cost issue for the hospital (imo).

So we left with no concrete answers other than having spent 5 hours waiting for a "good" blood test and a $17 hospital parking fee.

On a side note, I had a large hard dry bowel movement at 8 am. The previous days bm was surprisingly not as large so I think this one made up for the last two days. When we got to the hospital at 10 am I was starting to feel the discomfort of this rectal pressure, tightness. I started having a habit of spreading my but cheeks while standing, bending over slightly to stretch, and occasionally walking oddly trying to adjust my stance due to the discomfort. My girlfriend gets annoyed at my habits telling me to "stop doing that" but the discomfort is hard to ignore.

The discomfort lasted from 10am till about 3 pm when I got home. It's 8 pm and I since haven't felt any discomfort. I don't have any pressure, rectal tightness, or pain and burning (haven't had much pain or burning lately more discomfort from tightness and pressure).

I will be keeping a journal of what time I take bm's and the time from when my rectal discomfort starts and stops.
I'll be taking this up with my surgeon in a weeks time when I see him for a follow up to the fistulotomy surgery.

I really hope this is some sort of "flare up" discomfort from the active skin abscess and fistula area as opposed to some other underlying issue like lavator ani.
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Re: Levator Ani?

Postby Deleted User 7275 » 18 Jul 2018, 11:45

How did it go mike? Hope it worked out alright for you. I am turning 44 this year and have been diagnosed with stage 2 hems and fissure. The doctors have told me also “ they don’t look bad” while undiagnosing a fissure.
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Re: Levator Ani?

Postby mike1971 » 19 Jul 2018, 20:37

Hi Walking Wednesday thank you for asking.

This was nearly 6 weeks ago. I remember it well as I've had many ER visits in the last 5 months.

I'm still experiencing some pain after bm's. It's still a few hours after but now they are not as intense. More slight burning and throbbing which subsides a few hours later.

On days I don't have a bowel movement I don't experience much pain although there is still soreness and discomfort. I still have a very small incision from the fistulotomt that is still healing 8 weeks after surgery. I am not sure if this is the source of my pain or a spasming external and or internal sphincter.

I've had an MRI tdone last Monday. I hope I get some answers soon.

it's been very difficult for me dealing with this.

How are you making out?
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Re: Levator Ani?

Postby Deleted User 7275 » 20 Aug 2018, 16:49

Sorry just saw the post. Had LIS on the 10th. Still in pain, but better each day little by little. I’m sure your doc will have good news. Let us know. I had a set back as you have read but 50% better. Constipation is no joke
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