Oh yes, I do sympathize with the fear of the rectal spasm (if that’s what it is). I know how sad it is to be hoping you’ll somehow escape it, only to end up in terrible pain for hours. I just had my second BM of the day. It didn’t hurt because it was very soft but now I’m terrified waiting for the potential spasms to come. Fingers crossed for us both!!

Well I'm not quite sure it's that. Neither is my surgeon. At first he though it was hemorrhoids, just yesterday when I had seen him he thinks it might be muscle spasm.

He's arranging for an MRI and I'm not sure whether an MRI would should abnormalities in hemorrhoids or muscles around and including the rectum.

When I feel the pain coming on gently press on the area of the inflamed hemorrhoids and the pain intensifies. I don't know, it could be hemorrhoids. But I've had this pain everyday for 3 months. Is it possible for hemorrhoid pain to manifest itself in such a nature of such a period? And I don't have any bleeding whatsoever.

It IS strange. Do you think your surgery could have caused your sphincter muscle to react more sensitively to bowel movements? I remember reading on this forum someone wrote that their CRS said the anus is a delicate apparatus and susceptible to dysfunction from trauma. Something like that. Although perhaps it’s possible that your hems are raising your internal sphincter pressure which could lead to pain perhaps? I often wonder the same thing about myself because I have hemorrhoids that are half internal/half external and I have a super tight sphincter muscle.

I don't think my surgery causes my sphincter muscle to react more sensitively to bowel movements. I did notice a couple external hemorrhoids before my surgery and I was experiencing this exact pain after my surgery, add to it when I go and gently press on my hemorrhoids I feel that exact pain intensify.

I understand you have a fissure. Pardon me for asking this question but would you feel the difference in the pain say, between a fissure, hemorrhoids, or a tight rectum / sphincter?

I’m not sure I can tell the difference. I’ve been so puzzled by my rectal pain because I obviously have hemorrhoids so that could maybe cause it. I potentially have a fissure because I have the classic sentinel tag which forms from a fissure, as well as bleeding. (No CRS has been able to see it and they suppose it must be too far inside me to see from the outside.) Meanwhile, I did figure out that the burning painful feeling I felt was from spasms and I did this by inserting a lubricated pinky finger inside myself when I was having pain. I actually felt my muscle spasming, so that at least cleared that up for me.

I also have great difficulty passing any stool that’s not small so I know my muscle is tight and working against me. It’s really frustrating because I believe it’s what is preventing me from healing. That’s why I want the LIS surgery

Sorry, I haven't checked the forum in a while! Sorry to hear that your fissure has returned. It's such an awful feeling, especially if you managed so long without pain. I'm still having both good and bad days. I also have to be careful about my diet because any "bad" bowel movement causes it to tear and bleed. I haven't given the Diltiazem much of a chance yet since I've been pregnant, but I really hope it will help me heal because I can't imagine living like this forever.

As for the pregnancy, I'm almost 36 weeks now and really need to speak to my doctors about how this might affect the delivery. I meant to ask sooner but chickened out since there was a student in there too. I don't know if it's too late to try and take the Diltiazem but I might ask. I have a feeling they probably won't know what to tell me because most people get fissures AFTER delivery. In any case, I think I'm most likely going to have a vaginal delivery and just pray I survive intact lol. I will probably start taking Miralax everyday soon and hope that helps. I hope I'm not making a mistake, but I guess I'll just opt for the surgery if things get a lot worse. As of now, I can usually manage the pain enough to live comfortably and it doesn't interfere with intimacy normally. I'll try and keep you updated the next few weeks. I feel like a guinea pig going into this since I can never find any other stories of delivering with an active fissure. Be terrified for me haha.

I finally asked my obgyn about the fissure and giving birth, but she basically said she had absolutely no idea. She actually said that she didn't know what would happen but it likely wouldn't improve... obviously lol. She hadn't heard of Diltiazem cream and wasn't really sure if I should take it. So she was completely worthless. I might try asking the CRS that I saw a year ago, but I'm honestly not sure if I will be able to get an appt in time or if he will even be able to give me advice. Kind of terrified. Less than 4 weeks to go.

I’m so sorry you’re left without good guidance. I was in the same position and felt like there was this big knowledge gap on fissures in pregnant women. Like they’re not all that uncommon so why isn’t there better guidance on how to treat? Ugh, So frustrating! Maybe you can get a prescription for diltiazem and not use it until baby comes if you’re feeling worried about it? Congrats on the upcoming arrival, by the way! New babies fill your heart with such joy that it’s hard to feel too sad about the fissure situation. Or at the very least they keep you so busy that it’s hard to dwell on your own discomfort for too long. That said, I’m seriously considering surgery if mine doesn’t get better. It’s just been too long! Sending you lots of luck for the birth!

Oh also, wanted to pass on something my OB told me. When breastfeeding our estrogen levels are suppressed, like we’re menopausal basically. This state of low estrogen makes our skin thinner and increases the likelihood of vaginal and anal tearing. Breastfeeding can also deplete levels of certain nutrients if our diets are inadequate, like magnesium, which can cause constipation. (So can dehydration!) So basically we have to be extra extra careful about our fissures when we’re breastfeeding. I’m taking lots of magnesium and Miralax to make sure things are super smooth.