From my research thus far I think I have a sentinel pile and have had for years. However, it has never swollen up like it is now. I get lots of itching at night. Lots and Lots of itching. The scratching has thinned out the skin and i have several open sores...I don't know if I actually have a fissure or not. The skin on my right cheek looks like i've got poison ivy or maybe a chemical burn. I've washed the area with denorex, use Tucks, and eat a ton of fiber. However, I have been drinking more coffee lately (which i'll stop) and haven't heard of a sitz bath till now (which I'll start). Should I be using something like neosporin? I've tried so many things I'm now experimenting with just trying to keep the area clean with no additives so to say. I may need to bump up my water intake and will do that. I've not experienced the sphincter tightness I've read several describe, nor any crazy constipation. Lately, the bowel movements aren't real comfortable, but they are expelled easily enough. Any ideas on the skin issue (looking like a chemical burn or poison ivy)? Or the itching? If I could stop scratching I think I could start healing.

Hi Benneaf, I experienced something very similar to you. I have what i know know is a sentinal pile and have had for about five years. I know know that the extreme pain I felt around that time was the formation of my first fissure. About 12 months ago I developed an itch down one side of my perineum. It was only on my left side. I often could not resist the urge to scratch it until it was red raw on occasions. Antifungal ointments did not relieve it. I put up with it for 12 mths until I found an ointment when I was in america for itch. It had steroids in it. That gave me great relief until the tube ran out after I had returned to Australia and couldn't find anything like it here. I did a bit of research and believe I had what is called is lichens sclerosis. I have now found a cream with hydrocortisone and lignocaine that has worked to reduce the itching and inflammation. Unfortunately I think the persistant itching led to pelvic floor muscle spasm and combined with constipation I tore my rectal wall again. Hence the current fissure which is slowly healing. The itching symptoms are now gone and I think it is because I reduced the inflammation with the steroids and now the constant baths keep me pretty clean. Hope this is of some help to you. Xx Pia

I went to the doctor today. She says I have a yeast infection, a fungal infection, hemorroids, and possibly something else as well. She wants me to go to a GI specialist and get a colonoscopy for whatever else may be ailing me. She gave me prescriptions for fluconazole (for yeast infection) and a cream with bith a steroid and anti-fungal (clotrimazole and betamethasone). My guess is that I and a lot of other folks have quite a few different things impacting or creating our conditions. Trying one or two leaves the other factors intact which may lead to the return of them all.

Benneaf, I am glad you will be seen a specialist, he will be able to see what is going on inside.
I also have a large sentinel pile for years that I always believe to be external piles because it will be swollen all the time, itchy and painful, never in my dreams I would think that this was the side effects of chronic fissures as a colonoscopy last July show that I have not hemorrhoids but a very small insignificant inside one, but I have fissures.
As for the yeast infection you are not alone, I developed a reaction to the nitro cream and also developed a rash that became flaky, not funny the itching was unbearable.
I tried neosporin in the area also, when the fissures is very sore but no all the time and it actually helps, also desitin will coat the fissure and the pile to avoid irritation.
Let us know how you are doing and how your appointment with the GI goes if want to share.