Hi!
I'm a 30 year old guy from Sweden, hoping my English won't contain too many errors. I've in my second month with this fissure. Or at least, I think it’s a fissure. My doctors have tried endoscopy, but it showed out to be impossible without narcosis (pain). The only professional diagnosis to date is therefore from a doctor that successfully inserted a finger and asserted that he felt 'a big fissure'. Now I'm waiting for a new endoscopy - but I've been told there's a long waiting list.
I’ve been diagnosed with IBS since childhood. Doctors say they can see that I have had a smaller fissure earlier, and I have had rectogesic prescribed for a chronic fissure that did not give me half as much a problem as the current one.
I think the current fissure is connected to a small surgery under narcosis a few months back. The doctors thought I had an internal hemorrhoid that showed out to be a polyp (that they removed). Anyway, the doctor must have been rather careless when using some instruments in my rectum, because directly following the operation I suffered from I-don't-know-how-many external and internal hemorrhoids for at least a month. Then things settled down and I was quite happy. Till about three or four weeks later, when these at least fissure-like problems started.
To begin with, I suffered from pain that started to build up when I lay down. Strangely to say, the pain was not located to the rectum, but seemed to be centered on a point perhaps 2 cm up. It really inhibited sleep, and I was woken many times during night and forced to walk around till the pain ceased. It seemed to be unrelated to BM:s and I did not have any problem during those. After about two weeks, however, the problem worsened, and I started feel the pain 24/7. Not excruciating pain all the time, but often becoming worse when sitting or lying down. Also, BM:s became extremely painful.
It was at this point that I visited the doctor that could feel a fissure with his finger. He prescribed a Swedish variant of Mirolax. I also started to change my eating habits somewhat, and notice that my BMs work better. I am a vegetarian and have also eaten extra fibers (made of some rubber I think, they call it Inolaxol) for some years (due to IBS-related problems), so I don’t think I need to change my diet radically. Try to drink lots of water, but often forgetting to.
I also started applying Rectogesic on my own initiative. I had a tube at home from before. When I had used it then, I hadn’t noticed any effect apart from the headache. When applying it this time, I felt an increased, intensive, but somewhat changed pain in the rectum for about 20 minutes, after which all pain ceased. I was quite happy about this, and have continued using the salve. However, the initial pain directly after application has worsened I think and now continues for hours, at least during daytime. However, I am not sure whether it is Rectogesic all the time, or just the fissure. Nevertheless, I really need to apply Rectogesic before sleeping, since I will otherwise have pain all night. This however causes me to have real excruciating pain for at least 40 minutes-1 hour in bed. It seems to come and go during that time, much like cramps. Sometimes I just scream. On the good side, though, the headaches are gone.
The pain has come and gone during these weeks. At one point I really thought I had made progress, but since a couple of days, the pain is back at full intensity. My job involves many meetings and long hours of sitting. Embarrassingly, I have been forced to bring a pillow to sit on to many of these meetings.
I have also tried some alternative remedies. I take Butcher’s Broom and Horse Chestnut extract each day, but have not noticed any difference. I have also visited a homeopath that prescribed Silicea D-6, Calium muriaticum D-6 and Magnesium phosphoricum D-6. I’m rather skeptical about homeopathy, but nevertheless have started to connect the better periods with me taking the pills. Right now I’m out of tablets and also feel worse than in a long time. Nevertheless, whatever effect they have accomplished, the homeopathic remedies have far from healed me completely.
I also started taking Propolis after having been recommended by a friend. Have not noticed any changed.
So what do you think? Would be thankful for any suggestions!

Hey there, your English is perfect :) Having spent some time in Norway and also Sweden, I can assure you that your part of the world generally speaks EXCELLENT English!
Anyway from what you've described, it all does sound very fissure-like to me. Fissure pain can radiate to other areas so it's not always at the anus 100% of the time. Also fissures themselves can occur in different parts (lower versus higher) of the anal canal.
I wouldn't think it's necessary to wait for another endoscopy (I think we call it a colonoscopy here in the States) to get the fissure diagnosed for sure though. Even if you're in too much pain to have a regular anuscopy done, they should be able to put you under conscious sedation (a strong painkiller like Fentanyl plus a strong sedative like Versed) and do the anuscopy that way. That's what I had done when my fissure was really torturing me -- I had to be wheelchaired in to the hospital, but after they sedated me, they were able to examine my rectum anyway they wanted lol. Both colonoscopy and anuscopy should be able to see the fissure, but an anuscopy requires less preparation and is actually better than a colonoscopy at visualizing certain parts (such as the "corners") of the rectum.
Some of us get temporary relief from muscle relaxants like Valium (generic name diazepam) too. I'm well known for preaching about the addictive dangers of Valium (hi Fissy :)), but it did give me relief from the insane sphincter spasms (which it sounds like you might be having at night), and I'd suggest at least giving it a try on a short term basis. At the least it may help you tolerate things until your next exam. How long do you have to wait for it anyway? It seems like so many people have to wait so long with pain and suffering just to get a very simple exam done :(

Thank you NGuy for your kind and caring response! It really helps me alot to read this and other threads on the forum!
Good tip there about the strong sedatives! The doctors have said I have to wait till after the summer, but I have been calling them about it, so hopefully sooner. Pitty I didn't know about the sedatives when they had to stop the last endoscopy and said I had to come back for narcosis.
Anyway; two questions. Does anyone recognize the thing about pain building up when lying down? And what about the pain being more intense about 1 hour directly after taking Rectogesic?

Hrm when my fissure first started, the least painful position for me was standing up. Sitting down was insane, and lying down seemed to make my sphincter spasm worse. The pain of the spasm had a very specific quality to it: it was an unrelenting throbbing sensation, almost like I was trying to have a bowel movement involuntarily. When I went to sleep, I'd curl up into the fetal position to make it more bearable. Over the counter painkillers like paracetamol and ibuprofen did NOTHING for that pain. The only thing that did was oxycodone, which is bad for fissures because it constipates, but man oh man I just didn't care at the time! If this kind of spasm pain is what you're having when lying down, then yeah, I don't think it's very unusual.
As for pain after applying nitroglycerin, that one I'm not familiar with. For me the nitroglycerin might sting a little when I apply it (and of course there's the headache), but after that, things always felt better rather than worse. How are you applying the Rectogesic? Are you using fingers, a syringe, etc. And are you putting it inside or outside the anus? Maybe it has something to do with how you're applying it?

Yeah, recognize the ineffectiveness of paracetamol and ibuprofen.
Today I have phoned every available and relevant number to the hospital I could find. First, a very irritated and inpolite nurse told me I could not be examinated till after the summer, August the earliest. Panicked, I tried to suggest the strong painkiller you mentioned, NGuy. Evidently, those require the presence of a narcosis doctor (anaesthetists), and they won't be available till August. In the end, I wrote an angry e-mail to my ordinary doctor, using at least two swearwords. Lo and behold! Suddently he called me up on the phone and said I would be examined tomorrow.
So now they diagnoze people by counting the number of swearwords used in communication with the hospital?! Well, Swedish healthcare is good, I won't complain, but sometimes... !
Hoping this exam tomorrow will lead to some more effective treatment.
I've stopped using Rectogesic this weekend, and started appying diltiazem instead. It seems to be less effective, but I don't get those spasms directly after application.
To answer your question, I applied Rectogesic with my finger, both outside and (0,5 cm) inside. Perhaps it should just be used outside? Anyway, those spasms for an hour or so have been strange. After all, Rectogesic should relax, not tighten the muscles?

Hey there, good to hear you got an earlier doctor's appointment :) Waiting until August just seems crazy. Guess sometimes doctors just need a little extra "motivation" too. Maybe next time if you use 3 swear words you'll get a same day appointment :)
Anyway yeah nitroglycerin shouldn't cause spasms. I used to put mine inside too but only with a small syringe. It hurt too much to apply in there using my finger. If you decide to try it again, maybe put it outside as a test and see if it causes the spasms again? It's supposed to work either way, although I liked it better inside myself. Just be sure to NOT use both diltiazem and nitroglycerin together.
Then again, if you're applying the diltiazem the same way, then I don't see how putting it inside using your finger could be causing the problems. Unusual reactions are possible, maybe you just have some kind of sensitivity to nitroglycerin.
BTW oxycodone is a relatively strong opiate painkiller. Some doctors won't like giving it out, but may be more open to some of the weaker ones like codeine (tylenol #2, #3, or #4) or hydrocodone (vicodin). They all constipate, though, so whether they're worth it really depends on exactly how much pain you're in.
Hope you have a good visit tomorrow.

If apoitments canґt be anytime sooner, Iґd say you try the sitz bath. It is actualy the STRONGEST pain relief Iґve tried and according to some medical papers, works better then most drugs. Wish you get better.

Maybe the finger entering the anus causes pain and reflex spasm happening VERY possible IMO.
I used all of my creams outside and all of my CRSs told me that they are absorbed through a skin anyways and work any way they are applied They definitely did work for me applied outside
Yes - try to take at least 4 , 20 min soaks a day - it is actually mandatory to promote a healing !!!!
Best of luck !!!!!

Fissulyna wrote:I used all of my creams outside and all of my CRSs told me that they are absorbed through a skin anyways and work any way they are applied They definitely did work for me applied outside

Copy that...

I agree I used to apply my cream (Rectogesic) inside which hurt quite a bit. But only stinging for about 10 mins. I think this is due to the cream being in the the fissure and irritating it slightly.
After using this method for about 3.5 years when I finally saw a CRS again he told me to only apply outside and to use only about an amount that is the size of a pea. This seemed to be just as effective as putting it inside and was a lot quicker, easier and less painful.
Let us know how your exam went and the next treatment that you have been prescribed.