I wish it were that simple for me. My muscles clamp up when my BM comes on and I have to fight through the sphincter tightness. This is how I tear. My stool consistency is usually very consistent. I think it is the external sphincter as this seems to get worse with the botox into the internal sphincter. It was quite bad today and my newest fissure has been stinging much of the day. The botox helps the spasm but I feel the fissure pain more and it seems to make my anismus worse. I am feeling so defeated I wonder if the LIS would do this to my pelvic floor too...

Does anyone know what is the difference between injecting the pelvic floor muscles vs. just the fissure (sphincter) area? Do you experience the same symptoms (urgency issues) no matter where the Botox is placed?

Pafen,

Have you received your test results?

Alyssa, It really depends on where your Doctor plans to inject your botox. For the most part, the pelvic floor passes through both the vagina and the rectum/anal canal so injecting the pelvic floor can definitely affect control back there, which was the idea for me. The main muscles are called:

Obturator internus
levator ani (this includes the pubococcygeus, puborectalis and iliococcygeus)
superficial transverse perinei (sp?)
bulbospongeosis
ishiocavernosis

scroll down on this page for a diagram:

http://www.pregnancy-yoga-resource.com/ ... cises.html

The levator ani are deeper muscles and are most likely to affect bowel and bladder control (I have never had bladder issues) so I suspect your Doctor would be targeting these since if they are tight they will hinder bowel movements. One thing with botox to keep in mind is that the stuff spreads some. I just got a very small amount into my internal sphincter and my pelvic floor is getting weaker (I can hardly contract and lift my pelvic floor anymore as I was really weak to start with). I feel very saggy in there but I have been getting botox for 6 years and it very much has a cumulative effect. I have never had an accident though. If anything, when I first started getting the injections I had more trouble having bowel movements as I seemed to lose my propulsion. It's tough to understand if you never experienced it but if your floor is too lax the BM won't want to come out but rather just stay in there. For a while I even thought I had a rectocele. I would put an enema up there and it would just sit there . I don't mean to scare you but I want to be honest. I was very glad to have the trigger point injections first (that is with just freezing and not botox) to be sure we were injecting the right area. It was tough at the start but after the muscles started to come back things were much better. One of the levator ani muscles called the puborectalis blends in with the external anal sphincter and if often targeted when you have nonrelaxing puborectalis syndrome/pelvic floor dyssynergia. These muscles are felt to be the ones at the bottom that form the kink that keeps stool in. Sometimes people can't unkink/relax this muscle complex and that is what I have trouble with. I would suspect that your Doctor would never give you enough to give you incontinence/urgency issues, and I think this would take more that one time to achieve. How is the strength of your pelvic floor? Did your physio asses that/ have you do kegel exercises? I would hope that he/she assesses this before giving you botox into your pelvic floor.

Sorry I am rambling (I can talk about his forever, unfortunately) but having said all this I never had urgency issues until I had my internal sphincter injected. I even had my external sphincter injected once and never had that issue. I have to say I will never again get botox in my internal sphincter it has not been a good experience. I also have to say I am complicated as I have IBS. If I can be of any more help feel free to PM me.

I have to say that reading what you have said, Alyssa and msimon, is why that even with all the pain that I go through, I will live with it rather than have it messed about with again. It is not so much for me that it is pain any more, but it is a constant uncomfortable sensation, and, coupled with that, difficulty to actually 'finish' a BM. I had spasms for at least two years that were agony. Been through much to find out what is going on, and now, on top of everything else, I have skin cancer. Not the serious type - only basal cell - but it is large, sore and there are no doctors where I live that I actually trust to remove it, especially as they want to give me general anesthetic, which I do not want to have. Just my little moan and . I will get it sorted soon, in a larger city where I will feel more confident. Always have trouble with surgery...blood transfusions, stopped breathing under moderate sedation. allergies to all sorts of things...ok. Went a bit further with my moan that intended.

Here is a post from one of our old members: pelvic-floor-dysfunction-t2260.html

Best of luck and everything else to you both!

Msimon,

Thank you for all this information... I will definitely ask my doctor more detailed questions about my procedure. I am only 35 years old so I don't want to live the rest of my life with having pain during and after bowel movements.. that is just no way to live. I am looking for a solution to be normal once again.

Savaici,

I'm sorry to hear that you are dealing with other issues besides anal pain... you are a very strong person to just put up with it so many years. Wishing you healing vibes...

You are very welcome Alyssa. I hope it was helpful and I hope you have a successful appointment next week.

Savaici, I hear you about the discomfort and difficulty emptying. That is what I m really struggling with now myself. Do you know what causes this for you?

Botox tomorrow... Totally nervous but want the "experience" to be over...

Alyssa,

I have collected my MRI films, however my appointment for discussion of the results with my pain specialist isn't until the 4th October.

I have been in pain for about 2 years now, So I wouldn't expect my specialist to call me in any earlier unless there was something that required urgent treatment. I have had multiple investigations to rule out infection of any sort.

I could always open the report up, but sometimes it's easy to interpret something as worrying, when it's nothing to worry about at all.

Lately even gas sets off the burning sensation in my rectum, then after it passes it eases somewhat.

I hope the Botox gives you some relief. It seems hard to convince doctors here in Australia to do it. A lot are very wary of the incontinence risk it seems.