Is this from internal or external tightness?

Is this from internal or external tightness?

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Is this from internal or external tightness?

Postby lilbopper88 » 14 Jan 2014, 09:50

I was wondering if any of you have experienced this? It may be TMI, but here it goes. When I have a BM I am fine until the stool makes its way down and about an inch out and then it is as if something is tightened down and the stool has to push past the tight ring. The pain is unbearable and I have to grab onto the towel rack and dig my toes into the ground it hurts like hell. It is not fissure tearing feeling, but a tightness that I am pushing the stool through. I do not strain at all, just hurts like heck once the stool reaches this certain point. It is the same point everytime. Like I said about an inch or so of stool passes fine, then the pain starts..Seems pretty far down for it to be from the internal sphincter, could it be I have a tight external sphincter too? Anyway if any ofyou have any ideas I would appreciate it. Saw one CRS last week and see another one next week. Thanks
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Re: Is this from internal or external tightness?

Postby LostForWords » 14 Jan 2014, 12:03

I had this too with my first fissure. Things would feel okay until I reached a certain point and then the scraping pain/tight feeling would start. This point were also the same every time and like you, it was when the stool was a few cm out. Always made me think "oh yeah, Im going to make it" only to find my self in pain the next second. It sucks!
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Re: Is this from internal or external tightness?

Postby jr2 » 14 Jan 2014, 14:06

It could be both sphincters giving you grief. It could also be other muscles that are involved in BMs such as the PC muscle and the levator ani muscles. When stool descends from the rectum, the internal sphincter automatically relaxes to let the stool pass through. Then, the external sphincter, the one you have control over, is the muscle you consciously squeeze closed until you can get to a bathroom. When you have a fissure, the internal sphincter usually is tight or in spasm. So, what could be happening is that you are experiencing the automatic relaxing of the internal sphincter coupled with an initial conscious relaxing of the external sphincter, which allows the beginning of the BM, but then a kind of unconscious bracing and anxiety sets in and is causing both muscles to tense in response to that. Do you feel you are achieving soft enough stools to pass through right now? Also, have you tried a squatting, or semi squatting position when you have a BM? Elevating your feet on a footstool and leaning forward helps the pelvic floor tremendously when it comes to a more natural relaxation of the muscles involved in BMs. Also, practicing some deep, slow belly breathing can help you to relax your nervous system that controls the muscles in the area.
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Re: Is this from internal or external tightness?

Postby Scientist2516 » 14 Jan 2014, 14:42

Great response, jr2!
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: Is this from internal or external tightness?

Postby lilbopper88 » 14 Jan 2014, 16:36

Thanks for the replies guys. My first CRS wants me to do a LIS. I am not sure if I should do this since I have other pelvic floor issues (vulvodynia). I think there is more going on than just a tight/spasming of Internal sphincter. CRS said a fissure is a fissure and it is caused by tight internal sphincter. That is why I am seeing a second one next week.

In the meantime I will try what you suggested jr2. I do fear the pain, but thought i was doing well at relaxing and not bracing,but like you said, maybe it is unconscious or other muscles are involved. I saw a PT for pelvic pain, maybe I can try some of the things for the pelvic floor that would help the muscles of the anus too. What a mess.

Thanks again everyone. I appreciate having this forum to talk with people that understand.

Lostforwords:: Did you ever heal your fissures?
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Re: Is this from internal or external tightness?

Postby LostForWords » 16 Jan 2014, 08:05

Yes, I did heal that fissure, without surgery or prescription ointments and was symptom free for 3-4 months. Then some burning and itching started to come back after BMs but not the classic sharp fissure pain that most people with anal fisssur(s) experience. I went to the doc and he told me that there still was no fissure to see. Some time after that I ran into a week of constipation/impacted stools and now I have 4-5 fissures.
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Re: Is this from internal or external tightness?

Postby lilbopper88 » 17 Jan 2014, 12:46

Sorry to hear LostforWords that you have so many. I have at least 3 chronic ones. I have had them for years and was managing okay, some days/weeks better than others,then something happened a couple of months ago and I have been in so much pain since. I think I have other issues besides the tight internal sphincter, so I have not done surgery yet, but may end up doing it if things don't get better soon. Hang in there, hope things get better for you soon.
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