Okay, so I first posted here a little over a year ago when I first found out that I had Anal fissures. I followed the nitroglycerin regimen suggested by my GI for over 2-3 months. I scheduled a follow up with a CRS and was told everything looked good (even though I was still getting irritation). This was a year ago. I just recently went back to a different CRS a month ago to make sure everything is healed and no more fissures, and everything looked fine.
My problem is I still get mild anal irritation that start after bowel movements and come and go throughout the day. Some days, i notice it more. Some days not so much. Sometimes it feels like a burning / stinging sensation when its at its worse.  It does not effect my daily life a whole lot but it is really frustrating that I cannot get rid of this problem. I notice that it gets worse when I have been walking for a longer period of time or sitting for long periods.
I must mention that all my problems started originally when urologist claimed I had non bacterial -Prostatitis. Until I later found out by a specialist to have pelvic floor problems / pudendal neuralgia / muscle spasm / etc etc . I still have a very minor discomfort/ fullness feeling right around perineum/rectal area. I have been going to a physical therapist to see if it would help get rid of these problems including the anal irritation but it has not worked.
- I must also mention that I think the over prescribing of antibiotics by my urologist made my condition worse by killing all the good bacteria in my system. I noticed my anal problems got worse after a round of anti biotics.
I am searching for answers and wonder If anyone has any experience linking Pelvic floor problems to anal fissures / anal irritation ? OR if anyone has any guidance in general related to my story that would be nice. My latest CRS recommended a Botox Injection because there could be tiny fissures that cant be seen. However I do not want to do that since it seems very unlikely thats the case.
Thank You. Take Care.

I wish I had some answers for you, but I can tell you that your story and mine are incredibly similar. I suffered through three bouts with fissures over the course of around 5 years. After the last one healed, I was left with a sentinel pile as well as a near constant feeling of pressure/fullness/tugging around my anus. It makes me feel like I need to contract my pelvic muscles quite often. I have been to see a urologist, a gastroenterologist/CRS, two general practitioners and a physical therapist for this and nothing besides warm heat (heating pad and/or a hot bath) and Xanax helps. I've been miserable for almost a year because of this. My urologist did the same thing yours did and put me on a long course of antibiotics (after I told him I didn't believe in using antibiotics for non-bacterial reasons). My GI/CRS diagnosed me with pelvic floor dysfunction after I had two tests (ano-rectal manometry and video defecography) which both showed some abnormal functioning in my pelvic floor muscles. He sent me to physical therapy which didn't help at all. If you come up with any breakthrough solutions, I'd love to know about them because I often feel like I'm at the end of my rope, and I've only been dealing with this for less than a year. I know there are a lot of people out there who are dealing with chronic pelvic pain, but I don't know how many of them can attribute the start of the pain/discomfort to fissures. We need to find some solutions!

acruelsummer wrote:I wish I had some answers for you, but I can tell you that your story and mine are incredibly similar.  I suffered through three bouts with fissures over the course of around 5 years.  After the last one healed, I was left with a sentinel pile as well as a near constant feeling of pressure/fullness/tugging around my anus.  It makes me feel like I need to contract my pelvic muscles quite often.  I have been to see a urologist, a gastroenterologist/CRS, two general practitioners and a physical therapist for this and nothing besides warm heat (heating pad and/or a hot bath) and Xanax helps.  I've been miserable for almost a year because of this.  My urologist did the same thing yours did and put me on a long course of antibiotics (after I told him I didn't believe in using antibiotics for non-bacterial reasons).  My GI/CRS diagnosed me with pelvic floor dysfunction after I had two tests (ano-rectal manometry and video defecography) which both showed some abnormal functioning in my pelvic floor muscles.  He sent me to physical therapy which didn't help at all.  If you come up with any breakthrough solutions, I'd love to know about them because I often feel like I'm at the end of my rope, and I've only been dealing with this for less than a year.  I know there are a lot of people out there who are dealing with chronic pelvic pain, but I don't know how many of them can attribute the start of the pain/discomfort to fissures.  We need to find some solutions!

Thanks for the response. Our stories do seem pretty similar. However, my problems started with pelvic discomfort/urinary problems and then not so long after I started to get the anal fissure symptoms. I believe the pelvic dysfuction is what caused my anal fissure most likely, though I cannot be 100% sure. My symptoms are much better than what they use to be 2 years ago, but they are still bothersome. I remember being excited when I actually got the diagnosis of anal fissures hoping that once the fissures are healed I would be back to normal(at least normal around the anal area). So much for that! Our problems are more complex than just fissures it seems.
I think I am going to try another round of nitroglycerin ointment since I am uncomfortable doing a botox injection at this point. I do think physical therapy is the way to go as well for the pelvic dysfunction. Even though I have not seen any results yet.

Hi I have just had a rectal prolapse repair - I am pretty sure my AF was due to the prolapse - or the 2 are connected. May be worth looking at rectocele, rectal intersusseption, may be part of the bigger picture.

I am also experiencing the same thing... I have been suffering from my fissure for two months before I went to the doctor. He prescribed nifedipine, after 6 weeks I went back for a check up since I felt as though my fissure was not healed but according to 2 general surgeons it has healed. After 3 weeks of using the ointment my rectum felt very sore, irritated, burning sensation, it hurts when I sit a long time, doctor said that it did not look irritated in there...but is it in my head?

He did an internal exam and the pain that I have seems to be coming about an inch deep into my rectum so don't know what's going on. I don't have spasm or pain when I go to the bathroom just pain afterwards. My doctor has referred me to a pelvic floor physical therapist so I hope it helps with the continued pain that i have even though i am "healed". I also asked for a referral to a colon rectal surgeon (kaiser refers patients to them only if their condition is more serious (cancer) so I am hoping to get an answer soon.

Alyssa, I am somebody who has successfully healed from a fissure after being bothered by it for three whole months. When you talk of a "healed" fissure, it is important to understand what actually is healing in terms of an anal fissure. There are a lot of pain nerves in and near our anal area. Once they get damaged, they need a lot of time to reverse back to their original condition. For me, i've had three whole pain-free months thankfully. BUT i still get weird, tingling feelings down their at times, especially after a BM. I believe with time, this will fade away too. In my own healing process, I realized that the one key to healing is: patience. You have to be patient. You have to make yourself stress-free some way. You have to stop stressing about your health so much. Trust me on this, it goes a long, long way. Good luck recovering! I pray that everyone recovers soon.

I must agree with buttqueen. I was once confident I had refissured the morning of a check-up, and then when they took a look, they said nothing re-opened. Only scar tissue.

Not knowing more about your symptoms, I can't claim to know anything, but don't underestimate the power of psychomosomatically induced illness. The problem is, once we are labeled with a condition, all normal irritation suddenly becomes pathological: occasional butt itch becomes 'pruritis ani', a suddenly onsetting and then disappearing cramp becomes a 'spasm', and a fart that is having trouble making its way out becomes evidence of hypertonicity.

These things happen to everyone, but we see them as part of a condition--something abnormal. People without a 'condition' will see this as a normal, occasional thing. It's hard to know what is real and what isn't.

Thanks for your replies... This morning I had an upset stomach (ate brown rice, green beans, and chicken) and when I wiped, I saw a little blood. How could I be "healed" if I have blood and I have the symptoms of the paper cut feeling outside of my rectum. This has me very depressed and I feel as though its never ending... I feel alone at times because no one understands what I am going through. I just had a baby 3 months ago and it sucks not being able to enjoy my baby. I am supposed to go back to work in two weeks and I don't know how I am going to deal with this at work. I can't even eat because I have no appetite.

Well, if you have blood, then yes, something is up. I'm sorry to hear that is the case. I can guarantee you that I have been working on this long enough that I have had similar feelings of being all alone and no one understanding me. I've felt mostly healed for the past 6 months, but never quite the whole way. I've been fighting hard to heal, and I also get the reaction from doctors that it's all in my head--which is mostly true, maybe not entirely.

Don't give up. It is your attitude that will ultimately heal you--and I don't just mean if you have a positive outlook on life, you will be cured. I mean that it is your level of care for yourself and your problem that will lead you to finding a solution. That's why you are here on this forum. You're still searching, whereas your CRS has made their decision and is done. You are on the right path.

Did your CRS check you out with a digital exam or an anoscopy? I would definitely say that you should get a thorough examination at this point. Getting a dietary allergy test might be useful too. I got one and it turned out I was allergenic to tree nuts, which I was eating lots of.

Also, micro fissures? I've never heard of such a thing. I wonder if that's what I've got...

But that whole 'positive attitude' thing is important too. Don't let yourself waste away because of a chronic papercutting sensation. I liken this whole process to chinese water torture--it's really something very little that is causing us problems. It's mostly the anxiety and the unending nature of it that makes it so horrible, and it is important to remember it for what it is.

Congratulations on your delivery. I hope your days are filled with joy.

I had both, a digital exam and an anoscopy... It's hard to keep a positive attitude when I have pain. I just want to be normal. My pregnancy was a difficult one plus I ended having a csection so I have been in pain a total of 12 months... I noticed my fissure about 3 weeks after delivering my baby. I thought it was going to be an easy solution to this problem when I was told I had a fissure and put an ointment on it but its not. I have good days and bad days and my attitude is not helping I guess.