The info I get from looking online tells me that the majority of people with fissures have them just at the opening of the anus. This isn't the case with mine. It feels a good few cms up and it's not visible at all on the outside. I've never actually seen my fissure and neither has any doctor. I think a surgeon who drained an absess on my bum may have had a look up with a proctoscope while I was under but I never got confirmation of that. I've had an MRI too and still don't know if it was visible on that.

My question is, can you see your fissure? My GP told me that they can be located further up sometimes but I still worry why i'm different to the typical case.

If your fissure is too far up to see it would likely be asymptomatic as 1-1.5cm in delineates where we feel pain from where we feel just pressure (this is called the dentate line). Of course it could bleed...Mine was not visible to me but my CRS would pry the skin and then see it but he really didn't have a good look until the day of surgery, when I was unconscious. Visualization is most likely hindered by the Doctor not wanting to cause the patient too much pain.

When my fissure was first diagnosed, the surgeon could not see anything externally, so did an exam with his finger. He told me that it would probably hurt (and boy was he right), but needed to know for sure if it was there (my screams were his confirmation). Years later, when having a sigmoidoscopy, he also couldn't see it, so after observing an internal papilla and the external tag, and knowing that there was no question that it was still active (and my debillitating pain was clearly another obvious clue), he had to do another digital exam to determine its exact location, and mark it on my file for the upcoming LIS procedure.

Thank you for your answers. I feel quite frustrated with my invisible enemy. I'm going to see the CRS tomorrow so hopefully he can tell me what the mri showed along with what the surgeon found when I had surgery to drain a fistula. I'm pretty sure they gave me a protoscope exam...certainly felt like they did when I came round, anyway.

I've been given rectal exams via finger twice now. Each time was the worst pain i've ever felt in my life, no exaggeration. Now whenever I go to see a doctor I say they can look but no touch. They seem quite put out by it which leaves me feeling like an awkward patient.

I know what you mean about the invisible enemy! The worst part for me is that also means you cannot see it for assessing progress. You can only go by symptoms. So frustrating. Not letting the Doctor's touch is likely why it cannot be seen. They tend to be just inside the anal verge and the skin must be spread because of all the folds of skin down there. It took me a long time to trust my CRS in doing this but he had a knack for doing it in a way that usually didn't cause any further damage. He did smirk at what a nervous mess I would always be about it though. I've never been given a rectal when I was suspected to have a fissure. That is barbaric! Some Doctors just seem so out of touch to me. Obviously THEY have never had an issue down there then. Another CRS I went to wanted to book me in for a sigmoidscope under sedation simply because he knew the pain would be too much in order to see in there. That CRS understood. They are all so different.

I hope you get some answers tomorrow. Let us know how things go. Good luck!

Thank you msimon :)

Went to see the CRS surgeon today. It was a different guy again. I've only seen my actual doctor once now, the last two times have been memebers of his team. Oh well, the doctor was very friendly and best of alll he assured me he wouldn't do an internal exam which was the part I was dreading.

He said he could see my fissure which is a new developement. No doctor has ever seen it before. I put that down to the fact that it's probably gotten bigger over the past month thanks to the enema bottle I had shoved up there a month ago. He said it looked partially healed already. I explained the pain was worse than ever but he said I need to carry on with the diltiazem cream. He said it usually takes about 6 weeks to make a noticible difference. As of today it's only been 3. He said botox would be the next step but he doubts it will come to that. I have to go and see him again in 4 weeks time to give him a progress report. The sigmoidoscopy I was due to have has pretty much been forgotten about. He said since I was young they didn't expect anything to be wrong with me as my bowel habits are normal aside from the fissure pain so getting a camera up there is something that can wait until i'm healed.

I'm not sure how to feel. In one way i'm more confident but I also can't help feeling a little bit fobbed off. I know diltiazem is expensive so it wouldn't be right of me to dismiss it so quickly. I'll keep applying and try and have faith that I will see the benefit in the weeks to come.

I also mentioned I took hot baths and used coconut oil and vaseline to keep the area moist. He looked at me a bit bemused and said if I felt better for it then it wasn't a big deal but really the area will heal better when it's dry and not moist inbetween bowel movements. Will lay off the moisturising routine for a while. Thought it might be helpful for others to be aware of that advice too.

Oh you are very welcome. Thanks for giving us an update. That is indeed good news that it looks like it's healing. Most people do go on to heal with just the ointment so here's hoping you are in that group. My fingers are crossed for you. Can you remind me of when you got your fissure and how you think it was caused? And are you able to keep your BMs soft?

That's great that you can avoid the scope for now. As for the moist/dry wound healing. That has been a source of confusion on here as it seems some Doctors think a moist wound heals faster than a dry one (my CRS being one of them) but then it seems there are others, perhaps just as many, that think a dry one heals faster than a moist one. After my last surgery my CRS had me keeping it moist with antibiotic ointment (I had an infection prior and had a fistulotomy surgery). Personally, I think a barrier is good, particularly if you have a wound that is weeping and affecting the surrounding tissue, otherwise, I think it is personal preference.

Hi again! It's strange that he said it looks partially healed. Certainly doesn't feel that way but he knows what he's talking about so i'll continue using the cream and hoping.

It's hard to say exactly when I first tore. I can't pinpoint the day or rather the specific BM that broke the camels back. I know around September last year I was struggling with the increasing pain. That was when I first when to see someone about it, my GP. Prior to that i'd had some pain and discomfort weeks before going to the GP. If I had to guess i'd say late July/early August 2014 was when this all started. It hasn't been a continuous thing. As I said in my introduction thread, some weeks have gone by without pain or discomfort at all and i've just forgotten about it. Then after maybe say a month (probably the longest i've gone symptom free) it all kicks off again. It's been a cycle of on/off symptoms for almost a year. This last month has been by far the worst. I've had no off periods which I blame on the fissure being severly aggrevated with rectal exams and enema application.

My bowel movements are unpredictable. I don't recall ever being seriously constipated in my life but I suppose it only takes one hard BM to tear. I take lactulose in the morning and at night. It's supposed to draw water into the bowel and sometimes the BM is soft and other times it's hard so i've found lactulose's effects to be both inconsistent and unrealiable. Gives me terrible gas too. I also have a laxative called Laxido that I take only when I feel I need too. My stomach is very sensitive and laxatives often leave me feeling crampy and sick. It's a hard balance. My BMs are now either watery or hard. Not so hard that it would cause a problem to a healthy bum, but when you've got a fissure the definition of hard changes. Yesterday I had very runny BM and went twice. Today I have wind and some abdominal cramping but feel no urge to move my bowels even though my stomach feels like it would benefit from doing so. I'm guessing when I do go it will be on the hard side today.

I've started eating bran everyday but again I don't think i'm terribly tolerant to it so I kind of worry it's doing my bowels more harm than good. I've cut down the bran to every other day and i'll see how it goes.

I think the cause of my fissure may have been a diet I was on last year. I was eating much less and therefore didn't go to the toilet much. Probably once every 3-4 days. I never drank water so the BMs must have been pretty unhealthy. Now I eat normally and go at least once a day. Something i'm not sure whether to welcome or not given the pain.

Are you able to get the stool softener called Miralax/Restorlax/Movicol? It goes by a different name depending on what country you live in. There is really nothing like it. Many on here swear by it.