I definitely have a fissure and I definitely had (may still have a fistula) before I go to the loo I always lubricate with vaseline. If i'm feeling brave i'll apply it further up for better protection. When I do this I notice the further I go up the worse the pain gets and most tender and painful area of all seems to lie around the sphincter opening itself. I can see the fissure a little on the outside so unless it extends that far up i'm wondering if it's actually the fistula tract that is swollen or maybe infected. The absess I had was drained and laid open last month and the wound has healed on the outside, not sure about on the inside. I am getting an exam under GA to see if the fistula still has an opening further up. I know all of us here have chronic fissures but a lot of people seem to be relatively ok to have rectal exams be it with a finger or some type of instrument. The pain I feel whenever anything tries to force it's way up I can honestly say is the worst pain i've felt in my life and I think of myself as someone with quite a high pain threshold. I don't know what's going on with my body anymore.