I took a valium by mouth last night. Didn't notice any changes in my spasms today, and unfortunately, I had another hard BM. Might be because of hormonal changes. Pretty much everything below my waist and above my thighs is aching horribly right now. My vulvodynia is really flaring up. Not surprising.
The problem is, I've already seen 3 colorectal surgeons. There aren't many more in my area, and the one I'm seeing now is supposedly one of the best in my state. And I don't think I can do the surgery again. I have such a large amount of pain from the incision site that I can't imagine having another incision made. :(
What are the odds that I have a fissure that they can't see? Is that common?

Unfortunately yeah I think it is common :( My fissure was partially seen upon rectal examination, but was never fully and clearly visualized until I had a colonoscopy.

Yes- it is very common. Your anus is full of folds and believe it or not, when completely relaxed and stretched ( which they can do with special meds under anesthesia) it is as wide as an apple in diameter !!!
So , you can imagine how many folds it has ! Small or superficial fissure is even harder to see and THIRD variation that exists is that fissure closes on the surface but does not grow together underneath the surface layer and is than hard to see.
In any case - good CRS always assumes that fissure is there if symptoms of a fissure are present!
Can you go to Gyn and ask for vaginal vallium suppositories ??? Maybe he/she is "smarter" than your CRS and know that they exist since obviously they DO and are used for pelvic pain treatment in women ! Do not feel shy to print out the info from the net and bring it to your doctor and let them read it !!!! I did it on regular bases ! If I waited for them to fix me I can tell you right now _ I would still be in pain and wanting to die :( !
Travel- if needed ! I went to another city (hour away) to see my last CRS !
Best wishes for your quest in finding help !!!!!

NeuropathicG- I had exactly same case ! My last CRS could not see it but told me that he is 99% sure that it is there but hidden in the folds. He performed Colonoscopy and found it and made a photo of it !!!! Now I have a "souvenir" form his "journey" LMAO

That is excellent I've always kind of wondered what my fissure actually looked like, but you actually got to find out LOL :)
I never thought about the folds in the anus thing, that would definitely explain why sometimes fissures can be seen and sometimes they can't. In the beginning I got told a few different things by different doctors until I had a colonoscopy and also a rectal exam under conscious sedation which both found the same thing.

Yeap LOL _ maybe I can post it LMAO
It does not look that "impressive" LOL - small little pink bugger LOL - who would think something so small can hurt SOOOOO much - right ??? Just crazy !
Yeah- that "folding" theory and anus "stretchability" was explained to me by my last CRS and one would wonder HOW COME ALL OF THEM DO NOT KNOW THAT ?????????
OMG - I still get so mad when I remember all nonsense I had to go through and what idiots I had to meet and have in my "butt" probing with no clue whatsoever : ((( !!!!!!!!
It is just mind boggling - I mean ALL they DO is looking at butts whole their life for god's sake - it is like what - 1/100 000 th part of a body !!!!????? AND STILL not knowing what is going on when they look at it O_O !!!???? I mean - by year 3 they should know what is happening before patient even opens the mouth to say "hello" !!!!!!!! Just by the frightened face and shuffling walk - I mean - HELOOOOO!!!!!!
Anyways - let us pray that new generation of CRSs reads this and starts learning their ropes !!!!! Just unbelievable LMAO

I did have an exam under anesthesia awhile back so that they could check for a fistula, but she didn't see one, nor did she see a fissure. That exam was at the beginning of the last school semester, which would be in September or October...can't recall for sure. They wanted to check for a fistula because I was still having so much pain, but she said the only thing she saw was some scar tissue. I had some minor bleeding during one BM shortly after the exam, but they told me that could simply be due to irritation from all the poking around that went on!

LOL Fissulyna actually the GI doc who did my colonoscopy also wrote in the report that I had a "small" anal fissure. I'd been having terrible pain for months at that point and was about ready to smack him for explicitly pointing out that it was small, because the pain certainly wasn't
CrimeOfPassion, that sucks, I don't know what to tell you :( I also got told various things from "you just have rectal inflammation" to "you have internal hemorrhoids" to "I don't see anything that could account for the pain and bleeding." I think visualizing these kinds of things depends a lot on who's looking and how experienced they are. In general I've found that general practitioners don't know a whole lot about fissures, ER docs are hit and miss, and GI docs and CRS's know the best... Is the doc you saw recently the same one that did your LIS last year? Clearly that doc saw something back then.
If there's no bleeding then I suppose it's also possible that there really isn't much to see. Maybe the area has partially healed over and it's just difficult to see from the exams they've been doing? I've also been told by a few docs that lower back (sacrum) problems can also cause rectal pain. In fact that's one thing I'm investigating myself right now. For some reason I've got new rectal pain in my left side but the docs don't detect any sphincter spasm and say my previous fissure looks at least largely healed. So one theory they've tossed around is that I have a tailbone problem causing problems with my butt muscles.

No, the CRS who did my LIS is not the same one who did the exam. I left him after I told him I was still having spasms after the surgery, and he said there was nothing more he could do, and that I should see a gastroenterologist. The CRS who did my exam is supposed to be one of the best in the state. But who knows if that's actually true.
I do know that a large portion of the burning and aching pain I get during/after a BM, while sitting, and all day in general is from the incision site. For me, it's very easy to tell the difference between the incision and fissure pain. The former is more achy, the later sharper and "pinchy." Plus, the incision is pretty much opposite the fissure. And I do know there's scar tissue there, of course.
To be honest, I think I'm shit out of luck. My parents probably aren't going to let me see anyone else, even if we pick up the COBRA.

There are definitely folks here who have had LIS more than once (you've been on the boards a lot longer than I have so I'm sure you're aware already). Your original CRS' dismissive attitude sounds pretty unwarranted.
Why would your parents not let you see anyone else? Is it a cost issue or do they not believe that you're in pain? It's impossible to understand fissure pain unless you've had one yourself. But still, if you have a problem you need to get it treated...
Maybe if you post a general geographic location someone here can recommend a good CRS that they've seen before?