Ughhhh, CRS is on vaction until next week! If anyone else has any advice, I'm listening....
mm925: Were you diagnosed with pelvic floor dysfunction or a specific diagnosis such as levetor ani?

when this originally began back in 1999, my general practiioner had no clue why I was hurting. He checked me for hemorrhoids and fissuers and found nothing. He finally sent me to a urologist who suspected some sort of prostate infection. I was given several types of antibiotics, none of which did anything for me. I was also given some different types of anti-inflamatories, which offered very little relief. Now at this time, I was just dealing with the type of rectal discomfort that you describe. The feeling that something is lodged up the butt and it is very uncomfortable to sit, but otherwise I could function. I ended up seeing probably 3 or 4 different urologists from April 1999 until about October 1999 and none of them could find an "actual" cause for my symptoms, but just suspected an infection. I did not even see a CRS during this time. In October of 1999 I made a conscious decision to stop chasing a cure and just learn to live my life in spite of the discomfort. From October 1999 until about August 2000, I did not see a single doctor or take any medications. And, over the course of about 10 months, I actually went from being about 40% healthy to being about 90% healthy, with very, very little discomfort in the rectum. The only discomfort I would have is when I would sit for several hours and even then the discomfort was very mild and was more like a sore muscle feeling and didn't last long. BUT in August 2010, I had a major setback. The rectal discomfort came back with a vengence and this time, not only was it the uncomfortable feeling of something being lodged up there, but I also experienced some burning and just general irritation in the rectal area. Again, it was not the type of "pain" you get with a fissure or thrombosed hemorrhoid and I functioned ok if I didn't have to sit, but I absolutely could not sit at all without being in major discomfort. At this time I saw my first CRS and he did a scope and only found some mild internal hemorrhoids which he treated with some sort of infrared coagulation therapy, but he said that he did not find anything that would account for the level of discomfor that I was feeling, other than maybe my muscles were not functioning properly and causing spasming and irritation of the nerves. It was actually another urologist that I saw during this time who, after many, many different tests and failed medications, gave me the very generic diagnosis of chronic pelvic pain syndrome. CPPS is nothing more than chronic pain in the pelvic region that is unidentified by any specific cause. Once I received this particular diagnosis, I pretty much stopped taking meds and going to doctors to find a treatment and just learned again to adapt to my situation. So, for the next several years, I saw very, very slow improvement, but I was able to learn to function. I wasn't really limited much; I went to movies and restaruants, and worked out every day at the gym, starting running, playing drums, etc. THEN in January 2006, I got my first fissure and that is where everything went down the toilet, so to speak. The fissure healed in a month, but the pain in the rectum since then has been much worse and has not resolved to the point that it had previously. It has been during this time that I have doen quite a bit of research and have been to the Mayo in Phoenix where I was diagnosed with levator spasm and hypertonicity of the anal canal, most likely due to pelvic floor dysfunction. My local CRS agreed with this diagnosis and I went to California to a clinic that specializes in the disorder, where they also feel that I suffer from pudendal neuralgia as well. I've done physical therapy and nerve blocks, etc., but haven't seen the benefits so far. I would like to do biofeedback, but I'm not sure if I can do that with an active fissure. I don't get fissures very often, but I have had about 3 that were diagnosed over the past 5 years. I do feel that I've had others that I just didn't go to the doctor for. RIght now I feel like I have a fissure, but at my last CRS appt. a few weeks back, he did not find one.

mm9259,
I started another thread about levetor ani today. Just wanted you to know that I think we have exactly the same problem. How have you been feeling lately? I am not so sure if I would advise you to go ahead and have the LIS anymore as my CRS has told me mine was not effective (arghhhh!) If interested, read my other post for details.
Came across some websites that talk about magnesium supplements for levetor ani. Just wanted you to know that. I'm trying it, you never know. Daily dose should be around 350mg. Early signs of too much is diarrehea and abdominal cramping in case you were to take supplements and already have a high dose due to diet. You can counter this with high calcium doses if that were to happen to you.
Was also wondering if when you went for therapy if you went for 10 weeks at two times per week from a qualified pelvic floor specialist. My CRS and pelvic floor specialist both told me that was the best solution for longer term results. I also question your pudendal nerve diagnosis as you stated nerve blocks didn't work for you.
Hope you are doing better. Please keep me posted. Maybe we can help each other figure out the best solution and one day be rid of this torture!

I read your post on levator ani and it does seem as though we have alot in common. I went to a pelvic dysfunction clinic in San Francisco for three weeks back in December where I received both internal and external physical therapy from both a physical therapist and physician qualified in pelvic floor dysfunction. I received this therapy about 4 times per week for three weeks. I also received nerve blocks for pudendal neuralgia, but the blocks were not image guided, so I'm not sure how accurate the location was and they did not help. I am not doing well these days. I am having incredibly difficult bowel evacuation issues and I am desperately searching for what treatment I should pursue next. I do not want LIS, but at this point, I can't rule anything out. I'd prefer to get treatment for the bowel evacuation issue and get that under control. I truly believe that if I could relax when having a bm that I would be able to manage the pain and fissure issues. Not sure how to accomplish that though.

MM,
Sorry to hear you are not doing to well. I'm curious to know if you had relief while at your physio sessions or for some time thereafter? I was wondering if you have ever tried a calcium channel blocker (dialtezam or nifedeprine). I've used both and find the nifedeprine to be more effective. That should relax the lowest portion of the rectum if you insert inside and on the outside. Also I suggest trying to time your bm's. Try to soak for a while, hop out and go and then hop back in the tub. On days when it is not so bad try just doing it after a bm. Are you soaking in hot water covering the pelvis and legs three times a day? I know it is a drag but it helps. God I feel like I live in the tub! I'm still in a lot of discomfort but I really feel it if I don't soak. My physical therapist gave me a sheet on how to "poop" effectively. I forget now but posture on the toilet was important. I've also read about other people arching thier back like cats or squatting, which seemed to help others. Maybe give that a shot. As the stool is exiting you should also make a hissing sound as you are exhaling (a snake like "s" sound through your teeth). This is supposed to relax the higher up rectum muscles.
I got a second thrombosed hemmeroid over the weekend, lucky lucky me. I called my CRS to ask why and he said some people are prone to them because of constipation and/or genetics. Personally I found that odd becase I haven't been constipated at all due to the metamucil 2X a day and water. I'm wondering if I got it from sitting on a sitz bath (perhaps too much "toilet" sitting with that) or from using nifedeprine and a heating pad at the same time since they both dialate blood vessels. Who knows. Luckily I got it calmed down within a day or two because I recognized the brutal stinging pain right away from my previous experience. I think I soaked about 15 times over a period of two days. Last time I had it lanced, the pain was equivalent to the LIS surgery.
I've switched from armytriptalyne back to the Flexeril. Still unsure on "relaxation" effectiveness however it does allow me to sleep. I'm really having trouble coping with the watermelon up the butt sensation. Driving me nuts! Have you tried that? Although at my last check up my fissures were still there, they are better, just not completely gone. So perhaps you should still consider the LIS. Have you decided on that yet? Have you had a recent colonoscopy? Any blood?
Good luck, keep me posted!

I've actually been using .5% Nifedipine ointment about 3 times per day since January of this year. .5% is actually a higher does than is usually prescribed as I was only prescribed .2% when I visited the Mayo Clinic last year. The .2% didn't do anything for me, but the .5% seems to help a little bit. Not enough to make a big difference for me though. Plus, I am unable to get any of it inside the rectum because of pain and tightness in the rectum. I too have lived in the tub for the past several years. I usually take at least 2 baths each day. Sometimes they seem to help relax me, but obviously they have not helped with long term relief, since I am still dealing with the same problems. It's interesting that you mention thrombosed hemorrhoids. I've had these and they are so incredibly painful. I actually had one cut open to remove the clot and it was HORRIBLE. Biggest mistake I've ever made. Took me forever to recover and I honestly believe that having that minor procedure may had led to the development of my anal fissures since I had this procedure done less than a year prior to developing my first fissure and the fissures develop near the area where the thrombosis occurred. In my research on Nifedipine, I have found where they actually prescribe it for treatment of thrombosed hemorrohoids, so I would find it interesting if it could actually be a cause for them. Please let me know what you find out about the connection between the two. I have not yet decided on whether to have LIS or not. I have a doctor with 25 years experience who is willing to do it, but he is out of state, so it would be expensive and require alot of time off from work. Just not sure yet. I had a colonoscopy in 2006 and am scheduled for another in a month. Other than some polyps, nothing else came up during the exam. Never really have had any blood. Just pain. Please let me know how your recovery is. Oh yeah, and the relief that I felt after physical therapy was not long lasting. I may have seen some progress for the days immediately following my therapy, but it was not long term and wasn't really all that dramatic. I have the option of doing some biofeedback for pelvic floor dysfunction which I think may yield better long term results. Not sure if I'm gonna pursue it or not at this point.