i believe paul's pain or another AF member brought this up today in another post: anal stenosis.
hmmm, for those who get no relief, i wonder how much of it could be due to anal stenosis.
couldn't find much about it on the web that quite really gets down to the easy to understand details, but how does one tell if he/she has or could have anal stenosis?
how does a CRS diagnose this?
for those with chronic fissures, could this be a reason?
it makes so much sense. especially in cases where LIS does not produce a positive result.

I mentioned this since I was told about anal stenosis from my CRS.
My CRS gauges this by doing a gentle rectal exam - I assume he has developed a sense of this over his 25+ years of clinical experience. I got my fissure in 2005. When I started seeing him he thought I could heal it since he thought everything "felt" normal in terms of muscle tone. I did get it partially healed and went for years like that. When I got another fissure in fall 2009 he did an exam again and said my anal canal was very tight. And then thought the LIS was my only option plus the fact I had a new fissure. He said the scar tissue building up causes anal stenosis over time. He said most people that have this condition he can barely do an exam and usually doesn't. This was another parameter that pushed me into getting the LIS.

Anal Stenosis:
Symptoms
The restriction of the anal canal prevents the normal expulsion of faeces, resulting in constipation, babies may also experience pain when trying to open their bowels.
Causes and risk factors
Anal stenosis may be present from birth, when it might be accompanied by malformations of the anal opening this happens in one in several thousand births.
Sometimes the opening appears further forward than normal, in girls, it's usually immediately behind or inside the female genitalia, in boys, there may be no obvious opening at all or just a small area of bulging skin or a tiny channel under the skin.
More commonly, stenosis develops as a result of scarring from a tiny fissure, or crack, in the anal canal. This is what tends to happen in adults with anal stenosis, but it can also occur in babies.
Treatment and recovery
Low-risk treatments:
Laxatives and suppositories are used to help loosen motions and lubricate the anal canal, to make it easier to empty the bowels, there's little risk the person affected will come to any harm if they're used as prescribed and only for a matter of months.
It must be remembered the risks are considerably less than those if they were allowed to become constipated, individuals suffering from anal stenosis aren't likely to become dependent on the laxatives and suppositories.
Surgical treatments:
Treatment of anal stenosis depends on the extent of the problem, in most cases all that's needed is for the anal canal to be stretched, often this can be done by the doctor in the hospital clinic, without the need for anaesthetic.
If the stenosis is severe, dilation may performed done under anaesthesia, more major surgery is only needed if there are other malformations or the anal canal needs repositioning.
Even in this case, surgery shouldn't be too painful, patients should be given adequate pain control using drugs as necessary.