Hi,
Ive been brousing this site for quite a while and I have suffered with an anal fissure for the last 6 months, this post may be quite long as I have been through the medical mill regarding this fissire since the begining of Oct 2011 with what seems very little support from Drs, and Im feeling quite low and extremely stressed by this whole situation and to be honest not really sure where to turn now and could do with some help.
It all started back in Oct when out of the blue I was bending down and I had this tremendous knife like pain that appeared to run through my anus all the way up througth my stomach and completely took my breath away, from then every day for about a week this same thing would happen, at this point, I did not have any problem going to the toilet, nor have I ever in the past. I went to my GP and she said it could be Proctagia and sent me away. A few days later I started experiencing knife like pains whist passing a bowel movement, went back to my GP, and she examend me and said that I had a fissure, but did not sprescribe anything, and just said to increase my fibre. anyhow, shortly after this i had 10 days of constant diariah and really bad stomach pains. managed to get a referal to see a private CRS and he confirmed that I had a fissure and prescribed Diatiziem and sugguested that I underwent a cononoscopy to rule out any other problems, This was done Via NHS back in January which fortunately was all okay. During this time I was still experiencing the usual spasms etc but usually the spasm started before I had my bowel movement, and I was left feeling very sore after which lasted all day every day. After the colonoscopy, the crs came to see me and said that my fissure had healed, I asked him how this was so, as I was still having spasms and I could still feel the fissure and he just said to just continue with the fibre diet etc and things should start improving. they didnt.
I was discharged from the hospital with no follow up appointment, so I was extremely fed up because, I knew that things were not right down below. to try and cut the long story short.. I went back to my GP and explained that I was still extremely sore and still having spasms she prescribed NGT cream which I have been using for the last 8 weeks along with lots of Vaseline before Bm which has helped me a great deal. I asked her for another referal, and the doctor wasnt very supportive and basically implied that I was being a drain on the Nhs for wanting another referal.
Anyhow, I got another referal in Feb and sore the understudy to the Crs that I wanted to see, so again was not to pleased, He had a look at my fissure and this time I was told that the fissure was healing. however he could not explain to me why I at this point I was getting lower back pain amongst what seems to be other pains in my pelvic area.
So up to now, I been going back and forth to my gp to try and and get explanations as to why my lower back and pelvic area hurt so much as well as the spasms and tightness that I getting accross my buttocks, she just puts it down to posture.
I went back for my follow up referal last wednesday at this time actually got to see the Crs who I didnt really think much of. He looked at my fissure and said it was healed, i expalined to him that I was still having rectal pain and tightness/ cramping in my rear end and that my back was still very sore and he said that It could be all muscluar and to start exercising and that the pain im experiencing in my stomach before having a bowel movement could be IBS?? He didnt mention anything about surgery or botox because he said at this point my fissure is healed.
So sorry to rant, but i dont feel like im not getting anywhere with these bloody doctors and could really aprieciate some advice on where to go from here and how to resolve my problem.
Many thanks.
Mich

I'm guessing you're in the UK! Is there any way you could ask for a second opinion. I have spent a year battling doctors and consultants until I have finally got some help. The only thing I can suggest is persistence and not to give up. I had a gynae op last year, was admitted to hospital again for 2 days with rectal pain and even a professor examined me and said there was nothing wrong. I had an MRI, all clear but I rang the hospital and asked what on earth I was to do as I couldn't sit down!! They saw me within 4 days and finally a registrar identified a fissure. Through pushing for help I have managed to have botox treatment and am (unfortunately!) awaiting a rather long follow-up. I feel GPs are not the best really, mine had me treating myself for thrush for 8 months when all swabs were clear of that (not that I knew until this year!). I got so fed up I went to a clinic who referred me to a dermatologist, I had been mistreated for the past 10 months. Is there another GP in the surgery for you to go and see? Or another CRS? Could they suggest another CRS?
I also have IBS (god I'm 28 and a complete wreck you are thinking!) and have not had exactly the pain you describe. I felt extreme pain across my abdomen and suffered for 4 weeks but tried buscopan and that worked. Ask if you can try that or mebeverine. Plus if you can see a dietician as thats what I did. At least then you can rule out that if it doesn't work and can go back. I do sometimes get pain in my lower left abdomen 15 minutes before a bm, and get some spasms top left abdomen when I get stressed or eat the wrong food. Like I said, keep banging at the door until they let you in!!!! I am only getting somewhere after 12 months! Good luck!

Has anyone mentioned Levator Ani Syndrome (LAS) to you?
About 7 months ago, I started experiencing rectal pain. After ruling out other benign or serious causes (i.e., fissure, hemorrhoid, fistula, cyst, abscess, etc.) I was diagnosed by my colorectal surgeon (CRS) with LAS. Unfortunately, the LAS led to a fissure, which brought me to this forum. Fortunately, my fissure seems to have healed (after 6 weeks of using Nifedipine), but I am still dealing with LAS.
LAS is episodic rectal pain caused by spasm of the levator ani muscle. The pain can range from barely there to annoying to debilitating, depending on the day. The pain can, and often does, radiate beyond the anal area. The etiology of LAS is unknown. There are no tests for LAS, which means LAS is a diagnosis by elimination. Unfortunately, most doctors know very little, if anything, about LAS.
If you have LAS, there are several treatments available, such as taking muscle relaxers, Valium, and NSAID's. You can also go to a physical therapist who can massage the levator ani muscle or you can go to a nurse or doctor who performs biofeedback, which helps you learn to relax the pelvic floor muscles. Studies show that biofeedback is superior to physical therapy. Most patients respond to one of these treatments. However, if none of the conservative treatments work, your CRS can inject a mixture of steroids directly into the levator ani muscle under local anesthesia, which helps to relax the muscle and reduce any inflammation.
While somewhat controversial in mainstream medicine, many people with LAS have reported success using the principle's in Dr. John Sarno's books to "cure" them of LAS. Sarno's theory is, in part, that the pain is an unconscious "distraction" to aid in the repression of deep unconscious emotional issues. Sarno believes that when patients think about what may be upsetting them in their unconscious, they can defeat their minds' strategy to repress these powerful emotions; when the symptoms are seen for what they are, the symptoms then serve no purpose, and they go away. Dr. Howard Schubiner has also done some seminal work on the subject, and has said that LAS is a common manifestation of Mind Body syndrome. Here are some links for both of them (you can also find their books, along with lots of reviews, on Amazon):
http://www.healingbackpain.com/
http://www.unlearnyourpain.com/
Both my CRS and my biofeedback nurse believe there is a connection between the emotions and LAS. Of course, you should always check with your doctor before beginning any treatment.
If you definitely do NOT have a fissure any longer (and keep in mind, fissures can be very difficult to see, even for a trained CRS unless you are examined under anesthesia), AND all other causes have been ruled out, you may have LAS. I would definitely ask your CRS about it.

thisfissure
I had heard of Dr. Sarno, but had never heard of the second site before. Great resource! Thanks for posting!
MICH
I can only second the great advice above. It sounds like some combination of fissure and pelvic floor dysfunction.

thisfissurecankissmybutt wrote:Has anyone mentioned Levator Ani Syndrome (LAS) to you?
About 7 months ago, I started experiencing rectal pain. After ruling out other benign or serious causes (i.e., fissure, hemorrhoid, fistula, cyst, abscess, etc.) I was diagnosed by my colorectal surgeon (CRS) with LAS. Unfortunately, the LAS led to a fissure, which brought me to this forum. Fortunately, my fissure seems to have healed (after 6 weeks of using Nifedipine), but I am still dealing with LAS.
LAS is episodic rectal pain caused by spasm of the levator ani muscle. The pain can range from barely there to annoying to debilitating, depending on the day. The pain can, and often does, radiate beyond the anal area. The etiology of LAS is unknown. There are no tests for LAS, which means LAS is a diagnosis by elimination. Unfortunately, most doctors know very little, if anything, about LAS.
If you have LAS, there are several treatments available, such as taking muscle relaxers, Valium, and NSAID's. You can also go to a physical therapist who can massage the levator ani muscle or you can go to a nurse or doctor who performs biofeedback, which helps you learn to relax the pelvic floor muscles. Studies show that biofeedback is superior to physical therapy. Most patients respond to one of these treatments. However, if none of the conservative treatments work, your CRS can inject a mixture of steroids directly into the levator ani muscle under local anesthesia, which helps to relax the muscle and reduce any inflammation.
While somewhat controversial in mainstream medicine, many people with LAS have reported success using the principle's in Dr. John Sarno's books to "cure" them of LAS. Sarno's theory is, in part, that the pain is an unconscious "distraction" to aid in the repression of deep unconscious emotional issues. Sarno believes that when patients think about what may be upsetting them in their unconscious, they can defeat their minds' strategy to repress these powerful emotions; when the symptoms are seen for what they are, the symptoms then serve no purpose, and they go away. Dr. Howard Schubiner has also done some seminal work on the subject, and has said that LAS is a common manifestation of Mind Body syndrome. Here are some links for both of them (you can also find their books, along with lots of reviews, on Amazon):
http://www.healingbackpain.com/
http://www.unlearnyourpain.com/
Both my CRS and my biofeedback nurse believe there is a connection between the emotions and LAS. Of course, you should always check with your doctor before beginning any treatment.
If you definitely do NOT have a fissure any longer (and keep in mind, fissures can be very difficult to see, even for a trained CRS unless you are examined under anesthesia), AND all other causes have been ruled out, you may have LAS. I would definitely ask your CRS about it.

I definitely think this is worth investigating, for many of us. My current crs says I'm 95% healed - he doesn't see anything awry going on . . . yet, I still don't feel quite healed, and I've had both an LIS and a fissurectomy. In my case, I might just need a bit more time . . . but for many of us, I do believe that there is an emotional connection to certain pain and how much we feel it.
Thank you for posting this. Whatever can help any of us here is great to know.

Thanks for the comments!
One thing I learned from reading Dr. Sarno's book is about the "nocebo effect" vs. the "placebo effect."
The "placebo effect" occurs when patients are given a placebo (i.e., fake) treatment (i.e., a sugar pill, a saline injection, etc.) and experience a perceived improvement in a medical condition. Unfortunately, the improvement is usually temporary, but it does prove the mind is very powerful. The "placebo effect" is widely accepted by the medical community.
Dr. Sarno talks about the "nocebo effect," which is the opposite of the "placebo effect." This occurs when you experience pain for a long period of time and then come to expect the pain, so your mind creates the pain even when it isn't there. This can explain why some people are healed, but still feel pain.
Just a thought.

thisfissurecankissmybutt wrote:Thanks for the comments!
One thing I learned from reading Dr. Sarno's book is about the "nocebo effect" vs. the "placebo effect."
The "placebo effect" occurs when patients are given a placebo (i.e., fake) treatment (i.e., a sugar pill, a saline injection, etc.) and experience a perceived improvement in a medical condition. Unfortunately, the improvement is usually temporary, but it does prove the mind is very powerful. The "placebo effect" is widely accepted by the medical community.
Dr. Sarno talks about the "nocebo effect," which is the opposite of the "placebo effect." This occurs when you experience pain for a long period of time and then come to expect the pain, so your mind creates the pain even when it isn't there. This can explain why some people are healed, but still feel pain.
Just a thought.

Hmm, now that is interesting. I think that concept ("nocebo effect") definitely has some merit -- especially where there's fear involved. IMO, people with healed AFs do not want to go through that experience, again . . . and in my case, I have "fissure phobia" - I just want this healing to be complete and to not worry about my bottom, anymore - and I certainly don't want an AF recurrence. My focus has been on my rear-end, for so long now, that it has become almost second nature for me to worry about any discomfort down below (or possibility thereof).
I know that some of my tenderness is very real (it's tender to the touch) - but I'm hoping, that given enough time, it will ease up and I'll then also release the phobia.
I'm really glad you brought Dr. Sarno up - because I think I had read about all of that, somewhere (several months' back, while in the middle of my acute suffering) - and it's valuable information. I know a positive mental outlook is important, in so many different circumstances in life.