I started my saga or should I say sagass in December with the removal of 2 thrombosed hemmies a week apart. I haven't been the same. I saw the first CRS in February. He said I was very tight and rx nitro ointment.
After a month with no improvement he recommended LIS or Botox. I opted for the more conservative approach and had Botox early April. his bedside manner left a lot to be desired so I went to someone else in May who rushed me, told me I could leave my list of questions and we would discuss them at a future appt. Seriously why would I see someone who couldn't take the time to answer my question? She did see a fissure which the first crs never saw and told me the same old song. Fiber, water, sitz baths. I told her I was complying with all that already but was still suffering. She told me to give Botox 3 months and see you then. I guess standing in someone's office( she had no seat for me to use) crying wasn't anything that required her attention. Received another recommendation and had my appt moved from the end of June to today. This doctor had excellent reviews and I liked him very much. He took his. time and answered all my questions. My problem is his diagnosis is
different. He saw a large hemorrhoid that he definitely thought could be causing my pain. He did not see a fissure at all. He did say it doesn't mean it's not there but if it is it is small. He feels my pain is spasms but not necessarily the sphincter but the levitator muscle which does not respond to LIS or Botox. He said he's not comfortable doing LIS without evidence of a fissure. Is this reasonable? He wants me try valium ( I'm not complaining) and if I'm not any better he recommends having the hemorrhoid surgery. If I was afraid of LIS, I'm petrified of hemorrhoidectomy! My pain is a deep burning stinging sensation which he thinks are spasms all this time I thought it was AF. I thought spasms were more of an ache. Any info or advice would be appreciated

Badd,
Oh wow, even more confusion now, huh? Unfortunately, this is all too common with anorectal problems. We can have different types of problems coexisting that can cause different symptoms, and each of those problems can be in varying stages of healing or flaring on any given day we are seen by a doctor. And as if all this isn't enough we can also develop some sort of pelvic floor dysfunction that involves the levator ani and/or puborectalis muscles in addition to the internal anal sphincter. There is so much that can go wrong down there that sorting out what is causing your pain can be a real challenge. Yes, it is reasonable that a CRS would not want to perform LIS if he can't identify a fissure. First of all, if he can't visually find a fissure he can't go in with any degree of confidence that LIS will help you. Secondly, a responsible surgeon won't undertake the risk of surgery when he isn't able to find the evidence that surgery is needed. It doesn't mean you don't have a fissure causing your pain. But if he can't find it, he can't operate for it.
All of this of course leaves you the patient in a really difficult position. What are you supposed to do when you've gotten all this different advice? You might benefit from further testing of your pelvic floor by a specialist in pelvic floor issues. It would be interesting to know if your pain is alleviated by the Valium. Spasms can feel differently for different people. Are you having pain during bowel movements? Do you have bleeding? Unfortunately, you may need to consider getting yet another opinion from yet another CRS. Sometimes with these more complex problems it requires more diligence to get to the root of the problem. Fissulyna mentioned having to see multiple doctors too before she finally found someone she trusted to help her.
I'm so sorry things just seem more muddled up for you know than they even were before. If the Valium doesn't help with the spasms, maybe it will just help you feel a little bit of distance from the stress from all these doctors and their different advice!

Sending you a hug...

Hi Jr
Thank you for your response and advice. I want to get to the bottom(no pun intended) of all this. I felt really comfortable with the doctor today. Who would I see for pelvic floor dysfunction? The whole thing makes me think. The first CRS was willing to do LIS without seeing a fissure because he said I was very tight. It makes me wonder if I would have done it all for nothing Today's CRS didn't think I was tight but maybe that's because of the Botox. I don't have additional pain during BM and I've never bled. He thought if I had a fissure it would hurt during BM. He said constant pain can come from hemorrhoids. Its so confusing. When I put nitro ointment on a certain spot it can feel it sting. I thought this was fissure pain. I'm at a loss!

Gosh I know it's so confusing. Can you tell if the area where it stings when you apply the nitro is in the same place as the hemorrhoid he saw? Did he tell you where the hemorrhoid is he was referring to? Was it an internal hemorrhoid? Keep in mind that when hemorrhoids are removed this can cause stenosis of the anal canal and some people get fissures after hemorrhoid surgery due to this narrowing, so if you do have a hemorrhoid removal, you probably want to discuss that with your surgeon to see what he says.
Mostly, it is physical therapists who evaluate and treat pelvic floor dysfunction. If your CRS mentioned levator problems to you, his office should have names he can suggest for physical therapists in your area who specialize in treating problems with the pelvic floor. You could also inquire as to whether he thinks anal manometry would be useful to evaluate the pressure in your anal canal or if he feels a digital exam was enough for him to be able to tell.