I have been having pain for 2 years. It all started when I was doing an insanity workout. basically the pain/discomfort began while I was doing jump squats. One morning I felt this pressure like there was something in my rectum. It came on somewhat suddenly. Regarding the pain description, I would describe it more like there is something which is shoved up my rectum. It feels quite uncomfortable. I went to a colorectal surgeon and upon inspection he noted grade 3 circumferential internal hems. He banded them however the banding worked for only 3 days and then the hem feeling would recur. I ultimately underwent 5 bandings! I went to another surgeon who recommended stapled hemorrhoidopexy however I reviewed the literature and opted for a total hemorrhoidectomy. Ultimately my friend underwent a THD (transrectal hemorroidal dearterialization) and it wasnt very painful but it relieved his symptoms completely. I opted for that. Unfortunately it didnt work and my surgeon was flummoxed so he asked me to get a second opinion. I saw another surgeon and he said hemorrhoids do not cause the type of pain I am experiencing and he found a fissure. He said the fissure may just be an incidental finding. Ultimately he wants to treat the fissure first and see if my symptoms improve.
I have had this issue for 2 years. I am unsure what my problem really is. I have seen multiple colorectal surgeons and I am unsure of the etiology of my pain!
My symptoms are the following....
I have rectal pressure which is worse with standing but somehow improves when I run. I actually run to make the symptoms improve when they are horrific. If I walk the pain gets worse. Eventually it feels like someone is shoving a pencil up my bottom and holding it there. The pain is worse with bending over and best with lying down. Again the pain is more of a pressure sensation. Occasionally I get throbbing where I can feel my heartbeat in my rectum. BM's dont hurt but I do notice that BM's do exacerbate the symptoms. For example if I dont have a BM then my pain might improve for that day. I am very regular and I eat lots of veggies. I do note that metamucil aka psyllium and citracel (both of which surgeons recommended) both worsen my symptoms because they increase the girth of the stool. I take colace which softens the stool and has somewhat improved my symptoms.
Basically I am at my wits end and I dont know what to do about this. It is truly ruining my life. I am 33 and have a new baby and it is hard for me to take care of him for a long period of time by myself because he likes for me to hold him standing up and prolonged standing causes the symptoms to worsen.
DOES ANYONE HAVE SIMILAR SYMPTOMS AND KNOW WHAT THIS IS?
Thanks for you help everyone

Hello fissurevshems,
Can see that you have truly been through the mill with hem surgeries . Having been there myself, I know what this is!
So sorry that you are in so much pain, but you have come to the right place as there are a lot of people here, with lots of information, and there is also a lot to be found on the forum if you use the search facility, top right.
We all know the pressure sensation - one of the typical fissure signs. Also, spasms which are the internal sphincter acting up and can cause pain for hours after a BM.
So many of us start the whole cycle with exercise, or with having an especially large BM, or getting constipated.
You mention that your surgeon recommended Metamucil. I take this too, but I am careful about how much I use. As a woman, I take about 18 to 20g of fibre a day, and I drink at least eight to ten glasses of water (64ozs +/-). I am consistent with this, day in and day out, as it is so important and learned through trial and error.
Colace is used by a few, but I would rather go with Miralax, which is what most CRS recommend, though I take Milk of Magnesia instead. :)
I am a vegetarian and eat enough to keep things going through me at the right pace. I never overeat, as I have
gone through hell to get to the place that I am in now, which is usually fairly well-balanced on the fissure plain...
Do you drink enough water? Especially with taking bulking agents, very necessary to drink at least 64ozs a day.
You mentioned that the surgeon who found the fissure said he would wish to treat this first. Did he have suggestions other than Metamucil and Colace? If you look in the Glossary on the forum, you will see the different methods for fissure treatment. There are ointments and surgery, and the ointments are usually the first line of attack.
I am sure others will come along with their suggestions too, and there is so much information here. A bit daunting when you first 'arrive' but you will soon get the hang of it.
All the best to you, and keep asking questions.

Hi Savaici,
Thanks for your reply.
I have used other treatments including lidocaine, steroids and diltiazem cream. I have not placed them high up in the rectum which my most recent surgeon told me to do. What I found initially was that when I did this it led to worsening pain. I recently started to do this in the bath tub and that seems to work for me. Seems that maybe the pain decreases but again I am not sure.
What is odd is that the rectal pain is not what people typically describe with respect to fissures. I dont really feel severe spasms and having a BM is not painful at all. The question I have is....Is this still consistent with a fissure as opposed to hemorrhoidal pain. Internal Hemorrhoids are above the dentate line so they should be painless.
Also could this be an atypical presentation of a fissure?
With regard to the spasm pain, am I just really tolerant of this? I occasionally can feel my heartbeat in my rectum. Is that what people describe with fissures?
Thanks again for your help.

I think the heartbeat-in-your-rectum feeling could well be fissure symptoms. That would usually be after a BM. The pressure symptom is what the majority of us experience with this. The only way I have got rid of this is with anal dilation. I have not had surgery, and this has been a life-saver for me.
I don't think you would miss it if you had full-on sphincter spasms as we had a marine on here and it knocked even him for six
I have internal hemorrhoids too, I was told, and personally I feel that though they may not hurt inside, they cause things to act up on the outside.
The trouble is that over-zealous hemorrhoid treatment can just lead to more problems, with the formation of scar tissue. This is what I have. And possibly you do too.
If you have difficulty inserting the Diltiazem, you could try slathering the little tube thing that comes with, for example, Preparation H, and inserting that. It does not have to go far in, in fact when I used Diltiazem, I used it on the outside...
You are very welcome with the help!

Interesting....So most people don't get the horrific spasms; they just have a pressure feeling. So you think these are probably fissure symptoms?

Sounds like the early symptoms of a smaller fissure. It used to feel like that for me too, before it went ballistic. I could totally function with it for months, thus ignored it. I curse myself for not doing anything about it, while I could.
I'm pretty sure it's fissure pain. I have huge external hems, they never hurt. Same for the internal ones. I understand hems only hurt when thrombosed.

Fissurevhems,
Your pressure feeling is kind of what I experienced during my healing process with my fissure.
I was actually a bit confused as to whether I was having spasms or not because they certainly weren't severe....It was just a feeling of intense pressure down there and tbh my BM's were also not particularly painful. I never bled but did get the intense knife-type pains when it all first started in the first few weeks. I too have the joys of internal piles and I know these contribute to a certain amount of pressure in the area but they don't actually hurt as such.
Fissures seem to have minds of their own and everyone's symptoms, pain thresholds etc. differ - it does however sound more likely that your symptoms are more symptomatic of a fissure as opposed to the piles, but they will just aggravate things a little more too....

Thanks for your help BGD and ever the optimist. I never actually had any knife like pain. I guess I am lucky for that. Currently I am trying diltiazem, lidocaine, and I am going to add some steroids as well. I will do this for one month to see if the symptoms improve. The CRS seems really nice and he told me we will keep trying things until the pain improves. He thinks since I have had symptoms for so long that I will likely need LIS but still worth trying the conservative treatment for one month.
I just hope that he is right regarding the fissure, because I have seen two other surgeons and they both felt hemorrhoids were the cause. There was one exception however and he was kind of an a-hole. He is supposed to be a great surgeon however. He said that internal hemorrhoids cause bleeding, seepage, or hygiene issues and not pain. He said he thought I had micro fissures based on my symptoms.
So hopefully this new guy who actually found a fissure is correct! I would not want to undergo another surgery to find out it made no difference in my symptoms.

Hi,
I was wondering too if perhaps your fissure(s) were smaller and not too deep because of your symptoms you describe. Mine did create a lot of pain initially but seemed to really heal up a bit after using Diltiazem, which made me wonder if the fissure itself was perhaps a small one and perhaps easier to manage and treat? Because I never bled or experienced excrutiating spasms, I'm wondering if this is the case with me. I don't get any of the above from the piles too, just a bit of soreness and a little hard to clean up from sometimes, but nothing major. They are just there!
If this is the case, then hopefully the issue may be easier to treat and the healing process not so long....
All the best to you and please just continue to be careful for a long time and hopefully this new guy will help you through. I, personally, would consider LIS as a final resort, if all else fails :)

Ever the Optimist,
yeah that would make sense. I would imagine that the symptoms are dependent on the size of the tear. All of this started for me while I was doing the insanity work-out. It involved jump squats and right after my jump squat I noticed an uncomfortable feeling. That is when it all started. I wonder if the squat led to a tear?!?!
Whatever the case is...hopefully it will heal without further invasive interventions.
Thanks for your help