Internal pain= external or internal fissure?

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Internal pain= external or internal fissure?

Postby hopefulbutt » 29 Jun 2013, 08:43

Can someone clear this up for me? I believe I have internal af as the internal muscle hurts inside but Crs said she saw external fissure. Is she missing the one inside or is it that the external af can cause muscle pain that much deeper in? Also when I had to take enema it was internal that was burning so badly from the solution. I beleive she gave me botox based on the external one but it hasn't quite reached all of that internal muscle. Thanks
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Re: Internal pain= external or internal fissure?

Postby Guest » 02 Jul 2013, 06:11

"....Is she missing the one inside or is it that the external af can cause muscle pain that much deeper in?"

Anal fissures develop externally but extend inwards.  The tear typically extends into a circular ring of muscle called the internal anal sphincter (IAS).  While the IAS is an involuntary muscle that maintains anal tone and is normally in the state of contraction, the EAS is a voluntary fatigable muscle that provides short term augmentation of anal pressure to postpone defecation.  In simple words, the IAS is controlled by the body, while the EAS is controlled by us.  Hence, the use of terms, "voluntary" and "involuntary".   Your fissure has extended inwards which is why you feel the burning from the enema as soon as it comes in contact with the sodium content.
"..... I believe she gave me botox based on the external one but it hasn't quite reached all of that internal muscle."......
Botox is usually injected into the internal anal sphincter -- the involuntary muscle, so that it doesn't contract or go into spasm.  It helps to lower the resting pressure or so-called tension and further improve the blood flow to the fissure area to promote healing.
I hope the above info clears your doubt.  Happy healing !
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Re: Internal pain= external or internal fissure?

Postby hopefulbutt » 02 Jul 2013, 08:08

Thanks mabs. So do u think she put the botox in the right spot? I am still having pain at fissure sight area. Maybe I am just too tight.
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Re: Internal pain= external or internal fissure?

Postby jr2 » 02 Jul 2013, 09:02

mabs is right. If your doctor had injected the botox in your external sphincter you wouldn't be able to hold in your BMs. The external sphincter is the one you can consciously contract and relax and is the one you contract to hold in a BM so you can make it to the bathroom. If the doctor had injected into that sphincter you would know because you wouldn't be able to hold in a BM at all.
Think of the anus as a donut. In the middle is the hole, which is the anal canal. The next layer, the layer lining the donut hole is the internal anal sphincter. Then, the cake part of the donut that wraps around the entire thing, that is the external anal sphincter.
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Re: Internal pain= external or internal fissure?

Postby hopefulbutt » 02 Jul 2013, 10:34

Ok makes sense. Thanks. Still feeling tight and sore. Maybe it needs time or it wasn't enough.
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Re: Internal pain= external or internal fissure?

Postby Guest » 02 Jul 2013, 20:20

..."Think of the anus as a donut"...
Lol jr2....  Terrific example !
HB "..So do u think she put the botox in the right spot? "
Yes HB.   CRS can't go wrong.  Botox has become a very common remedy for treating fissures.  
It takes 10 days max (varies sometimes) to kick in and should last for about eight to twelve weeks (sometimes 8 months if you are lucky).  Both depend on how much was injected.
...Maybe it needs time or it wasn't enough.....
If the quantity used was less than required, then it will wear off sooner than the estimated time.  So right now, it's all good !
....Still feeling tight and sore...
You will feel tight and sore, because you still have to relax your external muscle.  (Note : botox is only helping the internal one).   I hope your doctor has given you some prescription cream (preferably Nitro or Diltiazem) to relax the external muscle.
Good luck !
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Re: Internal pain= external or internal fissure?

Postby hopefulbutt » 02 Jul 2013, 20:54

Mabs it's been 22 days so its kicked in. My Crs have me 100 units. The most she could give. And yes I have been using diltiazam too for several months. Thanks for your help.
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