This year, I've been through successful treatment for a superficial fissure (nifedipine) and three grade 2 hemorrhoids (infrared coagulation shrunk them to grade 1). However, I'm still having very uncomfortable rectal pain. It's slightly better than before the treatments, but still somewhat debilitating. My CRS has thrown up his hands and suggested biofeedback and a colonoscopy.

The pain seems to move and change its form. It is usually only one of the following:

1. Stabbing or stinging pain in or near the anus on the left side that is triggered and aggravated by BMs, walking, sitting normally, or bending. When a BM triggers it, I sometimes see blood.
2. Moves slightly left and either feels like a thumbtack, a small rock, or a cocklebur. Can also feel like someone is pinching me hard.
3. Moves more left into my left butt cheek. Feels like a muscle cramp.
4. Moves down my leg. Also like a cramp.

Other symptoms:
- When there is no pain, it can still feel like something is hanging out of my anus.
- I don't seem to have the sphincter cramps that are usually associated with a fissure.
- Sometimes I just feel a tickle near the sphincter.

Other weird symptoms:
- Exams seem to make it feel a little better for about a day.
- If I lay down and lift my left leg for a while, the pain can subside a bit or completely. Putting a small pillow under my left leg while sitting helps.
- Swimming helps more often than not. I never feel discomfort while doing it.
- Passing gas usually takes away the pain for a few moments.
- Grabbing my left butt cheek and pulling it outward slightly (spreading the cheeks) usually gets rid of any sharp-ish pain temporarily.
- (Hopefully unrelated) Sometimes it hurts to pee.

Since the blood in my stool is always associated with pain, I do not see how a colonoscopy could help, other than potentially looking at the sphincter from the other direction. Any blood associated with colon problems should be painless.

If I think of any other symptoms, I'll add them later.

Anybody have any ideas?

I am in a similar situation. Despite being told my fissure is healed, I continue to have rectal pain, some days it's severe.

My doctor thinks that because the pain has persisted for so long (years), the nerves are supercharged and don't "turn off"....essentially sending pain signals to the brain.

I know it sounds odd, but it also makes some sense.

My doctor just prescribed me Amitriptyline...it's supposed to be good for nerve pain. Gabapentin is another option.

I'll let you know how it goes.

Thanks for your reply. I hope the medicine works for you. My wife has a prescription for Gabapentin for other issues, but hasn't tried it yet.

Is your pain affected by normal activities? Is you anus sensitive to the touch where you feel the pain?

My pain gets worse from sitting, in an upright position like driving the car.
My anus is not sore to the touch, the pain feels like it's higher up, almost under the tailbone but in the rectum. According to the CRS, there's nothing there. So frustrated.

I found the Gabapentin hard to take. Made me feel like a complete zombie. Apparently the side effects lessen over time, but I couldn't stick with it long enough.

I have rectal (anal?) pain too. I've been told by two CRSs that my muscle is not tight enough to be in spasm. And the the fissure now looks like a healed pink scar. I had botox back in May and I'm now seeing a new pelvic PT who wants me to do dilation since she didn't find any trigger points internally. According to her it's a stretching issue and could be resolved. Another option she gave me is electrostimulation to help the nerves calm down internally, but that's only once I get used to a certain dilator size.

When I presented these symptoms to my primary care physician, she agreed that it sounds like the nerves are still sensitive from the hemms/fissure and will take time to recover. I might try the gabapentin, but I'm not optimistic.

The fact that I still see a little blood sometimes when I feel a sting during a BM tells me that a hemm is still involved. I'm wondering if the one hemm sometimes pokes out and is grade 2, and sometimes doesn't (when I feel perfectly fine).

On a related note, I finally got around to calculating calories and fiber from my diet. I eat very close to the same thing every day, so it wasn't too hard to get accurate numbers. Turns out that I'm getting 2000 calories (hence the continued weight loss) and 54 grams of fiber (too much), one-third of which is soluble. I need to figure out how to up my intake of calories while dropping the fiber (more meat, I guess?).