Hi guys,

I really need some advice on this...I had a fissure for two months and it healed with nifedipine; after 6 weeks of being on the medication, I went back to the doctor because I was still having pain after bowel movements; dull rectal pain throughout the day but I was surprised to know that my fissure had healed. I've been to 4 doctors (2 general surgeons/ 2 CRS) and they all have stated that they don't see an active fissure and have referred me to a pelvic floor therapist; it has now been 3 sessions but it only provides temporarily relief just like like sitz baths.

After being on the nifedipine for 6 weeks, I felt as though I got an allergic reaction to it so i stopped using it, I felt rectal burning/ stinging, lesions (paper cut feeling around my anus) so i started using A & D ointment, vaseline, coconut oil, vitamin e oil, tucks instead but realized that I only get temporary relief for a day and then the symptoms continue.

When I have a bowel movement (without lubrication its worst) it stings and burns and sometimes I see a little blood (some bowel movements are painful and some are not); BM make the pain worst and other days it reliefs pain, my anus hurts (burning, irritation) when I sit for a long period of time; I feel dull ache (soreness)/ pain all day (pressure in the rectum as though I need to defecate and some days I don't). I have good and bad days in terms of pain ranging from 1-6 (stinging, burning), I feel as though my anus is tight but I have a normal sphincter according to the CRS. The odd thing is when I go in for an exam, I feel some pain during it but feel relaxed afterwards.

My anus feels as though it is not stretchy, (paper cuts feeling around my anus like chapped lips), some days it is sensitive to the touch (inside and out). There is no visible irritation or redness (to me or doctors) but I feel as though I have it. When I don't add anything there it feels really dry and chapped.

This week, I started to have painful bowel movements so I applied nifedipine; today is a good day but the constant ups and downs have me down. One day you feel as though you're getting better and then the other you're in pain again. I know I should not be complaining because there are others that are in much more pain than I am but I am desperate for answers. Any input would be appreciated...

Your symptoms are really similar t what mine were. Particularly the paper cut feeling and pain throughout the day. The CRS couldn't see a fissure on examination for me, but thought I might be getting title tears based on my description s did Botox and I think a fissurectomy two days ago. He mentioned when I was coming out of the anaesthetic that I have a minor prolapse but wont know more about that until the follow up appointment in a month.

I'd be interested t hear he you get on. What do they do in the pelvic floor therapy? Mine is certainly weakened after two kids and I'm sure it adds to the AF problem.

Alyssa,

If you are getting bleeding, there is something going on most likely with a fissure or internal hem. Does your doctor know that you are bleeding sometimes with a BM? Is the bleeding only on the tissue or can you see blood on the stool? I feel that you need to find the soruse of your bleeding to treat your issue. Your symptons are very much like an active fissure. As you are aware, a fissure can be very small and difficult for the doctor to find. Your chapped butt feeling may a reaction to the medications or creams your have used in the area. Are you using a stool softner? Do your down days start with the texture/firmness of your stool?

I asked my doctor one time about how sometimes when I have a harder stool, I'd get that paper cut feeling all around and then the tissue would have lots of little spots of blood. It was basically because things were so tight, I would re-fissure (tiny new ones) during a slightly harder bm. It was so frustrating and kept contributing to the cycle. These little fissures would heal on their own in a few days or a week, I believe. I know you've seen lots of doctors already but I'd go keep getting new opinions until you get one that feels right to you and helps you.

Physical therapy focuses on strengthening the pelvic floor muscles depending on what your issue is, they develop a treatment plan for you. You do exercises at home and massage muscles with a wand.

I don't take any stool softness since my problem is that my bm are too soft already; I don't really know what causes my bad days perhaps multiple bm... But not always. It's frustrating because I know that I am in pain but the doctors can't see anything going on so they blame it on muscles and nerves (hence the pelvic floor dysfunction). Why so I retear if I have a normal sphincter? It seems that no matter what I put in there (ointments and such) the pain is still the same so I don't know if I've developed an allergic reaction but if I don't put anything the pain is worst because its dry.

My pelvic physical therapist focuses on relaxing the pelvic floor muscles but other people need to tighten them.

I have a colonoscopy scheduled at the end of the month, do you think that they will be able to see these tiny fissures during the examination (that's my only hope to get proper treatment at this time).

Alyssa,

I did a colonoscopy with a GI and I asked him to check on my hems and fissure but there were no photos of the hems or fissure. All he said was that he did not see them and I know the hems were there. It appeared to me he was interested more in the colon. I hope you get better result with the colonoscopy on your anal issue than I did.

When you are under for the colonoscopy, the CRS should be able to get a better look to spot a fissure.

My colonoscopy will be done by a gastro doctor and they are aware that there is some bleeding when I have a bowel movement (I've only seen it on the tp not on my stool) which is the reason they suggested it to rule out any other conditions. It's frustrating because they can't see anything and no one has suggested that I might be refissuring tiny ones. The two crs I saw (kaiser) have 10-12 years of experience so I got another referral to a crs in San Francisco who has 33 years of experience hopefully he can provide more information and understand what is going on since he's been in the business for a long time.

Your first post could be written about me.... I have all your symptoms, but the difference is, I have a visible fissure.
Maybe your fissure is just getting missed??
As for feeling the need to put some sort of cream on your anus or it feels too dry and sore.... I was getting so sensitive to absolutely everything, so I just went cold turkey and used nothing apart from Vaseline when I had a bm, which got washed off after. It felt odd at first, but things start to feel a little better quite quickly.
Good luck with your new CRS

OMB x