I went to get a third opinion from a different CRS today and she did a digital exam. She said the muscle is not very tight but since I have pain internally that means there's some inflammation going on. She pulled out the anoscope too, but I said no way in heck are you putting that up my bum! She wasn't convinced I still have a fissure, but was talking about the possibility of fistula. I have no discharge at all so don't know how that could be a diagnosis.

If anyone could help me out here I'll be very grateful. I had botox five months ago so it's long gone from my system. I still have pain during and after BMs, but not as much as before Botox, and it's a burning sensation. Could the reason simply be muscle tightness that could be resolved by physical therapy?

My worry is that I have low resting pressure now and they will have to consider more invasive surgery to fix it, like flap surgery. Any opinions or ideas are much appreciated. I'm really not sure what to do next besides physical therapy.

Bumping.