Hello all! Very long story - have had fissure for 16 months. Horrific dehabilitating spasms daily preventing me from taking care of my kids or living any type of normal life whatsoever. I am barely hanging onto my sanity. Had Botox over 6 weeks ago. Didn’t work as dr was too conservative and did not inject enough medicine. I have to wait unti mid May to try again. I am in the US so this is a huge problem as this procedure cost $15,000 and I have no idea how much insurance will cover...

Anyway, in the meantime my GP suggested seeing a pelvic floor PT to help with the muscle spams. The PT works only though my vagina. All the muscles connect so it helps your booty. She does interior and exterior trigger point release. She had me buy a wand so I can try at home (I am still working on getting the hang of that). I also do exterior massage at home. It helps. She has me alternate ice and heat. If you see someone make sure they are certified for pelvic floor PT.

The PT suggested seeing a Urogynecologist. That dr confirmed my pelvic floor muscles (including levator ani) are in spams and prescribed 2 Valium suppositories a day (1 in am, 1 in pm), along with the 2, 5 mg tablets of oral Valium I already take per day. This is all to stop the terrible spasms so my fissure can heal. Vaiium is the best thing for this. You can use the suppositories vaginally if your booty is too sore to insert there. You need to get them from a compounding pharmacy and they are considered a controlled substance.

I am feeing far from normal but I am feeling better than I have in quite a while, I know I have a long way to go but I am so hopeful that with the suppositories and PT that maybe I can heal- and without Botox or surgery. Some days are better than others but I finally have a small glimmer or hope - knock on wood, fingers crossed.

I have no idea why the CRS do not prescribe this medication and PT. To Every. Single. Patient. It seems they would rather do surgery. And BTW, cutting your inner butt muscle like they do in surgery will not resolve all your problems if your other pelvic floor muscles (levator ani, etc) are also in spams bc they don’t touch those. And it is very common with horrible spasms that you have more than just your inner butt muscle in spasm. This is why some LIS surgeries are not successful.

Just wanted to pass along with info. Wishing all good health very soon.

It sounds like I could have written this myself. I am sorry you are going through this, but apart of me feels comfort in knowing im not the only one.
Long story short I have had THREE LIS's in the past year plus Botox. Nothing has working. I have severe rectal pain. It will be bad for about a week a month, and then the other 3 weeks its there but not flaring up. I have tramadol for pain. The doctor suggested the mammotry test and going to PT, so I have both scheduled in the next month. I dont want to do the mammotry test because I honestly see no point in it.
Does the PT help you? And do the volume suppositories help?
Anything I can do at home, besides pain meds to help?
My doctor thinks the pain is levator spasms, when it hurts i just want to cry all day long. I have 2 small kids and this has been going on for almost 2 years!!! I am losing hope that I will ever get better....

PT and self-dilation have helped me more than either of the CRSs that I've seen. I'm glad that the PT has helped you, too. I'm starting to become convinced that dilation and PT are better than surgery for fissures.

My PT also mentioned Valium suppositories, but I haven't tried them. I always worry about medicine because I tend to be sensitive to side effects.

Hi. So I have been working with the pelvic floor physical therapist once a week since the end of February. After the first several weeks she had me buy a wand to do self massage/trigger point release at home a couple times a week. We are still doing everything vaginally so that there is no danger to make the fissure worth. You can reach all the same muscles vaginally. All of my pelvic floor muscles are tight and in spasm as a result of the fissure pain for so long. So if I were to get LIS or Botox they only work on the spincter and would not fix the problem of all of the pain I have in that area. I fear that is what is happening to some of the people on the sight. The PT is definitely helping but I have setbacks. My kids are a little older (six and eighth grade) and have activities every night and weekend. I have very little time to rest. I spent all last weekend walking around Disney watching my daughter’s dance performances. Then this weekend I had to take both my girls to the mall to get semi formal dresses for the upcoming dance. Each one of these times is a huge step back because I am not able to walk around for hours without making the spasms much worse then it can take a week or more to get back to where I was. The key is to rest but I don’t know how a mom is ever supposed to do that.... I am also still using the Valium suppositories twice a day and I feel they are a huge help. The urogynecologist that they should not affect my head or body really in any way and I can take them for as long as I need. I am by no means back to normal. I still can’t go to an amusement park, the mall, or even grocery shopping; but there are times when I can actually sit still on the couch and not be in terrible muscle spasms, or actually not be in any pain at all, and that is a huge improvement. I have already put off my next round of Botox which was supposed to be in early May and will continue with the suppositories and PT. Right now I am scheduled to do 24 weeks in total (original Rx was for 12 but PT thinks I need two course) and am only at about eight or nine weeks. So we’ll see. Again I would definitely recommend pelvic floor PT and Valium suppositories for everyone because it may be that you have pelvic floor problems also, caused by the fissure. Best wishes for a quick healing from this awful thing.

This is really interesting. Thanks for the information. I will definitely try PT.

Hello! Canttakethis, just wanted to reach out, I have not been on the site for a while but thought I would stop in and provide some encouragement. I too suffered a chronic fissure which began in July of 2016. I had Botox in Dec 2016 and in January the Surgeon said it was healed. But as you said, since the area was in so much pain for so long it created continued spasms in the connected muscles of the levator ani. The good news is that it is about 17 months since the fissure was healed, it has not come back and the spasms most of the time are not there. A famed CRS in California, stated that it takes a long while for them to fizzle out. 6 months is quick, so most often medications do not work, it is a mind body situation for healing and takes some time, typically just the thought that it may not go away, triggers it, and it seems to set the cycle in motion. It is really important to try to not worry because it will go away. It does also get better with age, and it won't hurt you they are just muscles. Most times now it is just a tightness and uncomfortable feeling not really painful as in the past. I had 6 children and never had to deal with anything so painful. The CRS says some people just hold their tension in the root chakra and at the base of the spine and pelvic floor. Especially after having children it has already been traumatized. UGH! I am pretty much back to normal and just know that you will be free of this. Try to keep going and give it the least amount of attention as possible. Better days ahead... One day you won't even remember how it felt. Blessings and healing to all... Good days ahead... Don't worry be happy...

Do the vallium suppositories have any negative side effects?

I was given the diagnosis of 'far too tight-itis' and suggested pt, but I have extreme anxiety and I nearly vomit at the thought of seeing someone for anal physical therapy??? I can't even imagine what's involved, and it creeps me out. I'm 30 with fibromyalgia, so I've gone to pt before, but I've never felt comfortable, and I imagine I'd be less so over *this*. I'm wondering if there are ways I can find online to learn at home or something.. plus insurance.. ugh.

Hi, I recently did rectal physical therapy for 6 months - apart from rectal irrigation it mainly involved relaxation and breathing exercises, but I didn't find those particularly effective. I've now been transferred to a pain management clinic, and don't know what that will be like - my main source of pain management at present is pregabalin, which I do find helpful. I'm in UK, by the way.