Hi I’m 21 and I’ve been suffering with fissures for years. About two years ago I had a chronic fissure that was somewhat cured after Botox and diltiazem cream. The area still hurts sometimes but it’s manageable. I’m posting this because it now feels like I have a new fissure to the side of the old one, which will sting after every bm. I don’t have the spasms like I did for the first one but it still hurts a lot and worries me so I went to get it checked out. They put me under for the checkup so I wouldn’t be in any pain and gave me some Botox again, but they said they couldn’t see anything I found this crazy as my pain has to be coming from something? I saw my colorectal surgeon again yesterday and he just said there wasn’t much else they could do, so I started crying because I was shocked they’d even try and discharge me. Eventually after I broke down, he said he’s get another colorectal surgeon to look, but has a result I’m feeling really disheartened. I can’t live like this I just want my life back free of bm pain Has this happened to anyone. I don’t know what they’ll do if they don’t find a fissure, like I’m still in a lot of pain it’s awful, and this has been going on for years any advice would be great

Hi, sorry you're going through this. It's probably best to wait for the second CRS to examine you and give their diagnosis. If they still don't find a fissure there are one or two things you can do. Sometimes, although fissures have healed, the perineal region stays sensitive and inflamed, giving rise to a condition that's usually diagnosed with names like PFD (pelvic floor dysfunction). This is often treatable with physiotherapy, so if you can at some stage get yourself referred to a physio specialising in pelvic floor disorder that might possibly be the best plan of action, if you haven't already tried it. Hope you feel better soon.

Thanks for your advice, I have already wondered if it is pelvic floor disfunction, I’ll try look into that

This happened to me, the first time I went to a crs, my fissure was always fast to heal but recurring (until it wasn't), so when I saw him I was feeling mostly better and he could not find one. I figured I was crazy and got back to my life, my fissure cam back for good about 6 weeks later and I am now around 3 weeks post LIS. fissures can be so small that they are hard to find, they can also spontaneously heal.

Having suffered with fissure-related PFD for nearly five years now, I can say that nearly all the colorectal surgeons I've consulted here in the U.K. (mainly, but not exclusively, on the NHS) have ruled out surgery as a suitable method of treatment, and have recommended physiotherapy and pain management as the only advisable course of action. This may be because of my age - I'm 73 - but I get the impression that among health professionals in this country surgery is not the number one option when it comes to the treatment of AF.

BTW in general it's useful to know what country forum members are posting from, and it's a good idea to fill in the 'Location' field in the user profile.

Hi thanks for your posts, I’ve inquired about surgery before but as my fissure was so small (at the time) my surgeon said no. Which totally sucks as I’m at the end of my rope. They said they couldn’t do anything so I went back to my gp and got her to refer me to physio. I see them both in 2 weeks. Wish me luck :)

Good luck with the physiotherapy - it can be quite helpful. I'm assuming you're in UK.

dmcff wrote:Hi, sorry you're going through this. It's probably best to wait for the second CRS to examine you and give their diagnosis. If they still don't find a fissure there are one or two things you can do. Sometimes, although fissures have healed, the perineal region stays sensitive and inflamed, giving rise to a condition that's usually diagnosed with names like PFD (pelvic floor dysfunction). This is often treatable with physiotherapy, so if you can at some stage get yourself referred to a physio specialising in pelvic floor disorder that might possibly be the best plan of action, if you haven't already tried it. Hope you feel better soon.

Yes as noted above, I went from fissure, eventually to "pretty much gone"...now I'm left with no apparent fissure, but terrible pelvic pain/dysfunction.

I tried physio but it didn't help me much and became far too costly.

Dilation is something I'm going to try next, my anal muscles are constantly in spasm.

I have to admit that physiotherapy - or what I was able to receive of it - didn't help me very much, either. One odd thing was that on my final visit my physio showed me a whole array of dilation devices which she said the CRS recommended - but she was unable to prescribe any of them for me because they were used by a different clinic than the one I was enrolled in. She also said that in her opinion, based on what I had told her about the pain I'd experienced during digital examinations, dilation would be too painful for me. I also got the impression that there were two separate lines of treatment in this clinic - one for female patients and one for male patients. Also, age limits came into play, as far as I could see - and at 73, most therapies apart from PT exercises and stool softeners were more or less ruled out for me.

The whole area of colorectal and pelvic disorders (AF, PFD, CPPS, etc) seems rather hazy and ill-defined (for men there is a peculiar overlap with prostatitis). There don't appear to be any sure-fire cures for them, and beyond stool softeners, creams and ointments, physical exercises and pain management, clinicians and surgeons are divided about what constitutes appropriate treatment. In the UK there are a growing number of private, independent clinics - one example is the male-only London Pelvic Pain Clinic (https://www.thepelvicpainclinic.co.uk) - that offer physiotherapy-based and 'biopsychosocial' treatments for pelvic pain and discomfort. But it's hard to know how effective these treatments really are. My NHS physiotherapist was unable to advise me.