I just came back from a third visit with my doctor and I am clueless on what to do next. This is the THIRD TIME he has been unable to see my fissure, but I am still experiencing 24/7 discomfort (a pinching type of discomfort that gets worse after sitting all day), muscle spasms, and pain during bowel movements. In fact, the bowel movements I had yesterday and today were the most painful ones I've had since I got this fissure 6 or 7 months ago! My stool wasn't unusually hard, and I didn't bleed at all, so I don't know why I've had a sudden increase in pain these past few days.
My doctor gave me a refill of my diltiazem cream but other than that, he's kind of blowing me off because he can't see the fissure. He said if I really wanted to he could give me anesthesia and take a closer look, and he mentioned they could try a procedure where they stretch that area. I was under the impression that few doctors did that anymore, though - isn't that the treatment that has greater chances for permanent incontinence? He's made it clear he just doesn't want to do the LIS because he can't see the fissure.
This guy is actually a general surgeon at a surgical office. I originally wanted to see the colorectal surgeon when I first started going to this office a few months ago, but she didn't have any appointments available for months, so I opted to see this guy. And now they want me to continue seeing him, and won't let me see the colorectal surgeon. So the only doctor who has been able to see my fissure was a regular one at my local clinic, and that was way back in May or April, I believe. I can't even remember!!!
The doctor kept telling me that if I really had a fissure it would be impossible to do the internal exam, but (A) I know that's not true because I had the internal exam done when I had a VISIBLE fissure way back when, and (B) the exams are still quite uncomfortable, and todays was pretty painful, but I just dealt with it. Not much choice, y'know? Most doctors I've had don't want to stop an exam even if it DOES hurt (because they're jerks who don't give a crap, quite frankly), so I've learned to keep my mouth shut unless I truly can't bear it. But even then I've had doctors refuse to stop. Gotta love 'em.
What in the world should I do? Should I try to find a colorectal surgeon at another facility? Do I need to be seriously worried that this is something more sinister than a fissure? Like I said before, my bowel movements yesterday and today were the worst ones yet. I was saying "ouch" out loud even when I was trying not to. It's like passing shards of glass. I'm starting to agree with women who compare having fissures to giving childbirth! So I don't understand how my fissure can't be visible. I KNOW that whatever problem I'm having, it's not healed.
PS: I should note that my muscle spasms are painless, unlike the spasms many other people here describe.

I think you need to go to the CRS and get a second opinion really soon.
With my fissure, I had the "pinching" pain that you have. Sometimes internal exams would hurt, and sometimes they were not that bad. My worse pain came with the BM itself and I rarely had blood. Many doctors could not see my fissure because it would heal & reopen and they would do an exam while it was healed.
I can never hurt to get a second opinion. I did & I don't regret it.
I hope you feel better soon!

I second Jen - go and see CRS and a GOOD ONE !!!! My fissure was not seen by 2 CRS-s and the third one told me that if fissure is hidden in the fold of a skin or is not deep to the muscle , it could be very easily overseen . He said that he is 99% sure I have one, even he could not see it by regular exam. He did colonoscopy and since my sphincter was relaxed he was able to stretch it nicely and see the fissure . He even made a photo for me to show me the damn thing !!!!! So, I am pretty sure you might as well have a fissure and one that is not easily seen ! AND, I had MULTIPLE exams with visible fissure - so your doctor is a complete ignorant and I would run for my life if I was you !!!
I wish you all the best !

that was one of the worst things i hated about having the fissure.....the bm seemed so under control or without incident and then afterwards, bam! you get the most intense pain and anguish that seems illogical and down right evil.
sounds like you need a second opinion crimesofpassion......

I am sorry you are in such pain. Especially when there doesn't seem to be a visible root of it. That is so frustrating when the doctor can't find anything. I think a second opinion with a CRS would be very helpful.

Have they ever found a fissure before? I am wondering if you have some kind of nerve injury that flares up from time to time that causes the pain. Nerve pain is usually the culprit when they can't find anything physically causing the pain but it is a real entity and a very cruel pain. I would ask about it if they continue to find nothing in the rectum. Especially if you have had children, have had an injury to your sacrum or pelvis, have had shingles, herpes or problems with voiding/defecating. Does it seem to be related to your menses at all? Is there something that triggers it? Are you keeping your bms soft and manageable?

Sometimes it is impossible to pinpoint and that can be a very unsettling feeling because you don't know when it is going to rear its ugly head again.

Hang in there.

Hi Crimesofpassion !
I am so sorry to read your story and your pain
Are you in the UK by any chance ?– The reason I ask is that I too see a general surgeon, if I want to see a CRS on the NHS the wait is 6-12months...CRAZY HEY !
My G.S put me under for further investigations as the exam was just too painful, he planned to give me gentle dilation but last mintue I had the Botox instead !
You do have options here - One is to go under G/A and have things looked at by the G.S , You do not have to have the dilation if you don’t want to, just agree to have a further investigation
Do research the dilation, the plus of dilation is that it stretches both external/internal muscles and while it is an outdated procedure it is still used !
Your other option is to pursue a second opinion from a CRS which could take some time if you are in the UK !
Waiting and being in pain is the pitts :( I do hope you get some help soon.....

crimeofpassion wrote: The doctor kept telling me that if I really had a fissure it would be impossible to do the internal exam, but (A) I know that's not true because I had the internal exam done when I had a VISIBLE fissure way back when, and (B) the exams are still quite uncomfortable, and todays was pretty painful, but I just dealt with it. Not much choice, y'know? Most doctors I've had don't want to stop an exam even if it DOES hurt (because they're jerks who don't give a crap, quite frankly), so I've learned to keep my mouth shut unless I truly can't bear it. But even then I've had doctors refuse to stop. Gotta love 'em.

Funny!
Find a real CRS and let him/her do a proper exam on the inside..
Take care :)
Corsica

Another option if you are in the UK is to go and see a private colorectal surgeon - they are top consultants in their field and because you are paying for it they will treat you properly. And its also a fast track way of getting surgery if you do need it. Dont just take this idiots word for it that you dont have a fissure, most of us have had problems with incompetent doctors, just carry on until you find a good surgeon who knows what they are talking about. It is your right to have a second opinion, they cant refuse that.
It doesnt sound like its anything more sinister than a fissure, you seem to have classic symptoms, but it doesnt hurt to get it checked out just to put your mind at rest.

I'm located in the US.
They have found a fissure before, Lecia. A general doctor did an exam after I complained of some rectal bleeding, and she saw one. She said it was small, and at the time I thought a fissure was something that would heal without any treatment (because it was "just a cut!"), so I didn't seek any treatment for it, and she didn't tell me if I should do anything to help it heal. And here I am, 6/7 months later...
I've never had an injury to that area or anything that could cause nerve pain. No children... And it can't be related to my period, because I haven't gotten my period in about four months! I'm going off my birth control pills right now, and my hormones are all screwed up. I do have two chronic conditions - vulvodynia (constant vaginal pain) and interstitial cystitis (a bladder disease), but I've never heard of either causing rectal pain.
I'm pretty miserable today - had diarrhea all morning despite the fact that I quickly took two Immodium to try and stop it. It hurt so bad. I know diarrhea is awful for a fissure. So I'm beyond sore and praying it didn't make the fissure worse. :( This is the first time in three years I missed class (I'm a college student), so I'm super bummed.
I'll have to start looking for a CRS. Unfortunately, I did a quick search for one awhile back, and there aren't a lot in my area.

I have intermittent vulvodynia and the pudendal nerve innervates both the genitals and anus so it could be irritated and causing you pain there. It is bilateral or just one side?

Are you being treated for IC or vulvodynia? That doctor should know something about pudendal neuralgia. I am not saying you have it but what can happen is you get an injury in the anus and the nerve has a memory for pain and keeps firing even when the injury is healed.

I would see a CRS to rule out any injury, fissure etc though as you have had it in the past.

I doubt the diarrhea will make the fissure worse but you are right it burns so bad.