Haha what the heck. I guess your PT doesn't know a thing about fissures! Now that I've seen a billion and one doctors over the last year, I've come to realize that about 50% have zero clue what a fissure is (these tend to think of it as "hemorrhoids on steroids") and the other 50% know that it brings complete agony. Sadly this doesn't necessarily mean that you'll get good treatment one way or the other, but some sympathy is always better than none, I suppose.

I tend to stick with the same GP now, but even he isn't all that clued up about fissures, as you say, they think of them as hemmies on steroids LOL, it's only after a couple of years complaining that it's actually hit home with him, this shouldn't be the case though, what do they go to med school for
What I think it is with bum issues, not many people will go to their GP's about the pain etc because of embarrassment, and in turn the GP doesn't need to study up on many rectal issues such as hemmies and fissures, the latter being the least studied, in my opinion anyway, here in the UK we have a television programme called embarrassing bodies> http://www.channel4embarrassingillnesses.com/
this programme helps people to come forward with illnesses and pains that they are too embarrassed to go to their GP about, they actually descend upon a town or city and set up a clinic then invite members of the public to seek help with intimate problems which are then filmed and shown on TV, for instance, last week it showed a guy with severe fistulas then the operation (fistulotomy) was shown, graphic as it was, it was very interesting, another guy had hemmies like plums!! and the op was shown (HALO) which is relatively new but totally cured him with next to no pain.

LOL that looks like a great show! What a novel idea, I'm surprised no one here in the States has copied it yet :)
Yeah I was originally embarrassed to complain to my doctor about butt problems too. Now that I've had so many rectal exams it's not the least bit bothersome anymore though, the words just roll right off the tongue and I just continue chatting while the doctor is poking around "in there" :)
I've been analyzing my recent buttock pain and am now growing more convinced it's a back problem in my case though. Since I've had two recent butt exams that didn't cause any pain, I doubt it's related to the fissure. And the way the pain can be felt on my left side up to the hip and center of the lumbar spine seems to suggest some kind of back problem involving a nerve.
I wonder if lumbar problems can somehow lead to dysfunction of butt muscles that make people more prone to fissures. It seems suspicious to me as well, Steve, that you'd have pain in your hip and decreased left buttock tone... AFAIK that's not typical of a fissure (although who knows, maybe it's some kind of atypical fissure symptom). Have you ever had any kind of back imaging study or other evaluation? I canceled my upcoming CRS appointment (wasn't looking forward to a 3rd rectal exam in 2 weeks anyway :)) and am probably going to look at getting the lumbar MRI done before anything else...

I was embarrassed at first, must admit, but now i'm really not bothered who does the rectal exam, whether it be male or female, I look at it this way, they've seen one a$$ they've seen them all!!
I'm beginning to think there's a link between the back and hip pain, decreased muscle tone and the fissure, although i've read that a "pinched nerve" can cause both back and hip pain, (Pinched Nerves can occur in the lower back and affect motor or sensory functions in the hip area. These injuries will often cause pain in the back, as well as the area served by the compressed nerve) http://www.cure-back-pain.org/back-and-hip-pain.html worth a read, there's a few possible causes listed on that site, but i'm still convinced there's a possible link

Maybe there's some yet-undiscovered link between back problems and fissures :) And here we are, a couple of Joe Schmoes sitting around shooting the breeze about it, when in a few years someone is going to win some kind of award for figuring out the link
My primary doctor thinks I have a herniated disc that's pinching a nerve. I did some searching online and it appears that herniated discs in the lumbar spine have been known to cause pain in the buttocks. Yet another tidbit that I didn't really care to find out about :)

I think there already is a link. Tense muscles spasms. You should try a chiropractor. I never went to one until recently. I was very skeptical but I have to admit, he's helped me so much. I would stand to reason that if you are having spasms in your back muscles repeatedly why couldn't it affect the sphincter muscle and pelvic floor muscles. Just a thought but it kind of makes sense. Suzy

Hey Suzy, yep I've got a chiro next on my list. I'm seeing one more CRS today just to get a 6th opinion :) If he also says that my fissure is healing then I'm on to explore the back problem instead. I guess I just want to be absolutely sure the pain isn't from some kind of butt problem first since I've had the fissure for so long I don't want to just discount it as a possible cause.
My wife loves seeing her chiro too. Every time she goes, she comes back and immediately flops face down into bed because she says it makes her feel relaxed all over :)