ok, so I had recently posted that I was trying to decide wether to have LIS surgery for recurrent fissures. I have a long-standing history of pelvic floor dysfunction which has caused considerable rectal discomfort for 10 years and which has aided in the development of both hemorrhoids and anal fissures within the past 4 years or so. I have had 3 diagnosed fissures since 2006, but I may have had others that were not diagnosed by a CS during that time. I have been receiving treatment for the pelvic floor issues at a clinic in California that specializes in pelvic floor dysfunction and pudendal neuralgia and during my most recent visit, I was 99% certain that I had developed another anal fissure. Other than blood, I've had the symptoms associated with fissures, but today I went to my local CS and he says that he didn't see an active fissure. He did the finger in the butt exam and used an anoscope, but said that there was not inflamation and no ulcer or active fissure that he could see. So now, I don't think that I could find a surgeon who would do LIS if there is no active fissure, but wanted to know if anyone on here has had or heard of surgery on someone who had recurrent fissures, but did not have an active fissure at the time of LIS? Also, are there other issues that can very closely mimic the type of pain associated with a fissure? I just can't believe that he didn't find anything. But, to be honest, the exam didn't hurt very much, which is rare for the times that I have had an active fissure and he has examined me. I don't know. I start to wonder whether his exam was thorough or not.

I can't speak to whether anyone has gotten LIS without having an active fissure (sorry), but it's definitely not unheard of for doctors to miss a fissure during a rectal exam.
Just because one doctor didn't see it doesn't mean it's not there. It may have been tucked away in the folds of the skin, or maybe it wasn't bleeding much at the time and was easy to miss.
I think fissure pain is supposed to be pretty unique as far as the "pooping shards of glass" feeling. Supposedly (I've read) the most painful anorectal conditions are anal cancer, fissures, and thrombosed hemorrhoids. I remember you mentioning you've had thrombosed hemorrhoids before so I'd assume you know the difference there though. Other conditions like levator ani syndrome can cause muscle spasms in the rectum, but if we're talking about bleeding with "passing shards of glass" pain, I don't know if the range of possibilities is necessarily very wide...

BTW it seems like you're really on the fence with the surgery or not decision. Why not give BOTOX a go and see what happens? It's probably the least invasive way to tell if relaxing your sphincter really will give you any relief from your symptoms. If it does, but the relief isn't permanent, you can always get LIS afterward. At least then you'll have a better idea if spasm of the inner sphincter is at the core of your problems.

My situation seems to be very different from most of the sufferers on here, in that my rectal pain did not begin with an anal fissure. The anal fissure actually was the result of a chronic pelvic muslce and/or nerve condition that I have had for years. So, it makes it much more difficult to deal with just the fissure issue, because even if the fissure issue is resolved, most likely I will still have rectal pain from the underlying condition. I have only had 3 fissures that were diagnosed by a CS and they were all diagnosed by the same CS. The fissures each healed by the time of my 4 to 6 week follow up appointment with very conservative treatment. I have never had even a drop of blood from any of the fissures I have had, but I do get the razor blade feeling during bowel movements when I have a fissure, but that typically has lasted for only a week or so. My BIGGEST issue is bowel evacuation difficulty. I am very, very regular and I keep my stool soft about 95% of the time. I take Miralax every day, drink about 8 to 10 glasses of water per day and eat at least 35 - 50 grams of fiber per day. Not much more I can dietwise, I guess. LIS is something that I would consider because it relaxes things and that might help with bowel movements, which in turn could help to eliviate some of the rectal discomfort from spastic muscles and nerve irritation. I do agree that Botox would be a good first step, but I don't have anyone that I know of who can do it. My CS doesn't use it and he only has one other CS in his office and he doesn't use it either. Believe it or not, there are only 2 CS in the entire state of NM where I live. It's very frustrating.

If it's any consolation, I'd had nagging nerve issues for a while too (hence my user name) and still have rectal pain 3+ months after LIS even though my fissure and LIS incision have both completely healed. Bowel movements aren't very difficult for me anymore, but the rectal pain remains, and often spreads up my back and down my leg. I don't know how common it is for other pelvic problems to be involved when it comes to fissures, and your case certainly sounds more severe, but it doesn't mean you shouldn't try to treat the fissure.
If you have the razor blade feeling during BMs and have a known history of fissures, hemorrhoids, and pelvic muscle issues, then I'd say odds are real good you do have a fissure that was overlooked. My fissure happened to be a frequent bleeder, but many peoples' don't bleed much, if at all.
If you're keen on Botox why not get it done in California? If you've been here for other treatments you can come here again right? Both Nor Cal and So Cal have plenty of doctors that do it. I'm sure there must be doctors closer that do it, too, maybe not in New Mexico but in the neighboring states. Also, have you checked with any GI doctors? A lot of GI docs treat anal fissures too. I know we have at least several right around the corner from me that do Botox.

My local CRS was against trying Botox (probably because he doesn't do it and hasn't been trained to give the shots), but I have more faith in Mayo's than anyone here locally, and since they do it there, I would have been willing to give it a shot (literally).

well today was a really bad day. started out with a really horrible bowel movement at 6:30 this morning and then i went again about 11:00 and it again wasn't good. not sure what happened, but now I'm really hurting and I really believe it is fissure pain. I don't know, I may be over-dramatic about it, but I'm at the end of my rope and not sure how much more of this i want to endure. I have no life because of this. I'm really just surviving life and I don't really want to do that anymore. I just don't have the strength to keep seeking out treatment.

Hey I don't think you're being overly dramatic. Fissures suck BIG TIME and you've put up with a lot more crap than the rest of us given your more complex circumstances. But seriously, why not come out to California and get Botox? I'd be happy to help in whatever way possible since I live here.

thanks NG. i'm just really losing it today. i had an appt with my colorectal surgeon yesterday and was told that things looked good, no fissures or hemorrhoids, ect. and i thought that maybe i could try to relax and move forward a bit, but then this morning things just totally went wrong and there was nothing i could do about it, so now here i am with this horrible pain that I know is from a fissure. I just feel like I can't ever move forward with life because I never know when things will go bad and I end up like I am right now. where in california do you live and who do you recommend for botox? the clinic that I've been visiting is in San Francisco and he does botox, but he is not a cs or a gastro. im not sure if i would trust him to do botox for this type of issue.

Hey dude trust me, I totally know where you're coming from. My butt issues aren't as bad as yours but I have some other "private parts" issues that are pretty persistent and unpleasant myself.
I actually live in San Jose, about 60 miles south of San Francisco. I had Botox done by a doctor in SF, she works out of the Center for Colorectal Health on Sutter Street. You should be able to find her info by a quick search. At least one other member here has seen her and likes her. The Botox shots were effective for several months for me. I eventually retore the fissure, but I also admittedly got a bit comfortable and sloppy with my diet, which may have played a role.
Also, in San Jose I know there's a GI doc just up the street from me that does Botox too. And in my own searches in the past, there are definitely a number of other doctors that advertise Botox for anal fissures on their websites. I don't think you'd have problems finding a suitable doctor out here if that's what you decide to end up doing.
Out of curiosity, why SF for medical care in the past? Do you have family out here? Just wondering since Texas has excellent medical facilities and Arizona has some good places too. California, especially SF, seems like a good jaunt from New Mexico.