I've been suffering from rectal pain for 7 months. I've been having pelvic floor physiotherapy as I thought I had pelvic floor dysfunction. I had no success with the physiotherapy so I thought I'd try another physiotherapist, this second one found some scars in my internal sphincter which cause pain when pressed. A normal internal sphincter is supposed to be smooth, but mine has these tears.
This issue has completely ruined my life, for the past 7 months I have not been able to sit without pain. I finally had enough and quit my job 2 months ago because I couldn't take the pain any more.
I think I may have always had this fissure but I really aggravated it one day while doing some stretches. I was trying to touch my toes but I stupidly held some weights in my hand so that I could pull my self lower. 2 days later I felt this burning pain in my rectum, I had no idea what it was. Then after 2 weeks the pain went away. A couple of days after the pain went away I had a long and very stressful day at work where I was sitting in my chair for 13 hours, the pain came back and has never gone away.
My sphincter got so damn tight, it was like something was inside me. I also had urinary problems. My flow was awful and I was stopping and starting. I couldn't sit without severe pain. The worst feeling was the tightness in the sphincter. I actually massaged my external sphincter muscle (after I read the Heal Pelvic Pain book) and this released 80% of the tension. But the pain when sitting is still there. The pain from the fissure is also causing me penile pain. This is by far the worst thing that has ever happened to me. We take it for granted to sit pain free.
Although my external sphincter is fine, my internal one is spasming due to the fissure. I know this because I cannot pass wind silently anymore, the area where the fissure is is so tight that when I have bowel movements the stool will not pass through there. When my bowels are full I can sit down with no pain and pass wind silently because my internal sphincter is being stretched.
I will do whatever is required to fix this problem, including surgery.
I will be seeing a colorectal surgeon in the next 2-3 weeks.
Do you think that because I've had it this long, he will still prescribe the nitrate cream or will he go for a stronger method like Botox, LIS.

Hi Reckless and welcome to the forum!!! Sorry you have to be here though, but you are in the right place. 7 months is a long time to have a fissure. I had mine on/off for 3 years. Sounds like yours is chronic with the terrible spasms you are having. I had the same thing and the spasms are the reason I had LIS on Monday. I am 2 days post op and although bruised, swollen and a little sore and tons of gas. I feel great!!! I was given a Rx for percocet after surgery and never took any!!! The fissure pain and spasms are way worse than the surgery and if you look at my older posts you will see how anxious I was to have it. best thing I ever did!!! Just wish I did it like 2 years ago!! I don't know if you are in the USA, people post on here from all over the world. If you are I would ask for LIS. There is one boardie on here WECC who did dialation and had no problems as well. Search the threads and read, read, read. watch your diet and get some miralax and drink lots of water. Hope you get the answers you are looking for soon from you CRS.

Thanks Sue. I actually live near London in England.
I'm just glad that I've finally found the cause of my pain.
I thought I had something more serious like pudendal nerve entrapment. My first physiotherapist thought I had pelvic floor problems. I now know why those deep breathing pelvic floor exercises aggravated me instead of helping me, because they expand your injured sphincter.
I will not hesitate to have surgery because I have a poor quality of life. I cannot sit without pain. I spend most of my day walking or lying on my side. I can't work. I just hate that tight sphincter feeling, that golfball in the rectum feeling, the tightness around the perineum.
Anything which puts pressure on my sphincter aggravates it. Doing push ups will aggravate it because my sphincter is closed tight in that position. If I sit with my cheeks open then I can sit for longer without the pain.
I have some questions if you don't mind.
How long after LIS does the fissure heal? What is the recovery time from the procedure?
How long does it take to perform?
Are you knocked out of just given general anesthetic?
Thanks

Hi Reckless,
Sorry you're in pain. Thought that I would give my two cents worth on Standardized Anal Dilation. This is what wecc had done, and he seems to be recovering well from this. I would, just for good measure, check out his posts.
http://anal-fissure.org/t4104-my-standardized-anal-dilatation-this-morning
I also have investigated Pudendal Neuralgia. There is a good group on FB, if you happen to be a member of FB. The name of that is Pudendal Neuralgia Hope, and they are very helpful. There are a couple of men there with a lot of information too.
When it comes to LIS and recovery, if you look through the pages you will find quite a lot of information on this. Many have had the surgery, some have had problems healing, while others have done well. Hopefully, as this group is very helpful, you will get some replies to your question on reply times from LIS. LIS is regarded as the Gold Standard in the USA, but other countries have other views; such as Japan and Germany.
Here is a link on LIS here:
http://anal-fissure.org/t3045-anal-fissure-patient-information-uptodatecom
Hope this is some help.
Savaici

Thanks for the info savaichi. Yes I'm a member of the pudendal hope website. It could be that the fissure is affecting the nerve, which explains the penile pain.
The people on the website are very helpful but at the same time they can make you think that you have pudendal nerve entrapment when you don't.
I'm very confident that when the fissure and spasming go away then I will be 100% better.
I can't wait to see the colorectal surgeon and finally begin to treat this problem.

Hi there again,
I found their site to be very confusing, which is why I turned to the FB group. Much easier to glean info from there. I have not had physio, and begin to believe that a lot of the extra pain (mine is in the vulva and my coccyx) is pain that is from all the straining (in my case) in having a BM. Everyone says don't strain, and this is great advice, but so difficult when you feel you have a golf ball left behind.
I have seen a CRS and he could not see a fissure and said he would try botox (no!) and if not, then LIS. And, if I did not want to have LIS, then I would just have to accept that I have a 'sensitive rectum'...I do not believe that last one. I never had any problems before 18 months ago.
Anyway. Good luck with the CRS.
Savaici

Hello reckless,
I too are in London and have just started seeing a CRS
The first course of action will be to prescribe GTN 0.4% which you use for 6-8 weeks. If this does not work you will then have the internal camera followed by Botox injections.
If all conservative methods above fail then the final solution is LIS.
Davo

Hi Davo,
Thanks for the info.
6-8 weeks? That's a huge amount of time!
I've had to leave my job because I can't take the pain when sitting.
I want to go back to work as soon as possible. Do they give you the cream even if you've had the problem for 7 months?

Hi reckless,
Unfortunately i think they will - they follow a strict routine and always offer surgery as a last resort.
GTN does make a difference with pain relief, you normally some relief within a week or two and it gets better over the 6-8 week course.
I am at the 6 week stage and my pain is around 1-2 out of 10. Unfortunately i still have not healed so i will probably have to go on to the botox which lasts for about 3 months.
It is very frustrating i know - i am getting married abroad in the summer and are worried stiff that the fissure will ruin my day!
Whereabouts is your CRS located? Is he in London itself?

I'm still waiting to be referred. My bloody GP centre are taking their time.
I can't sit down without pain. When I'm not in pain my internal sphincter spasms. It feels so tight. Then when I sit the tightness is replaced with pain. I don't know why the tightness goes when I sit.
I live in the Slough/Windsor area so that's where the surgeon is likely to be.
If it's going to take a long time to be referred then I'll go private.