Have most of you received an anoscopy exam to fully diagnose your fissure(s)? I know my CRS didn't want to do one on me because he said it would be too painful and I was too tight (probably more due to nerves than the fissure... I was scared out of my mind to have my butt looked at). He just looked at the outside, but couldn't see anything. I know I have a fissure because I can see the sentinel pile and part of the cut/ulcer when I pull the anal skin back (as long as I'm relaxed enough).
I will probably have to go back to see him (or another CRS) again in a few weeks since I don't think the Diltiazem helped me very much and I'm scared that they'll do the anoscopy on me. The thought of having something big like an anoscope inserted in my butt when I still have pain from the fissure scares the heck out of me and makes me not want to go see him. : ( But, at the same time, I really want someone to fully look at it so I know what I'm dealing with. I heard about getting the exam under general anesthetic, but isn't that really costly? Or maybe he could use a pediatric or plastic scope? Those large, cold-looking metal ones freak me out!
Thanks for your help!

Rule no.1, never look at the gear! :D
I did anoscopy under local anesthesia (some gel) and it wasn't that bad. Doctor used a camera to look inside. I don't know how correct diagnosis is even possible without this.

Luka,
It is always up to you as a patient whether to agree or not to anything a physician suggests. If you are in too much pain and the muscle is too tight there is no reason for a doctor to put you through anoscopy. Most fissures can be diagnosed by visual inspection alone, but even if it isn't possible, yes, it is possible to have the exam done under sedation. I don't know what a physician would charge for that for a cash patient, but you could always ask about the cost before agreeing to anything. As an alternative to full sedation, a physician might be able to use a local anesthetic in the office instead.
Also, yes, there are smaller anoscopes and you can request a small one and also request to be able to see it first before the doctor tries to use it. But really, with an active fissure and a tight muscle, anoscopy without any anesthetic will likely do more harm than good, both in terms of your pain and the risk of making the fissure worse, and may not even yield the physician anything useful in terms of diagnosis because of the level of discomfort it could cause.

same case here Luka. I went to senior surgeon he just checked by slightly stretching the anus as far as I allowed him but I also visited two Dr who were not very old in profession they treated me like a sacrificial goat n I was screaming n at the end of proctoscopy bleeding n next day I came to know that I have one more fissure. so from that day I decided not to allow anyone do it to me like that again. n yes bgd n jr2 r right y can get it done under general anaesthesia or local as well. that will b far more productive. wish u gud health take care

Thanks everyone for the quick replies. : )
bgd: It's kinda hard not to look at the anoscope when it's sitting right on the table in clear view. : ( It looked pretty big and seeing it really freaked me out. Did you get a sigmoidoscopy? I think that's the one with the camera. I know they go further up into the colon with that procedure, though, not just in the anal and rectal area.
jr2: I agree with you that it's my decision as a patient to get the exam or not. I just know some people on here had CRS's that were not very nice and did the anoscopy exam anyway, which really hurt them. So that concerns me if I decide to see another CRS. Honestly, I don't think I could tolerate the anoscopy unless it was with a smaller, child-size one. Even with that, though, I'm not sure. I know that you can see the beginning of the fissure just by pulling the anal skin back a bit, so I would think that would be enough to confirm diagnosis. I'm thinking if I ever decide to get the full exam, I'd rather it be under general anesthesia and if the CRS thinks it's bad enough to warrant LIS, then I would do it while already under sedation.
ravians: Yikes, those two doctors you had sound like awful human beings. I've had my share of bad experiences with doctors and pray I never run into a CRS that treats me like that. I'm sorry you had to endure that. No respectable doctor should treat their patients like that by putting them through an exam that causes excruciating pain and possibly making the fissure(s) worse. : (

I totally share the fear of anoscopy!
As a result, I still haven't been properly looked at..
So far I have been to the CRS twice. THe first time was with a lady doctor who was very gentle.. until she tried to insert the anoscope. basically, she just kept asking me to take deep breaths. in hindsight, I should have just focused on relaxing my bum in my own way. (I just can't relax when someone keeps telling me to breath!) She was also forcing it in the wrong angle.. causing sharp pain and bleeding and a retear (at which point I had not bled for months..) but it was slowly healing and then I had another setback:( anyway, I don't think she managed to look properly that time, which I guess was partly my own fault

I then went back again but requested to see the lead CRS. but like many medical doctors, he talks really fast and would not let anyone ask specific questions or raise concerns.. he would immediately throw you something that is, to us AF sufferers, common sense!

Also, I could see the big anoscope (and a much longer scope) on the table so I told him that I think they are too big for me, considering my current state and my previous experience... He just kept saying that it would be fine, and that it is common to bleed a little from an internal examination (is this true? what about a retear?).

I asked about the possibility of an EUA, but he said that he had never used it just for examination. He would only use it for a procedure such as botox injection. I also asked a question about LIS, but he totally ignored it and said that he had not done an LIS for 5 yrs since other treatments work well.
This is the colorectal surgery department of one of the major hospitals in the U.K.
So I feel very confused because what he said were in many ways contradictory to what I read online or in this forum, and my own experience and gut feelings. (e.g. he gives me the impression that EUA is only performed under exceptional circumstances, and that LIS is rarely performed..) He also assumes that I don't know anything about AF.. So I had great difficulty trusting him (to me, a stranger whom I have problem communicating with) that he would even try to examine my bum gently.
So in the end I didn't let him look.. silly I know, but I was really traumatised last time!
Do I have a reason to worry?
Should I go back and let him examine me without anaesthesia next time and risk a worse retear...?
Or should I just leave it for now unless it gets much worse..