Eureka!
I think I finally got my answer!!! and Ravians, in NO WAY meaning to "hijack" your post - I think this might help answer a lot of your queries too. I have to thank you so much for your help because of your post and in fact, I did a bit of research after hearing from you, googled "Internal Sentinel Piles" and the most useful information it brought me back to was here, on this very website!.........
GOD BLESS the Anal Fissure Support Forum!!!
I have posted the thread link below.After 1 yr, 5 mths (and counting...!) with a chronic fissure, I'm still experiencing some ongoing throbbing, pricking , uncomfortable but not particularly painful sensations from what I've been led to believe are from two internal piles by my CRS...nobody even mentioned the phrase "Internal Sentinel pile", so I've been assuming I've normal internal hems, which will at some point hopefully disappear through careful diet and toilet habits..... Only I've been doing this now for 5 months and nothing is shifting those little devils.
Momof7 you hit the nail on the head I'm certain, when you simply stated "You may have both".....
I am 99% convinced I do. One normal internal hem on my left (far less troublesome) and the other an Internal Sentinel pile on the right, right by the chronic fissure site. I always wondered why I didn't see a Sentinel pile but I now I'm certain I do - it's internal, not particularly visible, but just as the thread below describes, small, pea-sized, pink and I can just see it if I pull my buttocks apart. I can also feel these damn things re-positioning themselves after BM's!!.......It's like some kind of light finally at the end of a very long dark tunnel.....
Now I stress I am NOT a CRS! I should NOT be self-diagnosing but I know my body and have had enough anal-issue experience over the last few months to recognise symptoms and distinguish what is what down there........I booked a further CRS appointment before I even picked up my emails this morning because I just knew something was still not right down there and now I'm sure I know.
I'm going to repost this Ravians on my own thread because I certainly didn't intend to hijack yours but I also need answers now like "How do I get rid of this once and for all?"!
In response to your own queries, yes, if you do have what I truly believe I have, then yes at least one of those swellings is certain to be a Sentinel pile accompanying your fissure, which might swell a little with a BM. Most are pretty harmless, some can cause issues and I think the internal ones moreso, because they "get in the way" in the anal canal. If normal hems, yes, they can also swell after BM's, particularly if the BM is hard to pass and hard (but not always as I have very soft stools these days and mine still gets easily aggravated)
I'm pretty sure that if they are regular hems/ Sentinel piles/ Skin tags that they are NOT the beginning of a Fistula. It really is such a different issue.
Have a good read through the attached link - I found it incredibly helpful and hopefully you will get some reassurance from it too with all your skin tags & piles (Sentinel or otherwise!).
I think it must be fate you messaged me and posted this & that I contacted my CRS again first thing this morning....I really feel like today, I have made some sort of sense out of my own issues through yourself. I hope I am right!!!! Thank you so much.
http://anal-fissure.org/t1014-sentinel-pile?highlight=sentinel+pile