by thisfissurecankissmybutt » 03 May 2013, 06:07
Well, here is a very brief overview: for me (and my experience might not be typical), it all started with a hard bowel movement that required me to push really hard. About 4 hours later, my butt started to hurt, but I noticed the pain was a little higher up and to the left. The pain lasted for about 8 hours. For the next several weeks, the pain continued but only after I had a BM (no BM = no pain). However, I never had any pain or bleeding during a BM.
After a couple of weeks, I went to my family doctor who did a THOROUGH rectal (digital) exam. The exam was pretty much painless. She looked for a fissure and fistula, but didn't find anything. However, she did say my sphincter was REALLY tight. She referred me to a CRS. However, as I left her office, I noticed that I actually felt better (which was an important clue that I didn't realize the significance of at the time - after most rectal exams, especially for those with fissures, the exam can be excruciatingly painful; however, I felt better because my doctor had essentially stretched my sphincter muscles which temporarily relieved my pain).
Of course, the next day, the pain came back after my daily BM.
Eventually, the pain I was experiencing would start immediately after a BM and sometimes last 8 to 12 hours (or more). In addition, due to my tight sphincter, I developed a fissure which turned into a fistula, which required me to have surgery for the fistula repair and LIS.
In any case, before the fissure and fistula, I found a wonderful CRS that correctly diagnosed me with LAS after other CRS's were stumped and just sent me home with more medication that did nothing for my pain.
I won't go into all of the details here, but my CRS tried everything to help relieve my pain (muscle relaxers, biofeedback, steroid injections, etc.) but nothing worked until I found a life-saving physical therapist that specializes in pelvic floor dysfunction. She was able to help me manage the pain through intensive internal stretching and other techniques.
Basically, although my symptoms seemed similar to those of a fissure, they differed in the following important ways to most (but not all) people suffering with a fissure:
1. No pain during a BM.
2. No bleeding during a BM.
3. The pain felt higher up in the anus, and to the left.
4. Rectal (digital) exams were not painful.
5. Rectal (scope) exams were not painful.
6. According to my CRS and PT, most people describe the feeling of LAS as though they are "sitting on a golf ball."
Of course, as you alluded to, it is possible to have both LAS and a fissure (or multiple fissures).
I hope this helps.