by Guest » 02 Jul 2013, 06:11
"....Is she missing the one inside or is it that the external af can cause muscle pain that much deeper in?"
Anal fissures develop externally but extend inwards. The tear typically extends into a circular ring of muscle called the internal anal sphincter (IAS). While the IAS is an involuntary muscle that maintains anal tone and is normally in the state of contraction, the EAS is a voluntary fatigable muscle that provides short term augmentation of anal pressure to postpone defecation. In simple words, the IAS is controlled by the body, while the EAS is controlled by us. Hence, the use of terms, "voluntary" and "involuntary". Your fissure has extended inwards which is why you feel the burning from the enema as soon as it comes in contact with the sodium content.
"..... I believe she gave me botox based on the external one but it hasn't quite reached all of that internal muscle."......
Botox is usually injected into the internal anal sphincter -- the involuntary muscle, so that it doesn't contract or go into spasm. It helps to lower the resting pressure or so-called tension and further improve the blood flow to the fissure area to promote healing.
I hope the above info clears your doubt. Happy healing !