If it was a fissure, I would think you would have extreme pain with every bowel movement. Plus, Botox should have helped in some way. What you describe could also be a structural defect (like an internal prolapse or twisting of the pouch) or muscular dysfunction (such as pelvic floor dysfunction). MRI may or may not sort this out. Defagraphy may be the next step, which shows the actual emptying process.

Jan

Hi Jan, thanks for you response. I've already had a scope of the pouch done under general anaesthetic, would this be able to reveal any structural defects or are other tests required to assess the structure? Nothing like this was reported to me afterwards by my surgeon.

Scoping is great for revealing inflammation, growths, strictures, stiff walls, overstretched pouch and those sorts of things. However, it cannot show what your pouch does when you are trying to empty it. Anesthesia would only relax things even more, so it is a passive exam, not a dynamic one.

Defecography is done in "real time," where you are given an enema of thickened contrast. Then flouroscopic imaging shows what your gut does while you try to empty the pouch. It can be embarrassing, but it is the perfect way to show if your pouch is twisting or collapsing when you bear down. There are some members here who have had this imaging test.

https://en.m.wikipedia.org/wiki/Defecography

Jan