Fissures can be incredibly painful, so I don’t think degree of pain is a strong argument for an (out of the blue) fistula. Most people have longer courses with fissures than a day or two, so I don’t think that points to fistula either. My best guess is that it’s a more severe fissure than you’re accustomed to, and it probably needs patient and meticulous treatment. I hope it feels better soon!

Hi Scott,

I just spoke with the nurse at my GI office and she told me that they want to send me to a proctologist.  My doc always took care of anything to do with that area.  What did you mean by meticulous treatment?

Thanks!

@Joey A posted:

Hi Scott,

I just spoke with the nurse at my GI office and she told me that they want to send me to a proctologist.  My doc always took care of anything to do with that area.  What did you mean by meticulous treatment?

Thanks!

By meticulous treatment I mostly meant a dedicated effort to keep stool from spending any time in the fissure (or fissures) so healing can occur. Perhaps a sitz bath after every BM, use of a bidet, local treatment with nitroglycerin or diltiazem, and patient persistence. In difficult cases Botox injections are sometimes used. A proctologist can help ensure that the diagnosis is correct, and may be more familiar with the full range of treatment options.

Good Morning Joey the pain you are describing is what my wife is experiencing she has had her pouch for 29 years.  She has intolerable pain every day she just had a MRI earlier this week hoping to see some cause like a fistula or fissure but nothing.  

I’m sorry for your wife.  It’s one thing to have pain, but another not knowing where it’s coming from.  Good wishes to you.