intense rectal pain/pressure like crushing of sphincter trying to find solutions

[LReilly23]

Male, 36
Family History of Colon Cancer on 2 sides siblings of grandparents
Not history until recent 3 years of any rectal pain, hemorrhoids or leakage
No rectal involvement in sexual history
gentle to my rear as one can be
Until 3 years ago, maybe 6 hemorrhoids total

Possible Pre-cursors:
-3 years ago, very sudden thrombosed hemorrhoid that burst, didn't even know it had burst until pants felt wet. Doctor said it might heal and never be a problem again, seemed to, warned it could return
Treatment was standard
-For the full year before the current pain, had a lot of unexplained itchiness in the rectal area and up towards the groin. Discussed with doctor twice, treated as possible jock itch though never identified any
Treatment was Clotrimazole topical around my crack, a full course which I took and seemed to work but continued to be needed off and on, and hydrocortisone cream right on the anus, which seemed to do nothing and I probably only took half. This itching did go away about a month and a half  before this new issue


4.5 months ago, the first occurrence of what I didn't know would be something ongoing at the time, I just had a sore anus out of nowhere. Hadn't had a hard movement or anything. Wasn't unbearable and only lasted a few hours. I thought at the time maybe it was something in my workout; I'd begun regularly working out about 3-4 weeks prior.

a week later, another day like that, lasted a little longer.
The next week had two, and they started to last all day more or less

I spoke with my doctor about my workouts, my supplements, my fiber intake. noted that I had not had any hard stools around that first day, and that I take fiber gummies. He did an exam and couldn't see anything, and just advised I was probably fine and to take Ibuprofin.

Week 4, end of the first month, I was having these days about 2-3 days a week, and I'd describe the pain as discomfort almost more than pain, a pinch of my anus. I asked to see a specialist, saw proctologist, thinking maybe my thrombosed hemorrhoid was coming back. He did an exam and thought not. bit young for it, but a colonoscopy sounded okay given my distant family history, so we did that. No issues found. I asked if the proctologist saw any fissures or if I was prolapsing, he says no. Healthy colon.
He treats as maybe a minor hard-to-see fissure and gives me nitroglycerin gel.
It is never clear if this actually does much. Feels like about 40 minutes of relief at most, but after 3-4 weeks, it became clear that even if so, it comes back worse after, hitting new levels

I talk to doc and return to proc. Proc does another exam, says pain localized back more towards the tailbone just inside my anus. Says I am spasming and he doesn't know why. Okay, if he says so, I can't discern that well. He prescribes Mesalamine suppositories and to continue nitro.
I do continue nitro for only like a week. Mesa DOES seem soothing all but one time, but (this is a big but) something I haven't mentioned yet is the positional aspect of this. Mesa is applied lying down. I already usually feel a TON of relief when I lie down. Also, Mesa is Chron's medicine, I don't have a bunch of the symptoms for Chron's, but again it does seem to cause relief and I don't know I'm not a doctor. It sometimes is hard to sleep with the Mesa, and it dehydrates so I'm only taking in on bad nights....doesn't seem to be solving anything like I said, soothing for the evening at best.

so now we're at 3 weeks ago, just before Christmas –> now.
It is easiest to describe in terms of...
If I had a bowel movement today (so, 5-6 days a week), this is what I have to look forward to after about 25-30 mins:
-pain/pressure on anus ramping up to and approaching agony for the rest of the day, I describe it like someone is vicegripping my hole
-total replacement of any signals that I have gas incoming, I get about 4 sec heads up that I'm about to fart, then pain is actually slightly relieved but this is still indiscernible from pain that doesn't seem to be any gas in waiting
-about every other occurrence, some anal leakage, which I've never experience in my life. When I say some, we're not necessarily talking new underwear needed every time but more like I didn't wipe well.
-frequent issues with a sense of urgent urination, though not actually much urination seems to need to happen

Notes on the bowel movements themselves
-Not much at all seems off, no pain, doing everything I can to be as gentle as I can
-My sphincter does actually feel a bit odd when eliminating, like its sorta slacking on its part of the job, eliminating fully while not straining has become mentally stressful, may rock back n forth and maybe engage the muscles a few more times than I ever did before, like a few more heave-ho's, not a strained squeeze or anything. This all wasn't something I noticed for the first month or so.

positioning
-sitting has become almost something I can't do for 95% of my week. This could be a form of torture. I can't do a 3 minute car ride without almost just wanting to shuffle off this mortal coil, and that's ON the pain meds (I'll get to those).
-Standing up is about 40% better. I can think about things other than my hole for brief periods standing up.
-Lying down is almost 90% better and that's fast. If I can lie down for 5 hours or so, I generally wake up re-booted, reset and ready to try not to dread my next poop. I have only had one occurrence of the pain increasing after lying down.


Pain treatment:
Before 3 or 4 weeks ago, prescriptions and then an advil and I wouldn't be comfortable but I'd be functional, just needed to get up from sititng often
Around Christmas, hit new levels.
I'm taking 6-7 advil or motrin, 8 tylenol, and 2 tramadol I've just been prescribed in the past 10 days. These barely take the edge off. a short car ride is too much.
Tram seems to do nothing, which I know it helps with some stuff because I had it for a broken bone before. Doctors won't give anything else at this time.

extensive labs PSA for prostate, the exams, a CT with contrast just this week of my tailbone area, the colonoscopy, the meds I listed, no AHA moments, and just newer and worser symptoms.

the only mention of anything looking off: your CT showed a lot of stool (which was kind of weird because it wasn't a day I felt I had to poop much or anything)

Both docs have said fissures shouldn't really last this long or fail to react to treatment this way.

Other things I've tried:
-completely abandoned my new workout schedule for about 10 days, stopped all the related  supplements and protein shakes; until the past 3 weeks that was the worst 10 days, whether or not there's a connection
-I was already on a 4th week of abstaining from alcohol when this all started, and I had planned on continuing another 4 weeks already, and I ended up doing 10 instead because of this
-circular butt pillow might buy me about 10 minutes of less uncomfortable sitting
-I already work standing up, so sitting less in my leisure time has certainly been attempted, but sometimes I need to sit! Plus the pain will start even if I haven't sat after my movement.
-Warm baths, a treatment for fissures...I don't take a bath over a shower often...The four or five attemps at this led to MAYBE slightly less pain but maybe some increased leakage? Either way, it wasn't a win by any stretch. Hanging out in warm water is nice, but I don't have a way to make that a feasible plan, kinda like lying down.

I'm healthy on paper, but when this is peaking, even on just 1 day but definitely 2-3 days in a row, I'm in so much pain I'm falling apart in my head

[LReilly23]

update: a friend conveyed to me that hes had that rectal unexplained itching i had for a year for even longer, with an occasional day of pain....we both swim a lot in his pool. Possible to get nerve damage or something similar from long term exposure to the chemical treatments if they were a bit strong? If so how should I proceed