Very tight anal sphincter

[jimbo108]

I've had chronic pelvic pain syndrome for almost 6 years. After several years of being pain free, it began to flair up again about 9 months ago, and I've been able to manage it with a modified version of the Stanford/Wise-Anderson Protocol - a combination of internal and external massage, trigger point therapy and meditation.

The treatments were going well, and I felt the problem was under control However, about 3 1/2 months ago things took a turn for the worse. I began to have significant pain every time I made a bowel movement. The pain would begin about an hour after the BM and persist for 2-5 hours. I posted on this forum and received the very helpful advice to use a heating pad after the bowel movement which has helped me significantly reduce the pain but not eliminate it. For the first time in months, I have some pain free days, but still have some very bad days.

Recently at the suggestion of my physical therapist I went to see a surgeon who can very highly recommended. I did this with some trepidation because of the many horror stories I've heard from people who have had surgery that either didn't help or made things worse. He did the following tests:

- Anal Rectal Manometry
- Flexible Sigmoidoscopy
- Defecography xray

After all these tests, I was told that I had no fissures, structural problems, etc. but do have a "hypertensive anal sphincter". This was described to me as a sphincter that was "tight as a drum" - in other words it is very strong and very tight.

My doctor recommended that I use a 2% Nitroglycerin ointment on this area twice a day. This ointment relaxes the blood vessels which in turn relaxes the muscles. Their hope is that it will break the cycle and if it's not enough to stop the pain he's probably going to recommend an operation to partially cut the anal sphincter to reduce it's strength (ugh!!!!).

I've been using the cream for a couple of days and to my pleasant surprise it seems to have helped - my pain is further reduced.

Assuming that an overly tight anal sphincter was part of the problem, my thought was why not simply stretch the sphincter muscle? I discussed this with my physical therapist who has given me good guidance on how to do this safely along with a set of dilators.

My questions:
- Does anyone have experience treating a very, very tight sphincter?
- Does anyone have any experience with using nitroglycerin ointment?
- Does anyone have any experience stretching the sphincter muscle.
- Does anyone have any experience with surgery on the anal sphincter?

Thanks in advance for any help.

[webslave]

This is an interesting post, Jimbo, and you raise some novel concepts.

[ramana]

I have had a very tight anal sphincter too. That was given a reason for my anal fissures.
>>- Does anyone have experience treating a very, very tight sphincter?
I am doing the same stretching that is taught in Stanford/Wise-Anderson Protocol. A PT (non pelvic) told me once that she had a woman whom she treated with her own version of stretching. Your PT also seems to have a method of his / her own.

>> Does anyone have any experience with using nitroglycerin ointment?
I used nitroglycerin for 4 months. There is a better ointment than nitroglycerin(forget its name will google and find it out). Nitro brings headaches. It is standard treatment for anal fissures.
>>Does anyone have any experience stretching the sphincter muscle.
Well just insert the finger and gently stretch it.
>> Does anyone have any experience with surgery on the anal sphincter?
I have had anal dilation done once. Was scheduled for LIS but fissure healed by that time. LIS does reduce anal pressure or strenghth. However, I have not heard of LIS being done just ot reduce anal pressure.
If you check pg 342 - 343 of Headache in the pelvis 4th edition, you will note that it is mentioned that the best way to reduce anal sphincter strength is well following Stanford/Wise-Anderson Protocol. I have been told by one PT that the the muscles acquire hypertone also due to overactive sympathetic nervous system. Calming it down will have more effect than anything else.
Let me know i

[mbaker]

Besides doing stretching of this area yourself with a gloved, lubed finger, you can also talk to your PT or physician about using a dilator to help stretch this area. They come in a range of sizes, and are used to help stretch tissues like this. You basically start with a small size and work your way up to the larger sizes over time until the tissue is stretched. This can take weeks or months depending on the severity.

--mb

note: not medical advice, and talk to your physician.

[SteveMalk]

I'm in the same situation as jimbo. My main problem is that my rectum is "tight as a drum".

I found these diators online:

http://www.enemasupply.com/klimdi.html

Has anyone ever tried the type of plug you can insert into the rectum and pump it to make it expand? This would also help stretch. Here is an example:

http://store.healthyandactive.com/ec120.html

I've never done either of the two above, but have just recently been doing internal stretching on my own at the 12-3-6-9 position. At first it seemed to help, but this last time it caused a flare that is now been almost a week strong.

In my humble opinion, I'm not sure the dilator would work simply because you really aren't working out the trigger points. I could be wrong. I still think all this could be TMS (tension myositis syndrome).

[scoobysnacks]

This was largely my problem too. I have found that once the trigger points are treated internally, the sphincter releases naturally. In my case, it wasn't so much a tight sphincter as the cause, but more of the effect. The cause was tighter muscles further inside internally. Just my findings and experience.

Seek out a good PT to assess your internal musculature. This takes time, a lot of time. I'm still dealing with it.

The Best I've found were nifidpine suppositories that my procto subscribed. The pharmacy has to make these, so I have to go to a hospital pharmicist, not the local grocery store kind. Ask about them.

Regards,

Ss

[PagesOfTime]

I've actually been thinking of ordering something similar to above for the sphincter. I thought sitting in a hot bath with one of them up there might be helpful.

But goodness, the smallest one is 1" in diameter! My thumbs thickest part is only 3/4" and that's a struggle. But that's what leads me to believe this might give me a much needed stretch that I'm not giving myself.

If you try any of them, let me know if it helps. I might hop to it first..

[mbaker]

Try Syracuse Medical Devices in NY state. Phone # is 315.449.0657. They sell medical grade quality devices. However, they only sell to people with a referral from a PT or physician. My PT was on their authorized list so it only took a phone call. Call them directly, or talk to your PT. If you have a pelvic floor PT in the US, it's likely they know of them. The dilators come in a range of sizes from XS up to Large. The XS is like a fat pencil. The sizes gradually go up from there.

--mb