Hi, just wondered what this might be. However, for a subgroup of patients with fissures refractory to medical therapy who are at risk of incontinence or are reluctant to undergo the gold standard surgical treatment of lateral internal sphincterotomy (lis), we have combined injection of botulinum with fissurectomy. An abscess close to the anus produces a throbbing pain that worsens over a few days, and is usually bad enough to disturb your sleep. Sometimes there is no poo just clotted blood and it hurts so much just like a knive cutting me inside. The lactulose was very usefull because constipation is your absolute worst enemy with these conditions in my experience. Never leave it tho. Last time i think is was a cyst cause it bled for a short time and then stopped.
This time it was a real bad one. Or the ani levator muscle can be the culprit if the pain is continuous which has other remedies.