My troubles started with what was initially diagnosed as an internal hemorrhoid. Symptom was bleeding after bowel movements but no pain. My physicians also checked my colon via a sigmoidoscopy and barium enema test and found nothing. About 6 months after I thought the hemorrhoids were healed, I suddenly started getting severe pain with bleeding during bowel movements which was diagnosed as a fissure. It was intense pain and I have no idea what caused this (no unusual events or constipation).
I went through the traditional series of fissure treatments, including sitz baths, stool softners, nitro cream (but at the US over the counter dose of 2%), and changing my diet (more water, fiber). The baths were the best, the softners helped, the nitro gave me a headache. The fissure didn't heal, and I later developed a fistula and at about the same time the fissure became infected (I noticed puss). At that point my doctor said I had no choice but to go for the surgery. I went to a well established, board certified, seasoned, surgeon specializing in colon and rectal surgery. He did a great job showing me my fissure via a scope with images on a TV and discussing the surgery. I was scheduled for surgery within 3 days.
It was an outpatient surgery, and the recovery seemed normal - but lasted longer than I expected (weeks). The pain was gone after about a week, and bleeding stopped after a few weeks. About 2 months into the healing process I started to notice bowel leakage after bowel movements. This caused me to return to the bathroom a number of times to "clean-up" after a bowel movement, depending on how loose or formed the stool was. My surgeon suggested doing kegels (a lot) to strengthen the muscles. His exam showed that my rectal muscles had lost tone. He was a bit perplexed at this given that I had good tone before the surgery and apparently OK tone after (but hard to determine due to the swelling).
I did tons of kegels and it did seem to help, my trips to the bathroom after bowel movements decreased. I slowed down on the kegels and after another few months the leakage got worse again (it never completely went away). Back to the surgeon and more kegels recommended. After about a year+ of this (with about 18 months in total passing since my surgery), my surgeon finally sent me in for an ultrasound test (the first one I every had on my rectum). That test revealed that both my inner and outer spincters were "damaged", each in 2 places at about the same position.
The surgeon was again perplexed as the damage covered areas that he said did not involve the surgery. He did finally admit that he may have cut too deep. He said there wasn't anything he could do as surgey to repair the spincters would be too complex given the 4 different damaged areas. Now it is close to 2 years since my surgery. I have leakage after every bowel movement, sometimes worse - depending on the bowel consistency. I have learned how to deal with it, including showers following a bowel movement if I can. I do kegels every day. I have absolutely no explaination of the cause of the spincter damage other than the surgery. Fortunately, I have no problems prior to bowel movements and can effectively hold them. It is only afterwards that my life has changed.
For reference, I had no problems of this kind before the fissure happened and my doctors never suggested poor muscle tone. By the way, my surgeon said he didn't observe any indication of hemmoroids and suggested it may have been a fissure all along. He also said I am the first patient in 20 years to have this problem. Given that I had both a fistula and infection, I believe I had no choice but to go for the surgey. Something went wrong with that and now I have a problem that seems to have no end. I am currently 43 years old (male).