It's pain from chronic anal fissure. I know, I know .....who wants to talk about it, right? But you'd be surprised: more common than you think. Acute tears are painful, but not nearly so much as the pain from chronic fissure that causes spasms. Creams and salves, ointments are of limited value: the best is one containing nitroglycerin. Nobody wants you that this condition can happen due to surgery, after which time you may have to lay on your back at a slight incline. This puts pressure on anal area. Add to that complications due to painkiller or surgery-med  gut aftermath of bowel slow-down and you've got a recipe for disaster with fissure development. So, I'm on the list from 2 hospitals to see GI specialists who deal with this, and I'm on cancellation lists. Think this is a rare problem? Those docs are busy people. Think you can strong arm it thru this? I'm a tough person with high pain tolerance. I wound up having to go to the ER, the pain was so bad. I'd already taken some painkiller, it did nada. ER doc prescribed nitroglycerin ointment and tried to fast-track me to general surgery. I wish surgical teams would forewarn patients about this, particularly for shoulder surgery when you have to sleep on incline, on your back. I also with GPs would learn that the fresh fissures, though painful are nothing compared to the spasms pain from chronic fissure that is trying to heal. I'm hoping for Botox tx.....yeah, THAT bad.