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Painful condition near anus

For 20 months the area around my anus and between my anus and scrotum hurts whenever I sit (and often even just standing). The pain is a burning/prickly/stinging/pinching/raw feeling (no itching, though) of the skin; when I am sitting it also has a more localized stabbing feel near anus.
Description: Please see pictures posted at http://www.geocities.com/crf027/problem.html There usually a redness around my anus which darkens and extends when the area becomes more irritated (redness is ~1 cm radius normally). There is a tab of skin next to my anus (towards my scrotum) that has been called a "collapsed hemorrhoid" or a "skin tag" by different doctors. Also, there is a small crevice (1 cm long, 3 or 4 mm deep) alongside this tab that, when pulled apart, is pink inside. This crevice goes to the edge of my anus but not inside, and I believe this is the source of my problem.  None of these features are particularly sensitive when they are touched or pressed on, but if the area is probed/manipulated/scrubbed/sat on, then afterwards it becomes significantly more sore for a day or two. Also, there is a wetness that correlates with degree of irritation. It is a slippery brown stuff (probably mucus; one doctor told me that the anus is just one huge mucus membrane; sometimes it also has a little of what looks like fecal material). I think the irritation is causing the mucus, and not the other way around, because cleaning it off does not improve my condition. The skin itself is smooth (no bumps, pustules, etc.) except for this divit looking thing.
Colorectal surgeon found an anal fissure, which he treated w/sphinterotomy 11 months ago. The fissure went away (also confirmed by second surgeon), but no relief of symptoms. I specifically pointed out the area in the pictures to the second surgeon, but he didn
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233190 tn?1278553401
1) Without seeing the lesion, it would be tough to say for sure.  Certainly a fistula can possibly cuase your symptoms.

2) It would be unlikely that two colorectal surgeons would miss this.

3) Fistulas is one characteristic of Crohn's disease.  If it is present, then Crohn's disease is possible.  

4) There is no definitive test for Crohn's disease.  However, the colonoscopy is pretty good.  Serum antibody tests can also suggest the disease.  

5) Dermatitis, a fungal infection, or prostatitis can cause discomfort between the anus and the scrotum.  If the GI issues are non-revealing, a urology referral to evaluate for prostatitis can be considered.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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