I'm 25, female, 171 cm tall, weigh 55 kg, white, suffering from anal tears and defecation issues, living in the UK and I've been having problems with my behind since childhood but it got worse in my teens. I don't take any medication or have other relevant medical conditions apart from skin around my vulva being easy to tear as well (just not as bad so I can prevent it in most cases). Here are photos of my issue (sorry for phone cam quality). The top picture is from today, the bottom one is from 3 months ago. The red bits are the tears I suffer from. They also appear on the blue bits occassionally since the skin there is very fragile as well. http://imgur.com/a/67UfC I have seen multiple proctologists, GPs and have been at the hospital for surgery twice (careful stretching of the sphincter + botox injection once and the other time just botox). I've been bleeding from these tears since childhood but around 17 it got so bad that I couldn't handle it anymore and started seeing doctors. At first they'd give me creams for haemorrhoids and anal fissures, suppositories for either softening up the stool or lubricating the area but it didn't help. And I always avoided cortisone creams. Later I couldn't empty myself anymore and I tried taking off the shower head to make the area relax and flush out any stool (so basically a douche). This procedure makes me feel horrible but it was necessary to avoid a lot of pain for years. I always tried to wash the area once a day only because I am well aware that too much water can make it worse. Whenever I manage to not use the water, I put a little footstool beneath my feet so I have the ideal position but 90% of the time I can't empty myself fully and have to use a clyster/douche. Sometimes it helps when i push two fingers on my perineum to get rid of the rest that's inside. If I don't do this, the stool hardens up so much until the next time I use the bathroom so I can't pass it or it just leaves deeper tears. I also suspected a little rectocele but the Docs couldn't find anything like that. I stopped using toilet paper years ago as it damaged the area as well. I don't do butt stuff in the bedroom either. I also tried diltiazem creams in combination with carefully using a dilatator but I only managed 2 cm, which would be ok if I had pudding like stool but that isn't the case. In fact my stool would be "ideal" according to the Bristol stool scale but that doesn't help my issue. I go to the bathroom about once a day, in rare cases 2-3 times. In the past year I had the 2 surgeries I mentioned. I don't take any medication. I basically try to leave my anus alone and apply petroleum jelly. I think it prevents some of the pain but the whole defecation process is just painfully frustrating. Last time at the hospital they told me I don't have a sphincterspasm anymore (despite not being able to open up wider) and they don't know how else to help me. Thanks in advance for any help, it is really needed!