Turns out my "hemorrhoids" were actually high sphincter pressure. Anyone else? Botox next?

Hey everyone, posted here a few months back thinking my issue was hemorrhoids. Wanted to come back with an update because the journey took a turn I didn't expect, and I'm hoping someone here has been through the same.

Quick background: 32M, moved to Dubai from Pakistan late last year. About 2 months after moving, constipation started — but not the usual kind. Stool wasn't hard. I had to strain even when it was soft. Felt like something was blocking the way. No natural urge to go. Never felt "done" after a bowel movement.

Went through the full workup over the past few months:

• Blood tests, stool tests, thyroid — all normal
• X-ray transit study — normal
• Consulted 2 different doctors — both felt small internal + external hemorrhoids on rectal exam
• Colonoscopy + upper GI endoscopy + biopsies — colon completely clean, small hemorrhoids and a skin tag confirmed, incidental finding of hiatus hernia + mild gastritis (unrelated). Biopsies all clear.
• Was on Duphalac, Laxacone, Anotrit, Doxiproct Plus for weeks — stool got softer, but the core issue (no urge, incomplete evacuation, still had to force it out) didn't improve.

Here's the weird part that finally gave doctors a clue: during the colonoscopy prep, when my stool was literally just water, I still had to consciously push and concentrate to release it. That's not normal. That's what tipped everyone off that this wasn't a stool consistency problem.

Got referred to a colorectal specialist who did:

1. High-definition anoscopy — confirmed the hemorrhoids are minor, not the actual cause
2. Anorectal manometry ("pressure test") — and here's the finding: increased sphincter pressure. My anal sphincter isn't relaxing properly when I push. Basically the outlet is functionally closed even when everything else is fine. Diagnosis: anismus / dyssynergic defecation.

So now the plan is:

• 10-day trial of Rectogesic (GTN 0.2%) internally + Levorag Emulgel externally to see if relaxing the sphincter improves things
• If it works → Botox injection into the internal sphincter (buttock injection at the clinic, ~30 min, temporary paralysis of the sphincter for 3–6 months to let things reset)

My questions for anyone who's been through this:

1. Did anyone else here get diagnosed with high sphincter pressure / anismus / dyssynergia after initially being told it was hemorrhoids?
2. Anyone tried the Rectogesic (GTN) or diltiazem ointment trial? Did it actually help evacuation, or just help fissure healing?
3. Anyone had the Botox injection into the sphincter? Did it work? For how long? Any complications like temporary gas leakage?
4. Did anyone try biofeedback / pelvic floor physiotherapy instead of or alongside Botox? Was it worth it?
5. For those who resolved it — what actually fixed it long-term? Botox alone, biofeedback alone, or the combination?

I'm nervous about the Botox because it feels like a big step, but I'm also 8 months into this and tired of feeling like I'm never actually done in the bathroom. Just want to hear from real people who've been on the other side of this.

Any experience appreciated 🙏