Looking up from my computer I purposefully meet your eyes and smile warmly in an attempt to reassure you, but as you sit in front of me wearing just the standard issue hospital gown, I see that you still look very nervous.

The student nurses on intake did their best to prepare you but you are still unsure of what to expect from the appointment. I continue to make eye contact and you shift uncomfortably in your seat.

"Hello I'm Emma, one of the senior prescribing nurses here, I can see you have been seeing Doctor Payne for severe episodic anorectal pain. Is that correct?"

You nod and I see you swallow hard and take a deep breath. You are obviously too nervous for words but that's ok. Most patients in your position usually are. I look back to the computer and read aloud the main points of what's been sent to me on your treatment plan.

'Following extensive in clinic investigations, Mr Jones has been diagnosed with Proctalgia fugax, a variant of Levator Ani syndrome.

Two targeted injections of Botulinum toxin, to be given directly into the anal sphincter and repeated every eight weeks are recommended along with gradual anal stretches, initially three times a week in clinic and there after, as often as the patient is able and comfortable with. Enemas may also be useful. Please show the patient how to commence with anal dilatation.'

It seems like I will be seeing quite a lot of you, I muse as Amy, one of the young student nurses I have had shadowing me slips quietly in through the door.

"Ok, Dave. If you could pop yourself up onto the treatment couch and kneel on the platform at the end, please. I'm going to start with a quick exam and then a good enema, it will make the treatment more comfortable for you. "

As instructed you get into position, your bottom peeking out of the gown. I can see your balls and penis drooping down between your legs. It's all in a days work and nothing I haven't seen hundreds of times before but I can clearly sense how embarrassing you are finding this.

I move behind you and loudly snap on a pair of nitrile gloves and you flinch as I squirt a big blob of lubricant directly on to your anal crease, liberally coating my gloves.

"Just relax now...."