Hi, have just read your post and wanted to let you know that my vet emptied my dogs anal sacs also from the inside. I expected it to be done differently from what I'd seen on tv/online etc, but this was the way she did it, but they were fine after. Sorry to hear about how uncomfortable Joey must be, I'm afraid I'm not sure what may be causing it. Was he like this before you adopted him? Has he had a change in food? Just wondering if going through the process of elimination may help? I hope someone has an answer for you very soon.