Anal Resting Pressure After LIS

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Anal Resting Pressure After LIS

Postby jr2 » 19 May 2012, 09:08

Here is a link to a study with some very interesting numbers ...
I always knew that following LIS there is a dramatic decrease in anal resting pressure, followed by a gradual increase over the course of the first year. What I didn't know is that even at its lowest point following surgery the anal pressure is still higher than that of healthy controls, and further is significantly higher than those same healthy controls in the data one year later. While the pressure doesn't seem to ever reach pre surgery levels, it does rise quite high. The take home message in that is even after LIS it is a wise thing to keep the diet safe and sane permanently and to keep practicing whatever works for you to keep those stools soft, easy to pass, etc., and it would seem to be even more important to do so the longer the period of time you are from your surgery. It would be interesting to see data even further out, like 3 years, 5 years, etc. It also makes me wonder about rates of fissure recurrence following LIS, particularly years later. It seems logical to think that LIS works really well for healing the fissure you've got now, but doesn't do that much to your physiology to prevent it from happening again.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357726/
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Re: Anal Resting Pressure After LIS

Postby workingonit » 24 May 2012, 08:37

This is very interesting JR,
food for thought.
Thanks!
-Tanya
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Re: Anal Resting Pressure After LIS

Postby jax » 11 Jun 2012, 22:23

This is interesting. I wish my CRS had done a manometry test before LIS to have a comparison. Although I believe he just performs the procedure based on his feel.
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Re: Anal Resting Pressure After LIS

Postby aimonaali » 31 Jan 2013, 11:27

I'm a bit puzzled by this study. In the study the pressure is always higher with the patiens than with the healthy control group.
So does this mean that the people with tendensies to having AF's have generally tighter sphincters than regular folks? Or does the AF somehow still keep making the sphincter tighter even after it's healed?
Any thoughts? I hope you can understand what I mean, English is not my first language:)
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Re: Anal Resting Pressure After LIS

Postby pinpin » 01 Dec 2013, 05:41

Hello,

Just managed to read this, and it actually proves, that we here with fissure having twice as higher resting pressure due to pain inside!

The mean basal resting pressure before surgery was 138 ± 28 mm Hg
One month after surgery 86 ± 15 mm Hg
12 months after surgery 110 ± 18 mm Hg
Healthy control group got 73 ± 4.8 mm Hg


Which means, even after you got cut by surgeon, you have tone higher than a rest of planet. That completely describes the reasons of slow healing!

Reference picture
Image
The horizon line below is healthy persons.
07.02.2013 - got open hemorrhoidectomy, leaded to slow healing wound. Link to story
11.12.2013 - LIS surgery
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Re: Anal Resting Pressure After LIS

Postby Scientist2516 » 02 Dec 2013, 11:22

What we don't know is, what was our anal resting pressure before the fissure? Have we always had a high ARP? Is that one of the reasons we got the fissure? I mean, other people get constipated, have anal surgery, whatever, without getting fissures.

Or is the high ARP caused by the pain of the fissure? I think that would be really important to know.
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: Anal Resting Pressure After LIS

Postby Deleted User 2950 » 02 Dec 2013, 12:10

"Patients with chronic anal fissures generally have increased resting anal pressures caused by hypertonicity of the internal anal sphincter, but the causative mechanisms are unclear. Elevated anal pressure also exacerbates the ischemic state of the posterior commissure and the sphincter and reduces anodermal blood flow"

https://www.clinicalkey.com/topics/gastroenterology/anal-fissure.html

hypertonicity

http://www.wisegeek.org/what-is-hypertonicity.htm

scroll down for the causes and treatment of hypertonicity
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Re: Anal Resting Pressure After LIS

Postby Scientist2516 » 02 Dec 2013, 13:12

The only way to find out would be to measure the ARP of hundreds of people without anal fissures or hemorrhoids, and wait to see who develops anal fissures.
Once there is pain, you can't tell whether the high ARP was always there, or is caused by pain, or caused by some other problem.
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: Anal Resting Pressure After LIS

Postby Deleted User 2950 » 02 Dec 2013, 15:32

Yeah,

I was looking at the correlation of why some people get back spams and others don't.
What those references suggest to me is that indeed some people have hypertonicity
in their muscles causing the elevated ARP before getting AF's, while most don't.

Yep, who knows: And the study continues.......


aimonaali wondered
Or does the AF somehow still keep making the sphincter tighter even after it's healed?
Any thoughts?


I would think it's a due to the hypertonic muscles that some people have.
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Re: Anal Resting Pressure After LIS

Postby Scientist2516 » 02 Dec 2013, 16:16

It could also be that people with high ARP are more likely to develop chronic fissures.
I read a study somewhere that said a high ARP means you are less likely to heal with creams, and more likely to need LIS.
Think I posted it somewhere here.............
Wouldn't you think CRS's would measure your ARP during your first visit? Maybe it's a complicated or lengthy procedure.
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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