Anal fissure: LIS and Pudong Method

LIS success and Pudong Method

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Anal fissure: LIS and Pudong Method

Postby Swampy » 22 Jan 2017, 00:57

Hi Everyone, firstly thanks for the support from your posts and for the great camaraderie between admins and users. This really is a helpful site and my kindest thoughts go out to anyone in pain with an AF. I am a healed LIS patient (operation in May 2015) and want to share some thoughts. Take home message: whether in remission or with an active AF, avoid toilet paper, but try washing your bum with cold water.
I'm a male in my late 40s. In Jan 2015 I developed an AF which worsened over the period of a few months. GTN worked at the start, but I had intermittent flare ups and a progressive AF developed. Sitz baths and hot water bottles helped but provided only transient relief. Due to increasing pain and the necessary time off work, I began researching the options and settled on LIS with a general surgeon. Without health insurance, the cost of 'going private' in New Zealand was about US$3000 – mainly general hospital care and general anaesthesia costs, with the very experienced general surgeon cost contributing only about US$600 of the total cost. Incidentally, I was offered Botox injection as a first line, but this would have been only marginally cheaper than LIS and my literature research led me to believe this may not provide as effective and permanent solution as LIS.
When I woke up, I was told the procedure had lasted 15-20 minutes and included a pre-op sigmoidoscopy to check all was well further up the line. The LIS involved cutting the internal sphincter right up to the dentate line, corresponding to the (proximal) edge of fissure. The AF was scraped by "curratage" to remove surface inflammatory tissue in order to aid healing. The AF was about 5mm x 10mm in size. In the words of the surgeon: "...not the smallest, but not the largest I have seen". The LIS surgical wound was barely visible and the pain non-existent on the first day due to effective pain relief. After the next day's bowel motion, the pain was quite bad. But over the next days the pain abated and life and BM became normal again. I suffered no incontinence whatsoever. Because recently healed tissue can be weak, I did suffer some AF flare ups in late 2015 to mid-2016, but have not had a single issue since I stopped using toilet paper in late 2016 (see below). The flare ups were painful, but without classic cramping feeling and probably the worst flare up was only 10-20% of the pain experienced prior to the LIS.
Last year I had to undertake some long haul flights for work. For AF sufferers, international air travel is scary due to fears of constipation resulting from the long haul (stress, low fibre food and lack of exercise). The forced sitting and absence of showers made me a little concerned about how I would fare. However, using 1-2 daily Laxsol I travelled for over a week with no problems. During the travel I discovered my current post-BM clean-up method. The "Pudong method" was developed during my long-haul stopover in Shanghai and is a genuine bum-saver! Whilst sitting on the toilet and leaning slightly forward, hold the open neck of a 350-500ml bottle of cold water against your lower back to allow the water to flow down by surface tension over your anus. The other hand gently washes the anus. The cold temperature of the Pudong method appears to be important as soothes pain, and seems to retract protruding, soft tissue that may be inflamed and sensitive to fissure development. A gentle pat or wipe around the surrounds with a soft cloth is enough to dry. I really have no idea why I persisted so long with toilet paper and I am convinced that toilet paper wiping contributed to the AF development.
Finally, I am now laxative free. I believe that constipation is stress and pain-associated. With AF, the pain and suffering has psychological and physiological effects which lead to hardening of stools. So, my advice, have a good diet, don't over eat, avoid toilet paper and try the Pudong method! The LIS was a great decision. Good luck to you all. Swampy.
Swampy
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