10 months fissure… Should I consider LIS?

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10 months fissure… Should I consider LIS?

Postby empty_butt » 03 Jan 2018, 03:35

Hello everybody,

I’ve been plagued with an internal AF since April 2017. Unfortunately the fissure was caused by Campylobacteriosis and I discovered it by myself after 6 months of absurd abdominal pain and diarrhea on the top of the fissure hellish pain (my GE thought I was mental and misdiagnosed me with IBS, after which I autonomously decided to get my stools tested and found out I had been colonized by Campylobacter).

I can honestly say I tried it all: careful diet, water, laxatives, antibiotics (for Campylobacter), GNT, zinc, biofeedback, every kind of cream on earth that promised relief. The only thing working still today is GNT, I overcame the headaches and find it very useful even after 10 months.

The point is, I want to have my life back. I cannot wake up scared of going to the bathroom. I cannot live with the terror of re-tearing the fissure (happened four times) if I do not take a laxative before going to bed. I mean, we’ve all been there.

I openly talked to my CRS about getting LIS, as every conservative treatment is obviously only temporarily reducing the problem, not eliminating it. She advise me to continue with Biofeedback as she feels if I do not solve the muscular contractions first, LIS would be inefficient, and I’m doing what she says.

I am terrified of doing LIS, but at the same time I feel I’m running out of options. Anybody out there on the same boat (chronic fissure duly re-tearing after months) that is considering LIS? What are your thoughts?

Thank you all.
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Re: 10 months fissure… Should I consider LIS?

Postby Mypoorbutt » 04 Jan 2018, 10:51

Hi, sorry to hear your suffering
If you have tried the creams and your still not healing then I would advise LIS, I’m not sure why she is saying that it wouldn’t work without the biofeedback as my resting tone was over 130 and my LIS worked without any biofeedback at all and my fissure was deep to the muscle and nearly two inches in length.
Maybe it’s because you heal that she thinks the biofeedback would work or maybe she thinks LIS is not an option for a different reason but it was and still is the treatment that has the highest success rates for fissures.
Good luck
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Re: 10 months fissure… Should I consider LIS?

Postby empty_butt » 05 Jan 2018, 02:00

Hi Mypoorbutt,

Thank you so much for this!

I think she is somewhat skeptical of me having LIS because I was diagnosed with an early stage of fibromyalgia right before falling in this tunnel…
I’m currently not taking any meds as I can handle it, but I think fibromyalgia and muscle stiffness are part of the problem or at least aggravating it as in the spasms and muscle contractions surely do not promote healing (especially in deep down muscles of the perineum that you cannot massage in the “usual” ways.

I’ll talk to her and ask for a manometry since I haven’t done one ever. I’m giving myself a year (April 2017-April 2018), after that I will ask for surgery as this stupid fissure has already ruined so much of my life and I’m missing out a lot of things for it.

Have a nice day!
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Re: 10 months fissure… Should I consider LIS?

Postby Deleted User 7275 » 24 Oct 2018, 18:13

I hope you are well and recovered nicely. I saw you post about proctitis because I too have a dr that thinks I’m crazy and he is at a loss. What were your symptoms of proctitis if you don’t mind me asking? And has it gone away? Thanks be well ww
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Re: 10 months fissure… Should I consider LIS?

Postby TubDweller » 28 Oct 2018, 11:46

I had my first AF when I was only 20 years old (in my 40s now). I had them on and off for years, when earlier this year (January) I ended up with two back-to-back thrombosed external hemorrhoids, and an anal fissure.

The pain broke me. Quite literally, I was sobbing and drooling on the floor in my bathroom, barely able to make it into the tub. After years of doing nothing, I visited two CRS (first one didn't work out), and after three months of Nifedipine cream I scheduled an LIS procedure.

My CRS called my ordeal winning a gold medal in the pain olympics, and I still feel the effects of it (mentally) today. I would consider — if it's possible for you — seeking a second opinion. My CRS is very compassionate, and has been very encouraging, while remaining realistic. I was so concerned about incontinence, but he talked me through it and made me think about aspects that I hadn't.

In the end, I had LIS + an external hemorrhoidectomy. Recovery was absolutely brutal, but worth it. I was able to stop using the creams, and at around 4 months, I've been doing better. Unfortunately, I seem to have re-aggravated my fissure this week (that's why I'm back here ;) ), but I have no bleeding, and the pain is so much less than it was before I had LIS.

So in short, even though I haven't healed completely after LIS, the benefits have outweighed the risks. I have no incontinence, but it is easier to move my bowels and pass gas. Everyone's risk factors are different, but I do not regret having the surgery. I would do it again.
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Re: 10 months fissure… Should I consider LIS?

Postby Tryingtorelax » 20 Jun 2019, 21:42

Tubdweller, what made the recovery brutal? I realize it’s very painful but what specifically caused you the most issues?
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Re: 10 months fissure… Should I consider LIS?

Postby TubDweller » 21 Jun 2019, 08:31

A handful of factors:

A) The pain. If an anal spasm with an active fissure was a 10/10 on the pain scale, the pain in the first week after the procedure was 9/10. For context, my fissure spasms had me uncontrollably sobbing, crawling through my house to reach the bathroom. I have a high tolerance for pain, having worked two days with a broken hand, shredded my palm while trying to open an old plate glass window, and sliced a 2” laceration into my calf with a machete, wrapped it in duct tape, and finished the job. None of those injuries caused me to miss a step, but the AF and LIS/hemorrhoidectomy recovery had me lying in my side. I will say that the surgical recovery was, overall, much easier than living with the AF. The pain was really only during and immediately after moving my bowels. Most of the time it was a tremendous sense of relief (so long as I was relaxed).

The pain before/after surgery was very different. Before surgery, the pain was sharp and shooting, with intense peaks that would stop me in my tracks. As if someone was stabbing me. It was debilitating. After surgery, the pain was (at times) dull and achy, as if someone had kicked me square in my anus. I had a lot of bruising. Passing the surgical packing was extremely difficult for me, and caused a huge hemorrhoid to swell up, but it did not clot and thrombose (thank god).

It took me two weeks to really stand and walk around. Five weeks to return to work (standing desk) for half days. And six weeks for full days. I only recently stopped feeling minor discomfort about 80% of the time.

B) The fear. I was in a constant state of fear. Fear that my stool would be firm. Fear that I was going to be incontinent. Fear that I would get an infection. Fear that my recovery would be long. I still have anxiety related to my condition, but it has gradually subsided.

C) The complications. After four months, I developed an abscess. My doctor misdiagnosed it as a hemorrhoid and sent me home with cream. The abscess burst that night, making a huge mess, and causing 10/10 pain... again. Hello anxiety. Fortunately, I felt immediate relief after it ruptured. The recovery from the abscess also lasted weeks. I'd go through cycles of reduced discomfort, and then the area would get inflamed until more discharge. There was speculation of fistula formation (I still think I have one), but I never received a diagnosis. The hole I think is a fistula is very close to my anus, so it is difficult to see. You have to pull the skin in just the right way.

C) The time. As I mentioned in the pain section, my recovery happened on a time scale of weeks, not days. Immediately after surgery, you'll have pain and mucus. Oh the mucus. Mucus for days, filling gauze pads, making you wonder if you're OK (you are). A year later and I'm now at a point where I feel unaware of my condition 90% of the time. I've learned that this could change next week, but for now, I feel great. I feel more confident in what I can eat, and going to the bathroom is anxiety free. I still occasionally have some irritation (always later in the day, not during BMs), but I think I may have some other kind of IBD going on. Maybe Crohn's, I'm not sure. I don't really want that diagnosis until I'm at a point where I *need* a solution. Right now, I know that I can't eat too much fiber, or I get inflammation. This is challenging, because all the doctors will tell you "eat more fiber, eat more fiber; bran, psyllium". Just know that you'll be responsible for figuring out your own body, and that is a hard thing to do. Our bodies aren't like calculators where you enter your inputs and get results. It can take days for your body to equalize. Just give it time and make small adjustments to figure out what's going on. If you figure something out, and you've tested it, be confident when communicating with your doctor. If your doctor doesn't listen, find another one. I had to change doctors twice. I now travel over 2 hrs to see a really great CRS (who has tons of experience) at a large hospital.

Even with all this, I would do it again. I lived for years with an AF that I did not understand. Since my LIS, moving my bowels is an easy and relaxing experience. I cannot remember a time (pre-op) where this was the case. I always had some sense of anxiety over moving my bowels because it always involved straining. The LIS changed my anatomy in a way that makes it work more normally, and that has made a huge difference, even if other aspects of the recovery sound difficult.

I wish you luck, and remember that everyone's experience is different. I've met other patients who had none of the issues I faced, and recovered fully in four weeks. You are you, not a statistic.
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Re: 10 months fissure… Should I consider LIS?

Postby Tryingtorelax » 21 Jun 2019, 09:43

Thank you so much for this information. It is extremely helpful to me as I go through this recovery. As we all know, the fear of everything drives you crazy. But once you have such intense pain the fear is understandable. I just hate that it rules my life. I’m eager for the day when my anxiety about this whole matter subsided. Concern and care for my diet and bowels movements will be fine but I want the total fear gone.
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