3.5 months post LIS update

Ongoing leakage issues and more

Are you having, or have you had a Lateral Internal Sphincterotomy (LIS)? Please share your experiences here, or ask any questions.

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Re: 3.5 months post LIS update

Postby boodles » 24 Feb 2015, 18:50

Hi again,
so if you just had the LIS then that makes sense that the body is still healing and readjusting. Yes, I guess the leakage issues I am having is something I've always had, and like I said, even my husband has and he hasn't had the surgery. Maybe it's a normal thing nobody talks about. :) I think you will notice a big difference in a few months, as the area finishes healing. I remember I was surprised that it took about 5 months, but after that I didn't think about it anymore. Until I happen to have a large bowel movement or leakage issues-then I come visit this site! :)
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Re: 3.5 months post LIS update

Postby Worrier12345 » 25 Feb 2015, 08:44

Hi again Boodles,

I really hope you're right and things will settle down and heal up. I'm not too hopeful to be honest - since I have constant soreness down there. Not sure if its from my new routine of 2x morning BMs followed by using the bulb syringe to clean out the rectum, or if it's normal to be constantly sore 3 1/2 months after having LIS.

I'm finding it really hard to take my mind off it. It's sore when I sit at work, it's sore when I walk, and I feel the constant need to check for leakage. Finding it all a huge struggle.

With the ultrasound on Friday - I know that if they find sphincter defects then the chance of the leakage getting any better is very small - even with treatment. What I don't understand is - doesn't LIS create a defect? Anyone out there have an answer to this?
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Re: 3.5 months post LIS update

Postby msimon » 25 Feb 2015, 11:33

I tend to think that LIS does cause a defect. There should be a palpable gap where the internal sphincter was cut (I have yet to feel mine as I am still healing). I think it's a matter of whether it becomes symptomatic or not, which is likely a combination of degree of muscle cut and strength of the other muscles in the area. I assume your ultrasound will also evaluate your external anal sphincter...
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: 3.5 months post LIS update

Postby Worrier12345 » 25 Feb 2015, 15:53

Hi msimon,

Haven't spoken to you in a while but I've been following your posts. I'm sorry that your surgery has caused you so many problems. Seems like we both had our lis done at the same time and we both went down different but similarly miserable paths afterwards.

Thanks for replying to me.

I think you're probably right. The ultrasound will show a defect at the lis site - I suppose it will show the extent of the cut which may shed some light on my leakage issues. I fear that it will also show a defect in the external sphincter too.

The more I think about it the more I'm convinced that lis was not the right operation for my situation. I've got an anterior fissure and I never had painful spasms. That makes me think that I probably had normal pressure sphincter. Wish I'd have asked for the manometry tests before the surgery. The surgeon said that I didn't need to have them since I'm a young man. He also said that my sphincter was in spasm when he examined me - but surely I could have just been tight because the examination was painful.

I would give anything to go back and not have the op done. I'm constantly sore, it takes ages to go through my terrible bm/cleanung routine every morning. And it's my fault for making such a big deal about a fissure that was more uncomfortable than painful. I feel like a fool, and the fact that I can't handle the outcome just makes me feel even worse.
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Re: 3.5 months post LIS update

Postby msimon » 25 Feb 2015, 16:51

Thanks Worrier. That's very kind of you. Do you know what technique your surgeon used, open or closed? Sometimes in the closed technique it is possible to knick the external sphincter as well. Have you had a manometry test done? Or are you going to have one?

I know what you mean about regretting the surgery. I still have hope this is going to work out in the end for both of us but it's just going to take a long time.

What do you think causes your soreness? Is it tissue soreness? Like from constant moisture down there, or more muscle soreness? Do you think your fissure is still there? I wish you wouldn't feel like a fool. We are so hard on ourselves (myself included) when we judge our decisions with the clarity of the outcome. That it, hindsight is 20/20. Your surgical outcome could have turned out very different. There was no way for you to know and this forum is full of people who have benefited immensely from this surgery. You had every reason to believe it would work out well for you.

I hope your ultrasound goes well on Friday. Keep us posted on how things go.
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: 3.5 months post LIS update

Postby Worrier12345 » 25 Feb 2015, 17:35

thanks msimon, you are always so thoughtful in your replies.

Not sure what technique was used. No stitches so does that mean it was closed?

I wonder whether I had a previous external sphincter defect. I've been doing endless amounts of obsessive research and seems that anterior fissures are associated with occult sphincter defects (although this might be something to do with childbirth - being a man this wouldn't be applicable).

I'm having manometry done next week. Wish id had it done before the surgery - then perhaps I wouldn't be in this situation.

As for the soreness I wish I knew. If anyone could shed any light on it that would be great as I'm going mad trying to figure it out (my obsessive/anxiety has taken over on this matter and I can't work out what's going on). I'm pretty sure the soreness is inside the anus. It feels like raw skin but I don't think it's the Lis or fissure sites. Using an enema bulb for rectal cleaning each day means that I'm only getting a small amount of leakage. Most of the time not enough to reach my underwear, but if I part my anus I can see small bits of stool/residue just into the anus. Could this be causing soreness? Isn't this part of the anus always moist? I thought leakage only causes problems when it reaches the external skin if the anus. Why is such a small amount of leakage causing such soreness? It can't just be caused by my (adnittedly) obsessive checking - because if I don't check for half a day it still gets sore.

Any input on this would be great as I'm clearly driving myself insane here.
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Re: 3.5 months post LIS update

Postby chachacha » 25 Feb 2015, 18:02

It's too bad that we can't find a CRS who would come onto our forum once a week to answer our burning (ptp) questions!
Fissure since about 2007
Fissure diagnosed in 2011
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LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: 3.5 months post LIS update

Postby msimon » 25 Feb 2015, 19:10

lol! I so agree Chacha!

Worrier, are you able to insert a finger in your anus? Or even an applicator of some sort. Would it hurt to do so? I do wonder if you tried a barrier cream that would protect you from constant moisture if it would help. I do think that further inside should not have an issue with moisture as that is considered mucous membrane. The first 1-1.5cm is not, and that is where we have sensation and I wonder if may be burning. I get burning too. Sometimes really bad but I think it is due to the constant discharge from my wound. It seems to burn more when there is more discharge. I am still so tight I can't put anything up there so I am just trying distraction and positive thoughts for now.

As for the technique, I don't think you will know except to ask your surgeon. Stitches are just done based on the surgeons' preference. I had them and I had the open technique. Here is a link to explain the difference. The LIS video (if you can stomach them and are curious) on the top shows the open technique and the one below is the closed technique:

lis-and-fissurectomy-video-t7478.html

As for a sphincter defect, are you able to hold in gas? If so, then I doubt it's your external sphincter.
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: 3.5 months post LIS update

Postby Worrier12345 » 26 Feb 2015, 03:18

Hi Msimon,

I can get a finger in - is it safe to put barrier cream inside?

I think I can hold in gas. It seems that I have more muscle strength higher up, and it is at the opening where is lacks strength - although this is just a guess.

Obviously I am only guessing about the external sphincter defect. But I am convinced that mine was a low pressure fissure. Since I never had the excruciating pain associated with most fissures who experience painful spasms. The most pain I ever felt was when being examined - and it was this that lead to my surgeon saying that the pain was caused by the spasm and that pressure tests were not necessary.

I can't help thinking that LIS was the wrong op for me. I've been reading about "subcutaneous fissurotomy" - http://www.ncbi.nlm.nih.gov/pubmed/17712594 - and that sounds like it would have been a better option. They treat the fissure almost like a fistula, and deroof it, excising the skin tag, which essentially widens that part of the anus and allows it to heal on its own without the need for LIS. I wish I could go back and suggest this.

The people who did that study say that a fissure is like a small blind fistula tract - and I've often thought that mine is like that - I can almost feel/see the fissure going under the skin tag and up towards the pernieum. Since LIS, the fissure looks exactly the same. In fact, the only positive difference since LIS is that I have not bled, and I can pass larger stools easier. That is not enough of a positive outcome in my opinion, considering that I am facing the downsides of considerably more soreness and discomfort and leakage.

I am close to giving up again. My problems are probably nothing compared to many people's, but combined with my mental issues I find it all too much to handle.
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Re: 3.5 months post LIS update

Postby msimon » 26 Feb 2015, 03:47

I am glad to hear you are getting the proper tests done Worrier. That should shed some light on things. Don't give up hope at least until you have a better idea of what is going on. I would be sure to mention to the person doing the the tests about how you feel the muscle is weaker lower down. That shouldn't be if the external sphincter is intact. I wonder if you would benefit from muscle strengthening exercises down there. Any tone might lead to an improvement.

As for putting a barrier cream inside, I did it for years, and many on here do. I would only put it maybe an inch or two up there. Many on here really like coconut oil, the unscented kind I would think would be best. I have been able to use it myself down there with no burning and that is saying something as a lot of things make it burn down there for me now. I used to use petroleum jelly but in hindsight don't like the idea of putting that in there daily, for health reasons.

As for the fissurotomy. If it's the same thing as a fissurectomy, that procedure carries a risk on incontinence as well because if they nick the muscle at the back (6'oclock) it can really weaken things down there, since there is already an inherent weakness in the back. Although, I suppose yours would have been at 12o'clock right?

That is interesting that in hindsight you think you have/had a low pressure fissure. I think that low pressure fissures are mainly in post partum situations. Can you think of any reason why you would have been weak down there before?
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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