5 Weeks Post Op: Still in Pain

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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5 Weeks Post Op: Still in Pain

Postby Deleted User 2730 » 29 May 2013, 16:59

Hey guys. I've been reading this forum since I was first diagnosed about two years ago and it has brought me much comfort during some very painful times. Here's a brief synopsis of my experience:
About two years back, I was on a binge of terrible eating (I am a weightlifter and was looking to enter a new weight class). I ended up eating too much and drinking too little, resulting in hard stool and ultimately a fissure. I didn't get it checked out for almost five months after that, at which point it became chronic.
Over the next two years, I was prescribed hydrocortisone, nitroglycerin, ditilizem, and lidocaine. Nothing did much. I also take Metamucil and Miralix daily. I try my best to eat appropriately, but I am infatuated with not losing any weight; I try to balance high fiber with high calorie. I sometimes slip up.
About five weeks ago, I took the plunge and had LIS (by a very good CRS). It went fine. I was in pretty substantial pain for about a week and a half, using as few pain meds as I could (I have a high pain tolerance, and I wanted to avoid constipation). I also took 3-5 sitz baths a day for about three weeks.
At around week three, I decided to go back into the gym. I was not sure if my pain had improved yet, as I spent most of my time sitting during recovery, and didn't expose myself the opportunity to feel much pain. In the gym, I did only upper body (repetition effort bench press, pull ups, seated shoulder press, tricep pushdowns). I noticed a twinge during bench press, but stupidly continued all the way to the pushdowns. The next day I headed into NYC to meet my girlfriend and was in considerable pain when walking.
Today marks the fifth week and I am still in essentially the same pain as I had been before. There is very little improvement. I also just saw my CRS, who said I was healing well and had no explanation as to why I would still be in pain.
I'm very depressed by this, I really don't know what else to do if this fails. The pain is very considerable, and prevents me from doing a ton of stuff. I can't walk for more than 10 minutes without being in severe pain.
My question to you: Has anyone undergone LIS and had similar results? Has anyone taken longer to heal than five weeks, bearing in mind the lack of change in my current pain? I just really want someone to tell me I didn't waste $4,000 and two weeks of my life for what is essentially no change to a life-sentence of chronic pain. It is very, very disappointing.
tl;dr: Had LIS five weeks ago, CRS says he isn't sure why I am still in pain--fissure seems to be healing nicely. I am in the same amount as I had been prior to the surgery. Devastated.
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Re: 5 Weeks Post Op: Still in Pain

Postby Just 'Pain' Tired » 30 May 2013, 20:36

I don't know, but just wanted to say I'm sorry you're dealing with this. I haven't had this surgery, but I know some people have talked about incision sites as needing to heal. Do you have an incision site that is outside your anus? I'm just wondering if the pain could be from a different source than the fissure which your doctor thinks is healing? I am probably ignorant about this and I'm sure someone else will respond soon! I'm still trying to heal with other measures, but have found I've had to be careful about any exercise and squatting with my quite severe/large AF and other 'pathology.' I walk, but even that has led to retears at times. At times even a mild/moderate walk along with a recent (very small) BM will cause big problems. It's ridiculous (and has me considering LIS!). If I were in your situation I would consider seeking another opinion, to make sure your fissure is truly healing. Best of luck!!!!!
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Re: 5 Weeks Post Op: Still in Pain

Postby Jojo1 » 04 Jun 2013, 10:21

Okay, there are a number of things that come to mind about your particular situation when reading your post. First, I’m concerned you started lifting too soon – even limiting it to upper body and arms! I know it's important to you, but there's a reason why they say no heavy lifting after abdominal and butt procedures. You would be surprised at how much of our core movements involve the buttocks and, yes, anal muscles. I've done hard core weight lifting before and I’m also a singer. When I had my fissure, I couldn't even sing concerts or recitals because those muscles are included in the mechanism for good breath control and singing and it would hurt like the devil. The one time I tried, muscle spasms started 10 minutes after the singing began and I barely made it through on stage. I had to bow out of the other performances until after my LIS.
Next, I would not advise you to do sitz baths – unless you don’t have a bathtub. This puts undue stretching and pulling pressure on the area and can defeat the purpose, especially if you’re doing it for at least 20-30 minutes each time. I’d advise soaking in the tub, keeping the water as warm as you can comfortably stand and even add a bit of witch hazel to it for extra cooling and soothing. I usually laid on my side and positioned myself to comfortably allow the water to bathe the area. If you don’t have a tub, then invest in a good hand-held shower head so you can get water to the area that way – a good full spray for, yes, 20-30 minutes each time. Also keep in mind that if you had this fissure undiagnosed and treated for two years, that’s a long time of repeat trauma and you may not recover quite as easily as if you’d had LIS earlier. Also, you used a lot of ointments during those 2 years and those ointments can break down the skin elasticity and integrity which takes a while during and long after the repair of the fissure to completely heal. You will recover, you just need to be mindful of the history and allow for it in your treatment.
It can be easy to re-tear early on after LIS. But it is also easier to heal after re-tears as well.
While the initial healing of the fissure is quick (within 4-5 days), full healing takes up to two years. So, you can't really "go back to normal" after a few days or weeks. You need to stick with your softening regimen (only modified as needed) as you did prior to LIS for at least the next 8-12 months.
Having had this procedure, let alone having had a fissure period - will require life-long changes in your bowel habits. Some of the things I did and still do (and will be doing for life) include:
1. Lots of water - I get in at least 100oz daily.
2. Start every morning with Benefiber in my yogurt.
3. Nightly dose of Miralax (currently 1/2 to 1 full dose). I will forever have to do this because I take a lot of calcium daily which is constipating (caused my first fissure). I'll be taking the calcium for life, so I have to do what's necessary to protect myself from the effects. As a weight lifter, I imagine your diet it very protein-heavy which can also be constipating. You might also try incorporating magnesium oxide as a supplement to help with eliminating muscle cramping and combatting constipation.
4. Invest in moist wipes (I used Pampers Sensitive). I use this instead of toilet paper in the back. In fact, I dip 2-3 of them in water with witch hazel and initially clean with that after a bowel movement.
5. For the first year, I did 2-3 warm soaks daily. Now I still do a nice, long hot soak after my morning movement. It's become a ritual.
Beyond these things, I am mindful of any difference in feeling back there. If I feel the slightest stinging, tenderness, burning, etc., I'm right on it with A&D ointment or something similar. Also, I keep a couple bottles of Witch Hazel in the house always and add some to my bath water for my soak. I will always be taking these steps as I never, ever want to have another fissure as long as I live.
Don't get discouraged, just realize that healing takes time and has ups and downs and you'll be fine.
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