Hi everyone,

I've been reading these boards for months and I finally decided to post something.
I'm a 24 year old female and I've had a chronic fissure for years. I tried all the creams, botox, etc.

Eventually my fissure formed a superficial fistula, so 8 weeks ago I had LIS, fissurectomy, and skin tag removal. The surgery seemed pretty invasive, and I did have a lot of tissue removed between the skin tag, fistula, and fissure. I had stitches in two spots and the fissure was left open to heal.
The skin tag removal completely healed, but my incision from surgery and the fissure itself was not healed at my 6 week follow up. My surgeon said to come back in another 6 weeks for us to reevaluate. I'm so depressed, I can't believe that I could be in the small percentage of people that LIS does not work for. He said he was optimistic that it could still heal, and that the three month point is when we will talk about other options.

I can still see the fissure when I check with a mirror, and it has looked the same for the past few weeks. I feel so discouraged, and I doubt that it will heal. Luckily, I'm in minimal pain, but I know I will need more treatment if it doesn't heal within the next few weeks.


Has anyone had LIS and not healed at the 6-8 week point and still gone on to make a full recovery?
Has anyone had a second surgery or had botox again after LIS and healed?

lis was a fail for me. it's been almost 7 months for me and i still haven't healed. i'm scheduled for another surgery. i asked for botox if the fissure looked like it was healing, however if it still looks deep, then i want another LIS.

it is possible for you to still heal though. i've read posts of people healing after 3 months, some after 5 months etc

how are you feeling now blue_belle?

Hi whatsherface,

I'm 4 months post op and still not healed. At my 3 month appointment, my surgeon said I had not healed, but he though the fissure looks smaller and more shallow. He wants to see me at the 6 month point, and then we will decide if I need more treatment. He doesn't want to rush into another surgery, but I'm pretty sure this surgery was a failure.
How are you doing??

I am so glad I stumbled upon this post! I just had a fistulotomy yesterday (plus skin tag removal) that all developed from an infected fissure. I haven’t directly spoken to my CRS yet, but wondered how he made your incision for the LIS considering you had a fistula? When my doc was discussing the surgery ahead of time he said he would make a horizontal incision below the fissure to access the fissure/fistula. Did your CRS make a lateral incision (like they do in a LIS) or a horizontal incision? How was your pain post op? Did you make a diary entry on the forum page? I would love to read your story!

I am only 12 hours post op so haven’t had my first BM yet, but I did remove my packing/gauze-took a lot of prayers to get through! I am really nervous how my recovery is going to proceed. When my CRS was speaking with my family after surgery he commented that he was surprised how large my fissure still was and how much scar tissue it had. There was still a tiny bit of infection in the fistula tract, but it was also low and superficial like yours. He cut out most of the scar tissue around and on my fissure and said it wouldn’t have healed unless I had surgery.

I haven’t had muscle spasms or debilitating pain from my fissure in months (been dealing with it for 6 months now) and am nervous it will return since he cut away all my scar tissue and opened it up to remove the fistula tract. How was your pain post op? Did you have the muscle spasms still prior to your LIS? If yes, were they worse after surgery? If you didn’t have them, did they return? Acckkk! I have so many questions for you!

Thank you in advance if you take the time to respond!!!

I had a slow recovery with some complications, but 1 year out, I'm finally doing better. Remember that everyone's timeline is different. Sometimes it can feel like you don't have a lot of control (truth is, we don't). It's OK to feel negative feelings about it. I got so tired of everyone telling me to be positive. I just wanted someone to say, "This sucks, and I feel for you." Well, I'm here with that. It sucks. I feel for you. We all do <hug>.

My recommendation is to focus on what you can control (diet, exercise, testing & trying new things). Commit yourself to doing the things that you can, and keep looking forward. Don't let anyone minimize your feelings, and know that there are people here who know your struggle. You can get through it!

Let me know if you have any questions about my recovery/experience. I'm an open book.

woeisme wrote:I am so glad I stumbled upon this post! I just had a fistulotomy yesterday (plus skin tag removal) that all developed from an infected fissure. I haven’t directly spoken to my CRS yet, but wondered how he made your incision for the LIS considering you had a fistula? When my doc was discussing the surgery ahead of time he said he would make a horizontal incision below the fissure to access the fissure/fistula. Did your CRS make a lateral incision (like they do in a LIS) or a horizontal incision? How was your pain post op? Did you make a diary entry on the forum page? I would love to read your story!

I am only 12 hours post op so haven’t had my first BM yet, but I did remove my packing/gauze-took a lot of prayers to get through! I am really nervous how my recovery is going to proceed. When my CRS was speaking with my family after surgery he commented that he was surprised how large my fissure still was and how much scar tissue it had. There was still a tiny bit of infection in the fistula tract, but it was also low and superficial like yours. He cut out most of the scar tissue around and on my fissure and said it wouldn’t have healed unless I had surgery.

I haven’t had muscle spasms or debilitating pain from my fissure in months (been dealing with it for 6 months now) and am nervous it will return since he cut away all my scar tissue and opened it up to remove the fistula tract. How was your pain post op? Did you have the muscle spasms still prior to your LIS? If yes, were they worse after surgery? If you didn’t have them, did they return? Acckkk! I have so many questions for you!

Thank you in advance if you take the time to respond!!!

I had some similarities in my circumstances. I had two large anal papilla from long term fissure activity. Rather than see a doctor, I dealt with my AF for years when I should have seen a doctor. Prior to my LIS + hemorrhoidectomy + papilla removal, I had some progress with diltiazem cream, but after 6 months of that and still having periodic bleeding and discomfort, I made the choice to go ahead with surgery.

Through that experience, I've learned a few valuable lessons:

1) Everyone's experience is different. I know it sometimes seems like there are no answers, and there are an endless number of things that can go wrong, but you have to remember that not everyone who has AF posts here, and many who do are the ones who had issues. That's what brought them here. We're a rag-tag group of sufferers with a broad variety of backgrounds. Your recovery will be unique. Don't go too far down the rabbit hole of reading about complications and things that can go wrong. It only leads to anxiety, and anxiety doesn't aid recovery :)

2) There's only so much you can control, and the "right choices" are a relatively short list of things that are easy to do:

a) Follow your doctors directions. They have a lot more experience with these conditions than anyone on the forum.
b) Be as active as you can, but rest when you need it. Our bodies are amazing, and blood flow is key to healing.
c) Make things easy on your body by taking as few meds as possible, but don't put yourself over the edge. Manage your pain.
d) Understand your diet and food choices, and how they effect your body. Changes in diet can take days to have an effect.

3) Sometimes it's OK to feel down. I got so tired of everyone telling me to stay positive. This situation sucks. Sometimes you just need to say it out loud and have someone nearby to say, "Yep, it does, and I'm so sorry you're going through it." Communicate this to those around you. Let them know what you need.

To answer some of your questions:

How was your pain post op?

Mine was horrible, but many people are fine. Interestingly, recovery does not necessarily correlate with surgical details like incision type. Everyone is different. Let your body be your guide.

Did you have the muscle spasms still prior to your LIS?

Yes. Oh yes I did. My muscle spasms + AF put me on the floor. A sobbing mess. Nothing has humbled me like that pain. Nothing.

If yes, were they worse after surgery? [i]If you didn’t have them, did they return?[/i]

No. The pain after my surgery was very different. The spasm + AF pain was very sharp; like someone was stabbing me. Post-op pain was dull, like someone had kicked the hell out of me, right in the anus. That has been pretty consistent. I haven't had any pain like the spasm + AF since my procedures. Prior to my procedures, I wasn't really experiencing spasms because I was on the diltiazem cream, which works wonders to relax the muscles.

woeisme wrote:I am so glad I stumbled upon this post! I just had a fistulotomy yesterday (plus skin tag removal) that all developed from an infected fissure. I haven’t directly spoken to my CRS yet, but wondered how he made your incision for the LIS considering you had a fistula? When my doc was discussing the surgery ahead of time he said he would make a horizontal incision below the fissure to access the fissure/fistula. Did your CRS make a lateral incision (like they do in a LIS) or a horizontal incision? How was your pain post op? Did you make a diary entry on the forum page? I would love to read your story!

I am only 12 hours post op so haven’t had my first BM yet, but I did remove my packing/gauze-took a lot of prayers to get through! I am really nervous how my recovery is going to proceed. When my CRS was speaking with my family after surgery he commented that he was surprised how large my fissure still was and how much scar tissue it had. There was still a tiny bit of infection in the fistula tract, but it was also low and superficial like yours. He cut out most of the scar tissue around and on my fissure and said it wouldn’t have healed unless I had surgery.

I haven’t had muscle spasms or debilitating pain from my fissure in months (been dealing with it for 6 months now) and am nervous it will return since he cut away all my scar tissue and opened it up to remove the fistula tract. How was your pain post op? Did you have the muscle spasms still prior to your LIS? If yes, were they worse after surgery? If you didn’t have them, did they return? Acckkk! I have so many questions for you!

Thank you in advance if you take the time to respond!!!

Hi Woeisme,

So sorry to hear that you're going through a similar situation with the whole fissure/fistula/skin tag ordeal. I remember when I was reading these boards looking for ANYONE that had a similar situation and I could barely find anything. I'm happy to answer your questions!
Now that surgery if over you are on the road to recovery!
I did not make a diary entry, but I can give you an overview of my recovery so far.

I'm a somewhat unusual case, I'm 4 months post op and not fully healed, although I am functionally healed with no pain. First I'll try to answer your questions.
-My surgeon made a lateral incision for my LIS, at like the 3 o'clock position. My fistula formed from the fissure and skin tag, so that also seemed like one big incision area. The skin tag was removed, the fissure scar tissue was cleaned out and t he fistula was cut out. I had stitches on my LIS incision, and on the skin tag area. The fissure and fistula were left open to heal... The first few days after surgery everything is super super swollen, so you probably have difficulty locating where your incisions are until the swelling goes down. Just like you, my surgeon said that once the fissure had formed the fistula it would not have healed without surgery and it could've gotten worse if I didn't do something.

- I actually never had muscle spasms before (or after) surgery, which is probably why I waited so long. Before surgery, I would have stinging or burning pain when I used the bathroom, and that would sometimes last for hours after. And some days I would have zero pain. Now, 4 months post op, even though a small part of the fissure has not closed up, I have zero pain when using the bathroom and have never had muscle spasms.

Here is an overview of my recovery, which might answer more of your questions about pain.
My worst pain was the first 3-4 days after the surgery. I was extremely worried about becoming constipated from pain meds, so I only took one Vicodin the entire time. I was on a very strong anti-inflammatory drug that I took every 6 hours for the first week, that helped a lot. My wounds were packed with a weird hard, gel like substance, that I actually had a lot of trouble passing. It was extremely painful to push out. If you've already taken out your wound packing then you're past that hurdle.
Not gonna lie, going to the bathroom the first few days after surgery was excruciating. I immediately had to hop in a hot bath after. The first few days I felt like I was in and out of a hot bath every few hours. It was literally the only thing that helped the pain. I was also paranoid about keeping everything clean since there were so many different incision sites/open wounds. I ate really soft foods, took Miralax, stool softners, and drank a ton of water. No matter how soft my stools were, it still hurt, stinging/burning pain.

Around day 4-5 something seemed to change overnight where I was suddenly in a lot less pain. I was able to move around more. Going to the bathroom was still painful, but the stinging and burning went away almost instantly with a hot bath. I still continued taking multiple baths a day for the first 2-3 weeks to keep the area clean and promote healing.

Around the 1 week mark I was much improved. I could go for walks, sit more comfortably etc. I was still on a strict regimen of miralax, stool softners, and staying hydrated. I accidentally lost a stitch in my LIS incision site. A lot of swelling had gone down but the area still looked pretty bad.

By two weeks I had more improvement and I went back to work. At this point my skin tag had actually almost completely healed up. I was quite surprised because I thought that would take the longest to heal. It was itching like crazy at this point, but that only lasted for a few days. I was in minimal pain, and would take advil when needed.

Weeks 3-6 I was very worried. My doctor told me most people are completely healed in 6 weeks. By the 6 week point, my skin tag was healed, but I could still see the huge fissure and my incision from LIS had not healed (probably because I lost my stitches too early). I was not in any pain, but I was worried about not healing. My doctor said to come back at the 12 week mark for another appointment.

Weeks 6-10. It is also important for me to mention that I was extremely concerned about wound weeping. I had a constant small amount of clear fluid that was weeping from the fissure. This lasted until almost 11-12 weeks. I was afraid that I would have this forever. I used small pieces of gauze and pads to keep the area dry.

12 week follow up. My LIS incision site finally healed, fistula area healed, but fissure is not healed. My surgeon said it is smaller and more shallow than when he saw it at 6 weeks. He still believes it might continue to heal slowly. If it's not healed by the 6 month point, then we might talk about doing more botox or more surgery. But he seems to think that it's just healing slowly and he doesn't want to rush into another surgery. I agree it does look much smaller, but I'm shocked at how slow its healing. I know when people have fistulotomies it sometimes takes much longer to heal, especially if a lot of tissue is cut away, so I'm trying not to lose hope. I'm not in any pain, and I don't have any wound weeping or leakage. You will most likely recover in 6-10 weeks, it is very unusual for it to take this long, so please don't let my story scare you! Recovery is different for everyone.

So that's where I'm at now! Let me know if you have any other questions and I would be happy to answer :)

TubDweller-what words of wisdom! You are so right that there is only so much we can control in our recovery (diet, exercise, managing expectations). I need to continually remind myself of this! I really liked your point on how it isn't necessarily the type of incision or surgery that someone has that dictates recovery time. I can already agree with you about the change in pain levels. During my worst with my fissure pain and infection I literally thought I was going to have a nervous breakdown (barely sleeping, constant pain and fevers-I was such a mess). Post op day 2 following 4 BMs (might've overdid it with stool softeners, miralax, and prunes) and the way I would describe the pain is like someone hit me with a baseball bat in my rectum. No razor blade sharp stabbing/throbbing pain, just a deep ache.

blue_belle-thank you for sharing your story! Your surgery sounds so painful! So you had two or three incisions? My fissure was internal, but as it healed internally it pushed out a skin tag that also had a fissure like opening on it. I am assuming (as I can't see it yet, my rectum is too swollen), that my surgeon made my incision under my skin tag (which was in the 12 o'clock position) and cut it out. But, since my fissure opening was on my skin tag I think that means he probably made just one small incision to take out the skin tag and open up the fistula. No wonder your pain was so intense-you had cuts literally lining the opening to your bum! I am so glad that your fistula is healed! That is wonderful! I will continue to pray that your fissure heals!

7 month update:
I just wanted to follow up for anyone who reads this in the future. I had an appointment recently and my doctor says he cannot see the fissure anymore! I am technically healed, although I still have irritation occasionally, which he says might just be from harder bowel movements. As of now I'm not in any pain or bothered on a daily basis at all, but I plan on staying on stool softeners indefinitely.