Hi,
I've just joined this forum and wanted to talk about my 20 month struggle with anal problems. I'm a 23 year old student but I don't really live a typical student lifestyle. My alcohol intake is, on average, less than the recommended amount for a male and I eat a balanced diet with plenty of weetabix, salad, fruit and veg.
It all started in September 2008 when I suffered from excruciating pain from a lump in my anus. I was visiting family away from home at the time and after two sleepless nights from the pain and the inability to sit or lie down I went to the local out-of-hours surgery where I was told - without any examination - that I had a perianal abscess and was prescribed antibiotics (I can no longer remember which ones) and told that I would be fine after a week.
Well a few days later the pain was still just the same and I was still unable to sleep despite being fully dosed up on pain killers so I went to my own GP and was told just to wait a bit longer but if no improvement was noticed within two days to return.
Two days later I was back in the GP surgery and he examined me. He admitted me immediately to hospital awaiting an emergency abscess removal but because I had already had breakfast that day I was told I wouldn't be able to have the op that day and to go home (with some stronger suppository pain killers finally) and come back first thing in the morning.
That night, the abcess burst. It was unbelievably painful but afterwards an incredible relief. I went into the hospital that morning as planned and spoke to the consultant who said that as it had burst there was nothing to operate on and he suggested continuing the course of antibiotics and that would be the end of it.
At this stage, I was due to travel to Spain for a year of studying which is a compulsory part of my degree. So, relieved at the escape from the surgery and the pain, I set off for Spain.
A few weeks in the abcess returned with a vengeance. I contacted the health services there and was told to go immediately to A&E where I was seen very quickly and given more painkillers and antibiotics and requested to make an appointment for surgery. However, Spain being Spain, that wasn't very simple because I had to first register at a health centre, then see a preoperative anaesthetist, and then wait for a surgery date. All of this in a foreign country, in a language that I was then not very confident with, and the prospect of being laid up in bed for a week afterwards with nobody I could rely on to look after me (nursing care in Spain is very limited as families are expected to do the majority of the duties that nurses here would do). After some deliberation and juggling of finances I organised an appointment with a private consultant, Mr Anthony Dixon, at the Bristol Spire hospital to coincide with my return over Christmas.
I saw Mr Dixon and was booked in for an operation in February of 2009 but upon my return to Spain the pain worsened and I managed to get a cancellation for the end of January. I had been informed before-hand that I would be treated as a day case patient and should be fully recovered a week after the surgery. Immediately after the operation I was told that all had been successful and was in no pain whatsoever due to the local anaesthetic (to the point that my entire waist was completely numb - very strange going for a wee). However, a few hours later the pain was excruciating and I suffered like this for three weeks or more. Each bowel movement reduced me to a quivering wreck, literally shaking uncontrollably from the pain and the only slight respite I could get was in the bath. I saw the GP frequently during this time and was constantly assured there was nothing to worry about. After a while though I got fed up with it all and insisted that someone took a look. The wound was badly infected and I was once again put on antibiotics. Four weeks after the operation, once I felt I could travel without too much discomfort, I returned to Spain. I was still using pads for the duration to catch the discharge of blood and pus.
The pain, bleeding and leakage increased again and I eventually managed to speak to Mr Dixon on the phone who told me to come and see him (reluctantly). I saw him on a Tuesday evening and he accused me of "being a wimp" and that he couldn't possibly understand why there could be anything there. But when he had a look he said there was something there and booked me in for an emergency operation the next day - BUT on the NHS at Frenchay Hospital as I was unable to fund any further treatment privately.
Again he accused me of being a wimp and appeared to believe he was wasting his time with me. This time I awoke from the operation and was told (if I can remember what order each operation happened in correctly - Mr Dixon apparently has a habit of only speaking to you the second you wake up when you are really quite dazed and unable to retain any information and doesn't arrange any other form of communication - no letter or follow up) that there was some scar tissue from the last operation and that he had cleared it away and also injected some botox to help encourage the healing.
This unfortunately all coincided with my grandmother's death and I had the operation on 11th Feb, the day before the funeral which was not ideal at all but the pain was unbearable. This time around I suffered virtually no post op pain and was only using pads for a week. I returned to Spain 6 days after the operation almost pain free.
A couple of months later, whilst on a family holiday in New Zealand the pain started all over again and I was laid up on beds and sofas in agony for many parts of this "holiday of a lifetime".
Another set of phonecalls and emails to Mr Dixon and his secretary and a further examination under anaesthetic (EUA) was arranged. I was operated on again and apparently the fistula had re-closed and had to be cut open again. Mr Dixon was equally short and rude this time. I had more post op pain than the second op but I was able to start work in France 9 days later without too much of a problem. (Please note that the procedures of the second and third op could be the wrong way round - without any documentation of what happened when I can't remember exactly and the constant pain leaves me constantly tired and I struggle to remember exact details).
Since this op in June 2009 I have been fairly free of severe pain but there is definitely still something not right down there. Upon my permanent return to the UK in September 2009 I saw my GP and requested referral to a new consultant because I had had enough of Mr Dixon's condescending and just generally awful manner.
I am now being seen by Miss Ann Marie Pullyblank's team at Frenchay Hospital and although everything is taking a lot of time, I finally feel as though I am being cared about and they are taking me seriously. I have now seen three separate members of the team (not Miss Pullyblank herself.....yet), all of whom have been very friendly, sympathetic and appear to want to resolve the matter once and for all.
Initially I underwent a sigmoidoscopy and blood tests to rule out any disease. All clear. The doctor said he could see and feel an external opening to a fistula or a sinus but no internal opening so I went for another EUA (11th Feb 2010) to have a good look, expecting to come out having had another procedure fistula removed but apparently they couldn't find anything other than a fistula. Thankfully I came around from the anaesthetic without any wound at all (each time I have had some sort of infection which I understand is not uncommon given the difficulty in keeping that area clean).
There was a little confusion because I was given anoheal to apply to my anus twice daily for six weeks and then see one of the doctors on the team again to see if there had been any improvement. But I received a letter about two weeks later asking me to have an ultra-sound at the BRI. I have continued with the anoheal nonetheless and went for the ultrasound. The results have come through and I recently received a letter from Miss Pullyblank saying there have been "some changes consistent with my previous surgery" and she would like to cut away some of the muscle. I can only presume that this is a lateral internal sphincterotomy. She has organised for me to see her personally because she noted that I haven't actually seen her yet, and wants to discuss the procedure because it is not one she will "enter into lightly".
So that's as far as I've got now. I have heard that the risk of incontinence post LIS is quite high and I'm wondering, given that I am only experiencing limited pain at the moment that can be managed with pain killers, whether the risk is worth taking. I don't know if I just leave it whether the fissure may heal naturally, or by leaving it would I be risking further problems. Given the long line of bad luck I have had already I don't know which way is best to go from here.
I don't know if anyone else out there has suffered similar problems to me but I know lots of you have (had) fissures and will be able to sympathise with the pain and trauma I have had to put up with since September 2008. Does anyone have any experience with either of these consultants? Has anyone just left their fissures to their own devices?
One other problem: since using the anoheal, I have noticed that my buttocks seem to be tightening further up towards my spine. It's becoming slightly painful during bowel movements but not unbearable. It's almost as though there is skin developing between them because it feels as though the shape of my crack has changed.
I'm sorry to have written so much but I feel that it's important to start from the very beginning and I hope noone finds any of it too vulgar. After suffering for this long you become immune to all of the details.
Best wishes to all of you suffering!

Wow, what an epistle! I am weary just reading about all of your trials and tribulations. I'm sure you will get some feedback from those who have had LIS.

Hey there, I read your whole story and oh man have you been through a lot. I'm sorry to hear about some of the silliness you've been through already.
I haven't had LIS yet but am currently scheduled for it on May 3rd. I know others who have had LIS will chime in.
I wanted to say, however, that I can relate to not being 100% sure about LIS since the really severe, intense pain is no longer present. I also currently only have minor pain and itchiness. It's not even severe enough to require painkillers at all. In my case, though, my fissure has been like this for quite a while (several months at least) and I doubt it will ever fully heal on its own.
Anoheal is just 2% diltiazem. I use the same stuff and am not aware of it causing buttock tightening symptoms. But when my fissure acts up, the pain and discomfort does tend to radiate upward toward my buttocks and lower back, so maybe it's a symptom of your fissure? The nature of my fissure pain has definitely changed with time. In the beginning it was just blinding pain in the anus during and following bowel movements; nowadays it's mild discomfort during bowel movements and some lingering discomfort in the buttocks (but not really centered around the anus) afterward.

Hi, what a tough time you have had! I guess one thing it emphasises is to see a doctor you really feel confident with and who treats you with dignity and respect - but this can be really hard when you are in pain or when you are not sure who is really good or there maybe very limited options. It's good you seem to be on the right track now with a much better group of doctors/health professionals.
Regarding LIS, I have had three (the first two were done too conservatively by a different surgeon to the person who did the third one) and while I have still some pain (varies from 0.5 to 2.5 on a scale of 10) it is much much less than it has been in the past (sometimes a 10). I will be seeing my current CRS (colorectal surgeon) soon for a check up but last time I saw him he thought I was healing well. If you see an experienced and well recommended CRS I believe there is little risk of incontinence. A lot of the figures quoted (up to 30% incontinence) are not based on LIS being done by experienced CRSs or at good clinics. Most experienced CRSs will say it is probably less than 2% and for those 2% or fewer the incontinence was probably because the patient's sphincter muscle was not overly tight (ie they just had normal resting pressure - which can be measured by manometry if the surgeon has any doubt) or because their muscle had been irreversibly damaged during child birth or there is another underlying cause (eg Crohns).
If I was in your position, I would prepare really well before seeing Miss Pullyblank and when meeting her make sure you get the answers to all the questions you have eg clarifying what surgery she is thinking of, if LIS - what has been her experience with incontinence, are there any other options, why is this the best option etc. I like the way they have been proceeding slowly and doing a number of tests. You don't want to have any more surgery done until they are really clear about what may be causing your problems. All the best and please let us know how you get on.

Hi all,
Thanks for your replies. Well I saw my consultant on Friday and she discussed the options. She basically left the decision up to me but gave me the distinct impression she would not be comfortable doing LIS as I have already had two incisions in the muscle and the risk of incontinence would be too high. So my alternatives would be to a) leave things alone and see if I get any improvement or b) have an endoanal advancement flap. This sounds like it could be a painful post-op with two weeks off work/studies at a minimum. There is no guarantee it will work but that is the only risk associated with it (or so I'm told). I've decided to have a think about it over the summer (I'm graduating in two months and don't know where I'll be working afterwards yet so the ease of getting time off is unknown) and see how I feel then.
Has anyone got any information - positive or negative - on the advancement flaps? The online information seems fairly limited because it is a last resort operation and clearly not that common.
Also, I've heard lots of stories about people who've left fissures untreated and not had any improvement - it would be really nice to hear of any stories of people who have had success with this option.
Thanks for reading!

We had 2 members that I can think of who had anal flap procedure - both had fast recovery (maybe 2-3 weeks) and it did resolve their ongoing problems.
It has to be performed with top-notch surgeon though since it requires high expertize to be done properly .
Wishing you the best of luck with everything - you were through so much : ((((... I can not even imagine how you managed to travel and go to school with all those surgeries, infections and pain - oh man - you deserve a decoration !!!!AND a Sire title !!!!!