Hi, I'm a newbie here! I have had a chronic fissure for 2 years now, after my doctor mis-diagnosed my fissure for 3 months with a hemmorhoid and making it worse I finally got to see a consultant, I was in agony, the pain going to the toilet used to make me pass out and the spasm pain was horrendous lasting 8 hours, I was in a really bad way, I didn't eat for 6 weeks due to the pain I lost so much weight and was so weak! My consultant decided to give me Botox and cut out the fissure so it was a fresh wound again, Botox was amazing felt no pain after about 2 weeks, and after 6 weeks it had healed 50 percent until an abcess formed right on top of it! So I then had to go back in to have the abcess drained and the fissure re- cut again except no Botox was given as it was a different consulatant! The recovery was painful I had this done last November and I still have this fissure!! It starts to heal and even sometimes nearly closes up but I always tear it usually when time of the month comes or just my General ibs playing up, I don't have any spasms like before just pain and soreness from the fissure and going to the toilet still is very painful, my consultant recommends me to have an advanced flap with Botox but I'm worried that with my ibs the stitches will just split and I will end up with an open wound again which he said there's always a risk it can? I got a second opinion who says he wants to try Botox again instead and doesnt look like I need it cut out again? I'm confused as what option to take... I have 3 young children and I'm struggling just want my life back!! Sorry for the long post x

Hi Becka,
Really sorry to hear how much pain your in i can totally empathise with the hours of agony after a BM. I too have had botox and my fissure cut to make a new wound to help healing. My fissure is long and deep and my CRS said LIS would be the next step or if the fissure was still really deep he would do the advancement flap at the same time as the LIS.
Im just thinking he said he recomended this due to the hours of spasms i was having after a BM (ehich the botox has stopped for now) so he said LIS was the best option as that will stop the spasms and allow healing to take place...he said there was no point doing the advancement flap without the LIS first as the wound cant heal if the sphincter is still to tight to allow proper blood flow hence why my fissure has got so bad. My resting sphincter pressure was 5 out of 5...have you had yours tested. I too have IBS and there are days when i can go up to 12 times a day even when im being really careful...i dont know if this made a difference to his advice, but has none of your drs mentioned LIS to you.
Hope your pain improves

Hi, thank you for your reply,my new consultant said that if the Botox doesn't work he will give me the pressure test and he recommends the LIS the only thing that worries me with that is the risk of incontinence as having ibs, does that worry you? I don't get the spasms anymore just wound pain so I don't know what would be better for me, be been told I have a high anul tone which is tight so I guess the LIS would help with that? The skin flap worrys me with my ibs as it could easily tear open the stitches. So sorry your going through all this too and glad the Botox is helping it was such a relieve having the Botox!

To be honest if the LIS gets rid of the pain permanently then I really don't care much about the incontinence...but my CRS who specialises in IBDs has said the worse he has ever seen in 22 years has been soiling on underwear and that was from people whose test was a 3/4 he has never seen what he would class as "proper" incontinence from 1 LIS. I researched this CRS as my first one was useless, thankfully this one has been great so far...got to phone him up today though as I can tell the Botox is wearing off just hope he doesn't make me wait to long for the LIS.
In a way I think having the IBS has made my sphincter stronger as I have spent years holding desperate explosive BMs while I hunt for a toilet so I am very hopeful that I would still be able to do that even after LIS as it doesn't reduce your tone by too much.
If your not having spasms anymore maybe another round of Botox will see you fully healed and if your resting pressure isn't high then maybe you won't need LIS.
I guess it's what we are more concerned about...I would want LIS just because my spasms lasted so long and were debilitating, if they hadn't been I may have considered another option.
Oh yes I love Botox it's been amazing

Yes i agree if the pain goes away forever it's worth doing! I think I'm going to give Botox another go and hope it does heal this time without forming an abcess! Sounds like you have a good consultant and is reassuring about having the LIS with ibs. The ibs is hard enough as it is most days without this added problem, I know what you mean I have spent years holding on to bm's when I'm out in public! Maybe see if you can have another top up of Botox if he can see signs of healing? I eat it can take 2 rounds of it sometimes x

I am so sorry Becka you are going thru this. you sound like I did in the beginning when this nightmare started. I lost 35 pounds just because I didn't want to eat because eating meant having a BM and then pain for 8 0- 9 hours straight and on a scale of 1 to 10 I was at 20. I never thought I would ever be free of the pain, I was resistant to surgery wanting it to heal on its own but it just wasn't happening. an then an abcess formed and that was it my Colo Rectal Dr who was treating me said it was time. I was in surgery the next morning and had a Fistulotomy performed and the abcess drained. believe me when I say, it was the best thing I could of done. I have had No real pain since the surgery to speak of. a few minor burning sensations after a BM for the first four days but quicky jumping in the tub stopped it. My advice to anyone out there is Get the surgery. don't go thru hours and hours of pain like I did. for five months. you will heal and you will get your life back and those scary stories you hear about losing control. well perhaps a few farts that sneak out unannounced but thats about it.. I hope all going thru this nightmare get relief soon. I just wanted to share and let you know that the surgery really does work and lets you return to normal again. I had my surgery Aug 4th this year and have just went for my last post op appt and no longer need to pack it, I wish you healing.

Hey,

Thanks for your message, I'm so glad you are doing well it's nice to hear! Can I ask was it the LIS you had done? I had my fissure cut out and abscess drained and was left with a bigger open wound last November and it's still not healed although has probably healed about 40 percent since. Just wondering if that was what you had done too?

I figured this would explain better what i had done so I cut and copied it
.Fistulotomy Overview
An anal fistula is an abnormal channel or tunnel-like lesion that starts inside the anus and ends outside on the skin of the buttocks. Its development is usually the result of a previous anal infection or abscess. About 50 percent of people with an anal abscess end up with a fistula.

Surgery is the only means of curing fistulas. Surgery to correct a fistula is called fistulotomy. So I stated out with a fissure which turned into a fistula which is why I had the Fistulotomy done the abcess was drained while undergoing the procedure. This is where I think the surgeon is key. I went out of network to have who I wanted to do the surgery. because i wanted the best, its the Sphincter muscle that he cut a small cut to prevent spasm,and he carved a sort of pathway for the stool to flow out and not up inside to cause another abcess, they don't do anything to the fissure itself but by cutting the muscle a bit it allows the fissure to heal on its own. if you have internal hemorrhoids that could be causing an issue you can get them taken care of, My colo rectal surgeon gives them a treatment shot that shrinks them almost immediately giving instant relief. I had that done once before the surgery as they were swollen at the time and causing more pain to the fissure..I am not sure where you are located but if your near Southern California. I will tell you my Dr is simply the best and worth the trip in seeing

Thank you that helps a lot! I'm in the uk so a bit far from you! Im booked in for Botox now for end of October and if that doesn't heal it again then I think I have been swayed to having the muscle cut rather than the advanced skin flap I don't seem to hear of that procedure as much either. I'm glad that you are ok now I too have hemmorhoids that seek to keep bothering me too but unfortunately with ibs they seem to flare up every now and then .

thank you I do hope you find relief soon, going thru that type of pain is horrible. noone should have to go thru something like this especially for as long.