Hi All,
Sooo, I am back !! Some of you know my story, I had posted my AF journal here in the forum.
I am back because I am getting the recurring bad days and need advice from people of experience to take my final decision whether to go ahead for LIS or not. Thank you so much to Grateful Al, Bambi and BillUltra for giving me strength and hope.
Quick summary: I got the fissure 4.5 months back ( I hate how this number increases every time I write about this somewhere ). Initial pain was 9/10, was in extreme pain for a month. Consulted CR, tried Nifedipine with no help, then I healed myself with careful diet, natural remedies and routines. Pain level came to ZERO by 4th month with absolutely pain-free BMs.
Now:
After 2 weeks of my "Success story" post (oh, how naive I was !), I am still here, so you guessed it right ! After strictly following my fissure diet for a month, I slowly started incorporating small quantities of 'normal' (still soft) food into my diet, and my old friend is not liking that. I have had set backs 3-4 times after that post, nothing major, a max of may be 2 out of 10, that too only during the BM and nothing after that. So, the main reason I am here is to get the opinion/advice from people of experience in taking my final decision of how to put an end to this episode of my life. I WANT TO EAT (sorry for the yelling .. )
I consulted my CR at the beginning of this month, she is a very experienced surgeon (45 years experience) and she suggests that I have the surgery to tackle this for once and forever. But, she had suggested the same when my pain level was 6. The thing is, I feel so proud of myself being able to bring down the pain to this level and being able to have continuous pain-free weeks (provided I keep my fissure diet). BUTTTTTTT, my biggest concern now is that I cannot continue to live on this minimal fissure diet any more.
Questions regarding surgery:
1. Can any of you (who already had lis) please describe the exact nature of the LIS external cut ? I am slightly confused. Where does it start, where does it end , how long and in which direction of the anal dial ? or does the position differ according to the position of the fissure ? does it end at the anal opening or is it slightly away from the opening ?
2. I currently use coc oil suppositories before BM. After surgery, did you use any suppositories/oil pre-BM ? Or, did you apply Vasiline/coc oil at the opening to make cleaning easier ? Are we not supposed to do that after surgery ?
3. What did you use to clean the area after surgery ? soap/lotion/savlon etc ? I use unscented female cleanser now - can i continue that on the fresh surgery site ?
4. I read about using ice packs and hot packs post surgery. Can any of you please explain how to use them on that area ? I mean using both on that tender area really scares me !
5. I am a Yoga Instructor. How long do you think I should wait after LIS to get back comfortably to such advanced stretching routines ?
Questions specifically to women (sorry men readers!):
6. I haven't had babies yet. Me and my husband were planning to start a family right when this lightning hit me ! My main priority (or should I say dream?) at this point in my life is to be able to be healthy enough to conceive, carry and deliver naturally. What do you all think about my situation ? (especially you mommys out there). I am sure you can understand my woman "hormones" talking. My CR says, if that is my plan, I should not prolong the surgery any longer. She says, eventhough, you feel that you are healed, it will come back when you are pregnant due to the preg-constipations and she cannot perform surgery on a pregnant woman. She tells me that I can try to conceive as early as 3 months post-LIS. Do you think that is possible ? How long do you think it is better to wait to try post-lis ? (I know it is different for person to person, but would love to hear from people of experience). My fear is, will the weak anus post-lis be able to survive the trauma of natural child birth ? Half of me says, wait, you will feel better all by yourself. But then the other half stares at me and says dont listen to your stupid half ! (I know AF can lead to madness ?)
7. Post surgery, during the first periods, do we strictly have to use tampons to avoid infection from the period blood ? Or, are the sanitary pads better ?
I have my next CR visit at the end of this month, and she said come only after deciding on surgery, meaning like a pre-surgery visit. So, I am using these weeks to weigh in my options. I know I have suffered enough, this is the fifth month, but thankfully, the progress so far has been very good. At this point, I really am lost about what to do. On the bright side, for the first time during the journey, I am mentally prepared for the surgery, but waking up every morning with my fingers crossed. I really want to avoid lis, if you ask me (but who woudn't?)
I know you guys will not judge me or anything. Honestly, I was telling my hus the other day that this forum is my new facebook !!! I am socially inactive for several months now (yeah, as if they would hit "like" button for my daily fissure concerns and poop stories , phew ! ). So tell me guys, I need your Opinions and thoughts. I truly remember all of you in my daily prayers.. Hoping for big happy smiles on all our faces. THOSE days will come for sure ... I am optimistic.

- Angel

I have nothing to say except that I feel your embarrassment about being in the profession of helping people with their health issues and not being able to cure this on your own. I feel like I should be able to cure this on my own. My diet is crazy good (although I haven't limited portions like you did.) The diet the doc gave me is way LESS healthy than the one I already follow. I'm vegan and sugar free.
So many people heal themselves by simply improving lifestyle stuff. It kinda makes me mad at the universe, because I have a healthy lifestyle. I've put in the work. But for me, that's not healing the fissure. I haven't had the surgery, so I can't answer your questions. I just saw my doctor today and he did tell me that he does not prefer to do surgery on women who plan on getting pregnant in the future. He says its the one time that he prefers botox. I didn't ask into it, since I'm not in the position to be having children anytime soon.

Hey there,
My situation is probably quite different from yours but I can answer some of your questions. I had LIS nearly 5 months ago. I still haven't 100% healed, but I am pretty much in no pain 99% of the time, it's more just a bit of discomfort some of the time.
The LIS cut is to the side (lateral) of the internal sphincter. The length of the cut will often depend on your surgeon. Mine was very cautious and performed a relatively small cut in order to decrease any chance of incontinence post-surgery. The anal opening is your external sphincter, so the cut will be deeper. I couldn't see the cut after the surgery, but I could feel it inside.
I didn't use suppositories before surgery, but I did use coconut oil among other creams, which I continued to use post-surgery. The area was quite inflamed and tender, so I had as many baths as possible, especially after BM's and always put cream on afterwards. I have never experimented with ice/heat packs.
As far as your yoga is concerned, I've read a lot of mixed opinions on exercise. I do kickboxing, and I do a lot of stretching every day. I went straight back to training 2 days after the surgery, and I felt fine (I was worried I would start bleeding everywhere though!). I think it might depend on exactly where your fissure is, but for me intense exercise doesn't really seem to irritate it. I went through a period where I was convinced that my training was causing my fissure, and despite my CRS insisting it had nothing to do with it, I stopped training for 5 weeks. Worst decision ever! I felt worse physically and mentally.
My advice would be to listen to your CRS. If they are recommending the surgery, it is probably a good idea. You've obviously done a great job on your own, but you shouldn't have to live on an unsatisfying diet in order to remain fissure-free! At the end of the day, it is only very minor surgery, and if the underlying cause of your fissure is too much pressure in your sphincter (which is more than likely is), LIS should help to not only finish off the healing, but also to prevent recurrences in the future.
Sorry for the massive post, but whatever you decide, Good Luck!
Dan

coconut,
Thank you so much for the reply and for the support and understanding. And yeah universe works in its own mysterious ways... isn't it? Regarding your diet concern, I would say eating healthy is very different than eating fissure-diet. Fissure diet involves around the quantity of fiber and water content and acidity etc. Many of the healthy foods are not good for an active fissure, so it would be good to stick to the diet that your CR gave. And about the surgery for woman expecting to get pregnant, I have no idea why my CR has the totally opposite opinion !
- Angel

Dan,
Thanks much for the lengthy reply. Oh glad to hear you are 99 % healed. yay !! Are you eating perfectly normal now and as much as you want ? (that is my big question ! ). And regarding your description of the lis cut, you did not have any external cut and stitches ? hmm... my CR says there will be a cut outside the anus about 1-1.5 cm long and she will put stitches to it. Yours may be done differently then ? I understand about the internal cut to the internal sphincter which we cannot see.
OMG, you did kickboxing 2 days after surgery ? wow ! you are a strong man. :D Even my CR does not think Yoga can irritate the site. Thanks much for the response. I will update my decision in this post by the end of this month. Wish you a happy and healthy life ahead !
- Angel

^It seems to me that any outside visible cut would be do to the tag being removed. At least, that's what my doc described yesterday. Obviously, your butt is different than mine. All of our butts are special unique snowflakes!
(Sorry 'bout that. I'm in a lot of pain here, people.)

AF Angel wrote:coconut,
Thank you so much for the reply and for the support and understanding. And yeah universe works in its own mysterious ways... isn't it? Regarding your diet concern, I would say eating healthy is very different than eating fissure-diet. Fissure diet involves around the quantity of fiber and water content and acidity etc. Many of the healthy foods are not good for an active fissure, so it would be good to stick to the diet that your CR gave. And about the surgery for woman expecting to get pregnant, I have no idea why my CR has the totally opposite opinion !
- Angel

Alas, my diet is already exactly what is recommended. My only confusion is wether spicy foods are OK. Traditional chinese medicines has us eliminating anything that is pungent, meaning everything we see as seasoning, from onion to hot pepper. It makes for horrible tasting food and is counter-indicated for other signs in my body. I don't seem to be worse after eating hot-spicy foods. I'm also not constipated, so I wonder if my case is different.
I haven't heard anything about getting the poo less acidic. Maybe that's the same thing as spicy?

AF Angel,
I haven't had surgery so I can't provide direct experience information for you, but I did just want to pop in on a couple of things.
First, the decision to have LIS when you haven't had children yet is not an easy one, and you will hear different opinions from different doctors on this. That being said, most surgeons are pretty hesitant to perform the surgery on women who plan to have children due to the potential increased risk of sphincter damage with childbirth. It is just a total unknown for each and every woman. For this reason, most surgeons prefer to absolutely exhaust all conservative measures first, including stool softeners and topicals such as nitroglycerin, nifedipine or diltiazem, followed by Botox with or without fissurectomy.
Second, with regard to stitches vs. no stitches. Lateral internal sphincterotomy is performed in one of two techniques, either closed or open. It sounds like your surgeon is describing the open technique. There is also some debate about which method leads to greater risk of complications. Different surgeons will have been trained in different techniques. Really, the most important factor is how experienced the surgeon is, how many procedures they have performed, what their rate of complications is, and what their rate of successful healing is.
Complications of LIS include risk of bleeding, infection, abscess, fistula formation and of course, incontinence. The complications can arise due to the technical skill of the surgeon, but can also arise simply from bad luck. That being said, when performed well by a highly skilled, experienced surgeon, it is an effective and safe procedure for fissures.
Hope some of that helps. Wishing you all the best in your decision.

I can't really help you with the food situation. I've always eaten healthy anyway so I never really changed my diet, even when the pain was at it's worst. But every now and then I'll have a big night out with my mates drinking and eat a bit of junk, and it has never caused me a problem.
No, I didn't have any cut/stitches on the outside, I presume that is the closed method of LIS. Either that or the doc is planning on removing a skin tag? If you're unsure of anything regarding the surgery, write down all your questions and when you see the CRS next drill them for all the answers!
Best of luck!

coconut,
From what i have read, it is better to avoid spicy and acidic foods. Even though they may not create constipation, they will create irritation in the already agitated anal tissues. So stay off from spices and acidic fruits and juices.
jr2,
Thanks much for the kindness to give me the pros and cons and the info. Yes, mine is lil difficult to take a decision. I am consulting one more CR to finalize. Thanks again !
Dan,
Thanks for clarifying that you are eating properly post-LIS. To hear that itself is a big relief. I will let you all know once I finalize... This may be the biggest decision in my life only second to who I wanted to marry !! :roll: Just keep me in your prayers.. Thanks all again .. Take care
- Angel