Hi Guys,
As always I have been doing my research and yesterday’s research topic was incontinence following LIS. Now before I continue my CRS assured me that with a good surgeon the risk of permanent incontinence in both men and women is less than 1% (the NHS quote this as 0.5%) so the odds are definitely in your favour.
I did find quite an interesting article about anal resting pressure following LIS, now as you may know a tight sphincter (which causes the spasms) is the main cause of non-healing in anal fissures. Both GTN and Botox perform chemical sphincterotomy’s to relax things however if healing still does not occur then a surgeon will make a small nick in the sphincter (LIS) to permanently relax the sphincter.
So the report I was reading compared anal resting pressures in 50 patients (23 female, 27 male).
The resting pressure was read before LIS surgery, straight after and then at 3, 6 and 12 months.
Resting Pressure 1 month before surgery = 138
Resting Pressure 1 month after surgery = 86
Resting Pressure at 3 months = 95.4
Resting Pressure at 6 months = 102
Resting Pressure at 12 months = 110
What this demonstrates to me is why patients may suffer some mild temporary incontinence immediately following surgery and why CRS’s suggest that full healing occurs in 12 months. It shows that the sphincter is at its weakest immediately following surgery and a constant healing improvement continues over the course of 12 months post surgery.
It is also important to note that during the 1 year follow-up, all the patients were free of symptoms. Only 1 patient (2%) had temporary soiling, which resolved after 3 months. There were no other postoperative complications.
Davo

Hey davo..thnx for that post, very reassuring info! More than anything this was my greatest concern while considering my surgery. To date, 3 weeks post-op, I only dealt with minor soiling first 3 days, no issues ever since! These stats will be very helpful to those weighing pro's and con's of surgery! Best wishes, angel

Good to know.
Thanks,
my big fear for LIS though is complications in healing.
But this too is pretty rare, especially if the surgeon is as experienced as yours sounds to be Davo.
-Tanya

Davo wrote:Hi Guys,
As always I have been doing my research and yesterday’s research topic was incontinence following LIS. Now before I continue my CRS assured me that with a good surgeon the risk of permanent incontinence in both men and women is less than 1% (the NHS quote this as 0.5%) so the odds are definitely in your favour.
I did find quite an interesting article about anal resting pressure following LIS, now as you may know a tight sphincter (which causes the spasms) is the main cause of non-healing in anal fissures. Both GTN and Botox perform chemical sphincterotomy’s to relax things however if healing still does not occur then a surgeon will make a small nick in the sphincter (LIS) to permanently relax the sphincter.
So the report I was reading compared anal resting pressures in 50 patients (23 female, 27 male).
The resting pressure was read before LIS surgery, straight after and then at 3, 6 and 12 months.
Resting Pressure 1 month before surgery = 138
Resting Pressure 1 month after surgery = 86
Resting Pressure at 3 months = 95.4
Resting Pressure at 6 months = 102
Resting Pressure at 12 months = 110
What this demonstrates to me is why patients may suffer some mild temporary incontinence immediately following surgery and why CRS’s suggest that full healing occurs in 12 months. It shows that the sphincter is at its weakest immediately following surgery and a constant healing improvement continues over the course of 12 months post surgery.
It is also important to note that during the 1 year follow-up, all the patients were free of symptoms. Only 1 patient (2%) had temporary soiling, which resolved after 3 months. There were no other postoperative complications.
Davo

Hi, Davo -
That's interesting to read about the sphincter's anal resting pressure. My crs said the same thing - that incontinence is not an issue, and complications are very rare. --- For me, I haven't noticed one bit of incontinence, whatsoever, post-op -- not even the first few days after surgery. In fact, I don't think I feel any difference with my bms, thus far - and if I didn't know I had the LIS, I wouldn't be able to tell, except for the soreness thereafter. I guess that's a good thing - because it means my crs knows his stuff.
I do feel a lessening with the spasms -- I'm not sure they're gone completely, but they're much milder. I mentioned to my crs (last week, during a post-op visit) that I thought I might still have some mild spasms. He didn't seem a bit concerned about it.
The 12-month healing time seems right. I'm thinking that the post-op soreness and discomfort probably takes awhile to ease up, too - especially for someone in my case, who also had the fissurectomy. I feel better, but not completely well, yet.
Anyhow, Davo - I hope you're doing okay. Do you have surgery scheduled, yet? I can't remember . . .

Hi Guys,
I thought that was an interesting article and it covered the reason why some people may have temporary incontinence.
Sweet, My LIS is currently scheduled in eleven days time (14th) - Strangely enough my symptoms have considerably improved since the CRS booked me in for LIS. I am almost pain free and the majority of the time i can't even tell i have a fissure however i know that if i relax the meds or change my diet my fissure will re-tear. Also my state of mind has improved dramatically, I feel happy again knowing that i may be putting an end to all this in a few weeks so i personally can't wait for the surgery!!
Davo

That's good, Davo - because ITA with you - your fissure will surely re-tear, given time. That's what happened to me, and then my fissure wouldn't heal. At least I know it's been dealt with, and once I completely heal from my surgery, I won't have that fissure to contend with anymore.
Dealing with an AF is absolute misery. That's all I know.

Davo and Sweet,
I've noticed some soiling on my Tucks pad when I start getting the feeling that I have to go. Sometimes though, the BM may not occur for hours later, or like in the last one, just now. On this last one, I noted that the urge (and the bit of pain which accompnies it) began last night, right around supper time. Other than this, the only thing I'm generally seeing is a pinkish stain on the Tucks during the day as I replace them. This I can live with for a time.
Like SB, I've noted some post BM pain, which does feel at times like the sphincter spasmming. Be that as it may, the level of pain is far less than pre-surgery, and, in fact, it has been over 24 hours since I've had even so much as an Ibuprofen. I am going to take a couple once I've finished this post, as they do seem to calm the spasms.
Hope you all are doing well.
Rob

For what it's worth: I asked my CRS about incontinence following LIS and he said that it is VERY rare if the surgery is done by a CRS (as opposed to a general surgeon) and even rarer in men. Apparently, it is more common in females due to their anatomy, but is still pretty rare if you are under the care of a CRS. It sounds to me like the key is to have LIS done by a board certified colorectal surgeon.

Davo wrote:Hi Guys,
As always I have been doing my research and yesterday’s research topic was incontinence following LIS. Now before I continue my CRS assured me that with a good surgeon the risk of permanent incontinence in both men and women is less than 1% (the NHS quote this as 0.5%) so the odds are definitely in your favour.
I did find quite an interesting article about anal resting pressure following LIS, now as you may know a tight sphincter (which causes the spasms) is the main cause of non-healing in anal fissures. Both GTN and Botox perform chemical sphincterotomy’s to relax things however if healing still does not occur then a surgeon will make a small nick in the sphincter (LIS) to permanently relax the sphincter.
So the report I was reading compared anal resting pressures in 50 patients (23 female, 27 male).
The resting pressure was read before LIS surgery, straight after and then at 3, 6 and 12 months.
Resting Pressure 1 month before surgery = 138
Resting Pressure 1 month after surgery = 86
Resting Pressure at 3 months = 95.4
Resting Pressure at 6 months = 102
Resting Pressure at 12 months = 110
What this demonstrates to me is why patients may suffer some mild temporary incontinence immediately following surgery and why CRS’s suggest that full healing occurs in 12 months. It shows that the sphincter is at its weakest immediately following surgery and a constant healing improvement continues over the course of 12 months post surgery.
It is also important to note that during the 1 year follow-up, all the patients were free of symptoms. Only 1 patient (2%) had temporary soiling, which resolved after 3 months. There were no other postoperative complications.
Davo

Thought i would re-post for info
Davo

Davo wrote:

Davo wrote:Hi Guys,
As always I have been doing my research and yesterday’s research topic was incontinence following LIS. Now before I continue my CRS assured me that with a good surgeon the risk of permanent incontinence in both men and women is less than 1% (the NHS quote this as 0.5%) so the odds are definitely in your favour.
I did find quite an interesting article about anal resting pressure following LIS, now as you may know a tight sphincter (which causes the spasms) is the main cause of non-healing in anal fissures. Both GTN and Botox perform chemical sphincterotomy’s to relax things however if healing still does not occur then a surgeon will make a small nick in the sphincter (LIS) to permanently relax the sphincter.
So the report I was reading compared anal resting pressures in 50 patients (23 female, 27 male).
The resting pressure was read before LIS surgery, straight after and then at 3, 6 and 12 months.
Resting Pressure 1 month before surgery = 138
Resting Pressure 1 month after surgery = 86
Resting Pressure at 3 months = 95.4
Resting Pressure at 6 months = 102
Resting Pressure at 12 months = 110
What this demonstrates to me is why patients may suffer some mild temporary incontinence immediately following surgery and why CRS’s suggest that full healing occurs in 12 months. It shows that the sphincter is at its weakest immediately following surgery and a constant healing improvement continues over the course of 12 months post surgery.
It is also important to note that during the 1 year follow-up, all the patients were free of symptoms. Only 1 patient (2%) had temporary soiling, which resolved after 3 months. There were no other postoperative complications.
Davo

Thought i would re-post for info
Davo

Hi, Davo - How are you doing? How is married life? I hope you've been doing well.
I've been okay -- I've had my ups and down with my healing process. For me, it's taken months and months, and I still have tender days. What I've learned about myself is that, apparently, my rather small, thin bum has basically no fat to it, which sometimes makes things tender, because I don't much padding or fat . . . and that makes for a tender situation, at times.
Both of my Crs's - the one who did my surgery, as well as the one who checked me thereafter - have said I'm healed and see no signs of a fissure. However, they've both commented on my lack of fat (which would help pad things, a bit) and have said most of their patients are on the opposite end of the spectrum, with regard to amount of fat and padding on the backside.
So, although I'm glad I had the surgery and know it was necessary, I haven't had as quick or easy a recovery, as many post-LIS/fissurectomy patients have. --- About the resting pressure, it's a year post-op for me, and I can tell that the pressure has risen back up some, with my healing.
Anyhow, I hope you're enjoying married life, with an occasional pizza thrown in. So good to see you back here. :)