Considering LIS

9 months of fissure pain

Are you having, or have you had a Lateral Internal Sphincterotomy (LIS)? Please share your experiences here, or ask any questions.

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Considering LIS

Postby JulsPain » 26 Jun 2019, 21:13

Hello everyone!

I thought I had read everything on the internet pertaining to fissures, until i stumbled upon this forum and I am so happy I did!

I'm 25 years old, female, and healthy other than this pain in the butt which has been bothering me since around Winter 2017, but has recently gotten really bad due to what I blame on misdiagnosis and mistreatment.

The first time I noticed blood on my TP was right after I moved home from college, Jan of 2017, and thought it was a result of internal hemorrhoids. My mother warned me that sitting down could cause these, and I was laying in bed/sitting down a lot during the time because I was job searching online daily/not exercising.
Several months down, I noticed a tiny tag, but at the time it did not bother me nor do I recall much blood/pain. Perhaps I just don't remember.

Fast forward to a trip over last summer '18 where I got super constipated before/during/and after the trip which resulted in much more significant bleeding. From then on out through fall of 2018 (mostly during traveling) I found myself getting constipated a lot more. I had terribly rough stools, using the bathroom once every 3 days, lots of pushing. Luckily at this point I discovered Glycerin suppositories which were a lifesaver, but I did not think of stool softeners or to take them on trips with me. From here on out was where the itching and pain became unbearable.

Late October 2018, I saw a GP, who confirmed I had a hemorrhoid and referred me to a Gastroenterologist. I waited nearly 2 months for this appointment - getting anything scheduled in San Francisco has been a nightmare. The Gastro doc did an examination which involved inserting a metal probe which was a clamp I can say resembles what they use for pap smears, and also confirmed hemorrhoids and did not prescribe anything for treatment, just to monitor pushing and keeping stool soft. She then referred me to a Colorectal surgeon at UCSF to see if I want to do the surgery.

This experience was a nightmare. Being that this was at a reputable hospital, I thought I was in good hands but the surgeon hardly spent any time asking me questions, went right for the probe and confirmed I had both internal and external hemorrhoids, and that nothing could really be done other than the surgery. She then asked me if I wanted her to do a mild treatment in the office and I naively agreed. This treatment involved her rotating that probe-like thing in my anus a total of three times and swabbing me internally with some sort of cream. This was the WORST pain I have experienced in my life and I had significant bleeding. She then said she does not recommend hemmorhoidectomy to women who have not had children yet, and that if I worked on healing the internal hemorrhoid with the creams she gave me, the external one would magically get "sucked up". She then left the room to allow me to change, and in came a nurse who gave me samples of medications, did not advise how to use them or for how long, and told me I could pick up my prescriptions at my pharmacy. Nothing else. Terrible bedside manor as well, I lightheartedly joked that the pain was from my own doing from a poor diet, and she just looked at me with a stone face and sneered and said "well obviously."

When I went to pick up the medications, the pharmacy was OUT of both (2) , so I just decided to proceed with trying out the samples. One was a cream that needed to be injected internally, and the other was a sticky cream the color of pepto bismol that needed to be applied externally? I used both - and I'm not sure which one did the damage but it caused severe itching which woke me up at 2am several days later and I had to take a shower to wash it off. Didn't use again.

During this time, the part that looked like the external hemorrhoid - pink-ish skin tangling out of my anus, would occasionally swell up and become rock-hard on and off, at its' worst I couldn't even bend over to tie my shoe.
I was miserable and the only thing that took away the pain was a hydrocortisone cream that had a numbing agent that I continued to use.

The pain became unbearable so I decided to go for the surgery, but wanted to do it with a surgeon in my parent's hometown so I could have someone take care of me during healing. Being that my intial GP was with Sutter - they said it'd be nearly impossible for them to transfer my records to an "outside doctor" which sounded ridiculous, all I needed was a referral to a surgeon in a different city. I decided to see the family doctor my parents go to, who then referred me to a Colorectal surgeon in the area.

At this point I'm on doctor #6 within about a 6 month period. We are now in April 2018. Literally 2 minutes into my examination, she confirms I actually have an anal fissure, and that "external" hemorrhoid I was treating was a sentinel pile, and all of the creams I had been using had actually been making my fissure WORSE. She said this is a COMMON mistake made by inexperienced doctors. Why surgeon #1 is allowed to practice if she's inexperienced is beyond me. Allt that time in medical school and you miss a fissure? Even when a tag is present and all my symptoms align with a fissure, the glass-shard pain, bleeding, etc.

She explained what a fissure is, prescribed Benzocaine - Nifedipine, which gave me severe itching when I started using it so I could not follow through with the full treatment. Assuming this was due to my anal area just being super irritated from all the other creams. A few weeks later I tried again and it no longer itched, but the fissure was still bleeding every day and the cream "expired." I saw my surgeon again and this time around she prescribed Diltiazem-Lidocane. I have been using this religiously for the last week and a half and it hasn't really been helping and I have also developed these little painful bumps (3 tiny ones, like pimples but not pimples) on the skin of my butt near the anal opening which has been off-putting.

I'm at my wits end here. I wouldn't say my pain level is on a 10 as many on here, but the bleeding upon bowel movements, the burning and itching are terrible. The tag I have also gets super irritated when I walk from my underwear, and I can feel slight pain internally. I would describe the feeling as always having a really raw, and prickly anus (but internally). The tag has also made me extremely insecure and I can hardly bear the thought of dating/having a new sexual partner which has been making me SO depressed. I have anxiety in general, and just cannot stop obsessing over this.

I want to just go ahead and schedule the surgery so I can stop stressing out over this. It has consumed my life and I am constantly worrying about what I eat, and hoping that the pain goes away but it never does. Since I've technically been using the cream for about 2 weeks now, I'm not sure if I should see the treatment through or go for the surgery as it's been about a complete 9 months of constant pain now and my fissure is obviously chronic since I have the tag.

I strongly think that Surgeon #1 made my fissure 10x worse with all her probing and twisting, as the bleeding upon bowel movement has been non-stop since then. Surgeon #2 mentioned how tight the area was, and how she didn't even want to do a full examination as she barely had to spread me apart to see the fissure and doing anything more would be super painful. I'm just not sure what to do. It seems like surgery success rate is pretty good especially in younger people, but I just don't want to go into the surgery and come out worse. I also have a hard time trusting anything doctors advise at this point. I'm also hoping to have children in the near future (5 years or so) and I know that comes with additional anal issues.

For anyone reading, I just want to stress how important it is to get a second opinion as it's super clear that even reputable doctors in "big cities" just want to get you out of their office/on the operating table.
What if I had listened to surgeon #1 and done a hemmorhoidectomy instead of the Sphincterotomy? The thought itself makes me uneasy. My second doctor took the time to answer all of my questions, did not rush me, and presented me with all available options before even suggesting cutting. She also mentioned she does not practice the botox method due to insurance issues, and possible neurological damage.

Thanks for reading if you made it this far down!! Any input would be greatly appreciated here.
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Re: Considering LIS

Postby Abu » 26 Jun 2019, 22:00

Hi Juls, your story is very touching. You are so young and should be out there enjoying your life instead of worrying and enduring the pain. I noticed you did not mention anything about softeners. Do you take them? The first line of defense is to ensure soft stools every single day for a few months.
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Re: Considering LIS

Postby JulsPain » 26 Jun 2019, 22:10

Abu wrote:Hi Juls, your story is very touching. You are so young and should be out there enjoying your life instead of worrying and enduring the pain. I noticed you did not mention anything about softeners. Do you take them? The first line of defense is to ensure soft stools every single day for a few months.


Hello! Thank you for the kind words. This is perhaps the hardest part of dealing with this. I am at that point where I am wanting to date people, but I spend so much time worrying about this and dealing with the pain as well as insecurities about the visual aspect of this fissure to the point where I just can't bring myself to see anyone new.

I recently started taking Colace! It was a lifesaver on the week long vacation that I just got back from. I thought I was fine but got super backed up on day two so I started taking 1-2 daily and didn't have any more issues. I went 2 days without bleeding, then day 3 had a soft movement but the bleeding started again :( I bought the bottle a while ago, and wrote it off because I still experienced constipation but later realized it was just too late for the Colace to work its' magic. Currently looking into milder forms of stool softeners for every day use as I think Colace isn't meant to be used for longer than a week.

None of my doctors really recommended stool softens, just increasing fiber which I did but was not aware of the difference between soluble/insoluble, so that was an issue in it's own as the fiber increase did even more damage.
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Re: Considering LIS

Postby Abu » 26 Jun 2019, 22:34

Try magnesium citrate and see how it works. You received conflicting advice like most of us and thus you need to find your own way. If something doesn't work try something else until you find the key. Because you will!
Read as much as you can to find what works for others and see if you can relate. Also, do not worry about the looks of it, nobody except doctors are going to study it with a magnifying glass. Be proud of you and your appearance and know that it's not your fault as nobody told you how to prevent such issues in the first place.
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Re: Considering LIS

Postby patience_and_healing » 27 Jun 2019, 12:04

Just want to chime in and say that colace can be used long term as it's a softener not a stimulant. You can try magnesium citrate as well, or miralax. Three different doctors have told me it's fine to use miralax long term, as long as you don't find that you need increasing doses over time, because that could indicate a problem that needs medical attention. I've used a half to 3/4 dose for a couple of years now, and recently began eating 3 prunes almost daily, which helps to avoid inconsistent harder BMs.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
On and off in pelvic physical therapy
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Re: Considering LIS

Postby Coconutoil » 01 May 2020, 16:22

Hi how are you doing now?
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