Considering LIS

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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Re: Considering LIS

Postby SteveR » 10 Dec 2012, 23:54

Thank you guys!
@ Lauren12 I was going to ask on here how to avoid the constipation afterwards. I am refusing all pain relief afterwards such a morphine, codeine etc. is there something that they give you during the op intravenously that I need to avoid too?
Also a I'm on lactulose now and was thinking on day of op doubling the dose in the am and then when I'm home having double the dose again in the pm and doing the same until I go the first time. Do you have any suggestions?
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Re: Considering LIS

Postby Lauren12 » 11 Dec 2012, 14:09

Wow Steve, I wouldn't refuse all pain relief after the procedure, you might need it!
The general anaesthetic may constipate you slightly. It depends on what they give as part of the general anaesthetic. If they give morphine-like drugs, then coupled with the dehydration that comes from being unable to drink fluids for several hours before the procedure, you may become constipated. There are general anaesthetics without morphine but you might need more local anaesthetic in that case. Talk to both the surgeon and the anaesthetist before the procedure and tell them you want to avoid drugs which have a constipating effect if possible. They should be aware that this is a concern anyway, given the nature of the procedure (botox or LIS).
It's important to drink lots of water after the procedure (when you're allowed to). Also Lactulose to pull fluid into the bowel. I took my own Lactulose into hospital (in fact I took my own lunch!) but I think if I hadn't, the hospital may have given it to me anyway. It's probably not a bad idea to increase your dose of Lactulose, although you then have the trade-off between keeping it soft and having a bulkier stool because of the extra Lactulose, although it should go through without damaging because it's soft. I wouldn't know how much to increase it by - I don't know your current dose and it's a while since I used Lactulose. This is perhaps one thing to ask the doctor, or medical staff.
Regarding pain relief afterwards, if you have the LIS you'll need pain relief. In fact even when I had Botox alone, I found I needed pain relief - I don't know what your experience was when you had your first botox procedure. If you have opiates, which are morphine, codeine, tramadol, you'll tend to get constipated. Opiates decrease gut motility and as a result, as the stool is there for longer, the gut is able to withdraw more water from it.
You could ask for intravenous paracetemol. This may sound like a mild, over the counter drug, but when given intravenously it's apparently as good as morphine. As long as your stomach can take it and you're not asthmatic, you could also ask for the NSAID's - Diclofenac, Ibuprofen or Ketorolac. Speak to the anaesthetist beforehand and discuss it with him/her. Both the surgeon and anaesthetist should recognise that you don't want to become constipated.
Regarding diet, you've no doubt developed a diet that works for you to produce regular soft stools and you should stick to that after the procedure. My procedures were all done in the morning. The hospital need to know that you can eat before they'll discharge you, so come round with dreadful hospital sandwiches. Rather than putting a hospital sandwich through my digestive system, I took in my usual lunchtime sandwich (good quality wholemeal bread, good quality ingredients, etc.) and the fruit salad and probiotic yoghurt I'd usually eat at lunch time (plus Lactulose!). You'll have skipped breakfast (so won't have eaten for twelve hours or more) and won't have drunk anything for hours prior to the procedure, so your dietary routine will be somewhat disrupted anyway, so I try to get it back on course by eating my usual lunch rather than hospital food. I took it all in in a cold bag with ice packs. Even so, I think this only keeps it at the proper temperature for about four hours, so you may want to consider what foods you include. Smoothies might be an idea, if you like them - although that didn't occur to me at the time I had my procedures - whatever foods include the necessary level of fibre but also keep you regular and stools soft. You could try asking if they'll put your lunch in a fridge in the hospital. This didn't occur to me until my last procedure, when a nurse asked, pre-procedure, if she should put my cold bag in the fridge! I should have said yes! Having said that, it may be they don't have a food fridge available. Depends on the hospital and ward perhaps.
Regarding your possibly having re-damaged, having previously done well after botox, I wonder if it's because the botox wore off? The question seems to be, whether with Botox, it'll happen again. If botox has worked for you, the choice may be whether to have botox repeatedly, or to opt for the LIS, bearing in mind the pros and cons of each. Obviously this decision can only be taken in conjunction with your surgeon, who knows your particular case.
All the best, and let us know how you get on. ((((hugs))))
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Re: Considering LIS

Postby SteveR » 13 Dec 2012, 00:38

Lauren - thank you for all the advice. Thanks to everyone!
Today is the day. So into prep mode! Fingers crossed.
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Re: Considering LIS

Postby owmybum » 13 Dec 2012, 04:50

Good luck Steve xxx
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Re: Considering LIS

Postby marg6043 » 13 Dec 2012, 08:27

SteveR wrote:Lauren - thank you for all the advice. Thanks to everyone!
Today is the day. So into prep mode! Fingers crossed.

Steve, good luck and remember we all be with you during your recovery in this board. Image
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Re: Considering LIS

Postby SteveR » 20 Dec 2012, 04:09

Thank you guys. Actually had a bad experience with surgeon - actually had an argument before I went in. He was not the one I usually see - which is the drawback to the NHS. He basically said I had brought the problem on myself and the pain from the fissure was an inconvenience. Made me go mad!
Anyway, I complained and I have another appointment on 24th December.
I ended up having botox again - but after the op for days after I had really bad cramps. So bad it was really hard to have a BM - my muscle was just too tight to go.
I had to use Anoheal to make me relax, but now dealing with the consequences of a really solid BM despite 30ml of lactulose each day and 3 spoonfuls of olive oil!!
So now stopped the anoheal again, and hope it will get out the system quickly and I will be able to get soft again!! Just don't really know what to do.
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Re: Considering LIS

Postby Lauren12 » 20 Dec 2012, 08:23

HI Steve, good to hear from you and sorry to hear you had a negative experience with the surgeon. I really don't think some of these surgeons understand what this condition is like. Incredible to say you'd brought the problem on yourself! Having had a problem myself with a surgeon in the past, I know how that must have affected you.
Have you passed a bm now? When I had trouble passing a bm after one of the procedures I had, I went to the GP and she gave me Movicol in addition to Lactulose. You mix sachets of Movicol in water and drink it and I think it softens stools in the bowel that have become hard, allowing them to pass. In a high dose it's used to treat faecal impaction and in a lower dose, used on a regular basis, can keep the stool soft. For a while, I was using both Lactulose and Movicol, although both together made the stool very large, which could be a problem in itself, although it was soft. When I started using Movicol, I started gradually reducing the dose of Lactulose (I wasn't taking as much Lactulose as you) so if you do combine something with the Lactulose, ask the GP about doses initially.
I also asked the GP if I could have some valium tablets! I've never taken valium for any other purpose (except sometimes for root canal surgery at the dentist!) but I was in pain after surgery and was nervous about passing a stool every time I went to sit on the toilet. Valium is a smooth muscle relaxant, as well as relaxing you moodwise. The GP said it was an unconventional use of valium, but prescribed it anyway! I only used it for three or four mornings, on waking (I used to go about an hour after waking, after breakfast) and then didn't need to take it any more because I'd regained my confidence about going to the loo. As it takes a while after you take the pill for it to take effect, it was a problem to know whether to take it on waking, or take it the night before, in case I wanted to go to the toilet immediately I awoke! It wasn't a very high dose - I can't remember now what dose.
I take it that the Anoheal you refer to is Diltiazem cream to relax the muscles?
It's good to hear you've managed to get another appointment for next Monday. Presumably you'll be asking the reason for the cramps, amongst other things?
Let us know how you get on and all the best.
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Re: Considering LIS

Postby marg6043 » 20 Dec 2012, 08:52

I am sorry to hear the bad experience with the surgeon, SteveR, I am one of those that If I don't like the doctors I have not problem walking out and finding somebody else, but then again I live in the US and I have private insurance.
but it doesn't matter you have the right to do what is best for you and your body regardless of what type of health care you have is your body after all.
I hope everything gets better and you find some relief and be back to a normalcy as soon as possible.
In my case I am just managing and doing better for now.
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Re: Considering LIS

Postby SteveR » 20 Dec 2012, 13:30

Thank you guys. I'm worried that as I have just had the botox op I will be told to wait. But the cramping after the op has been horrendous. Actually found it difficult to have a BM because of being cramped so bad.
We will see - I think I might have to be just forceful. Also can ask for a referral to a private clinic - although really don't know how to go about finding one.
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Re: Considering LIS

Postby Lauren12 » 20 Dec 2012, 18:21

Hi again Steve. Where are you experiencing cramping, in the bowels? I take it you didn't experience this with your first lot of botox? Why not go to the GP if it carries on?
SteveR wrote:Also can ask for a referral to a private clinic - although really don't know how to go about finding one.

I'll pm you with some information.
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