Debating LIS Surgery

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Debating LIS Surgery

Postby countrygirl49 » 08 Feb 2021, 14:58

Hi All,
Sorry in advance for the lengthy post!
I am a 34-year-old female and I’ve had an on-and-off fissure ever since giving birth to my son four years ago. Nifedipine always seems to fix it up within a couple of weeks, but I always get recurrences within 2-6 months. I usually know what flares them, but this go around I don’t. My last flare was in November, this started a week ago.

I take massive amounts of Metamucil each day, though I've cut that back quite a bit and added fiber, but still a LOT more than "normal." My poops are generally quite soft. I drink LOTS of water.
I’ve been debating LIS for over a year. I know that the surgery doesn’t prevent fissures, but helps them heal. Though, I have also read that a tight sphincter may be a cause of recurrent fissures, and that I definitely have.
Every time I’m healed, I think there’s no way I would have the surgery: I’m terrified of surgery, terrified of hard BMs in the recovery phase, really dreading the recovery in the first few days, especially having a toddler. My husband can help out, but I just don’t feel that it’s right when my son won’t know what’s going on and why I won’t get out of bed. I also had a surgery 20+ years ago and I was VERY nauseous afterward. I don’t remember how long that lasted, but that’s one of the things I definitely remember.
And now, when I have a flare, I think oh my goodness, I need that surgery… I don’t want to keep living like this!
My CRS—as mentioned above—said I have a tight sphincter. She can barely do a manual exam with her pinky when I don’t have a flare and said I have spasms. She said to try Pelvic Floor Physical Therapy (PFPT) and if that doesn’t work, to have an open LIS.
I’ve had one session of PT and was told to raise my knees above my hips. Like with a squatty potty. I almost think that is what brought this flare on, though?? I also learned how to “unload” as she calls it—laying on my back with my lower legs on a chair and hips wide. However, I just don’t know what she could do for me over several sessions to help me not need a LIS. :(
So, I have several questions to start off!
Has anyone been in a similar situation?
Has anyone regretted getting the LIS?
Success stories?
Has anyone tried PFPT and then never needed surgery because it worked?
Has anyone tried anything else that worked great?
My CRS doesn’t prescribe this to her patients, but what about manual dilation?
Any other suggestions?
Thanks in advance!
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Re: Debating LIS Surgery

Postby Rich44 » 09 Feb 2021, 17:47

Hi,
Yes I can share a little bit. I had a very successful LIS last October and I only wish I had done it sooner. My sphincter was off the charts tight. I did an anal manometry test to see how strong it was and the normal range was 60-100 - I was over 230! CRS laughed and said I could crack a walnut in there. I even broke the balloon on the test! So there were no worries about being incontinent from the LIS. A month before we tried niphedipine with lidocane which didn't work. I was straining every BM and that was the main concern I had. I was living with fissure pain for years and in spite of how excruciating it could be - I could manage. Now I was in over my head. He said let's do the LIS and you can move on with your life. Surgery was a breeze, I am fine with anesthesia and recovery was what, 2 weeks? Trust me - the pain AFTER surgery is nothing compared to what it is now. I refused any pain killers too. Maybe I am a glutton for punishment. Bottom line my CRS says is everyone says the same thing - "why didn't I do the LIS sooner?!" Go get it and put all of this behind you.
Chronic Fissure June 2014 - October 2020
Botox, skin tag removed - February 2015
Levator Ani September 2014 - February 2016 (caused by stress - left my job, cured!)
Lateral Internal Sphincterectomy, skin tags removed - October 2020
Fissure 100% healed!
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Re: Debating LIS Surgery

Postby countrygirl49 » 12 Feb 2021, 17:18

Thanks, Rich44! Oh my goodness, that tightness sounds worse than mine! Though, I haven't had a manometry test. I'm so glad you posted, that's just what I needed to hear. I'm so glad the LIS worked and went so well for you!

The morning of 2/9--before you even posted--I called to find out if the doc had any openings for surgery and she did. I wasn't really prepared to sign up for it, but I did. I'm scheduled for 02/26.

My doc doesn't prescribe pain meds for after-she said something about alternating Tylenol and Ibuprofen every three hours. I don't take much as it is, so hoping for the best and hoping the pain after surgery is less than it is now and can be managed well with the two if necessary.

Did you have general anesthesia? Or conscious sedation? My doc said GA is the "quickest and easiest" way to go, so that's what is on my surgery orders, but she also said I could have CS. I think she said something about being able to "feel things" with CS, but from what I've read, you don't? I have one last pre-op visit with her just prior to surgery and will be asking again. Not only has my research shown that I wouldn't feel anything with CS and I would be asleep, but it is also safer with a quicker recovery time, so I don't know why I wouldn't choose CS over GA. She also said she uses a long term local that lasts somewhere around three days, so that would help (at least with the incision site, not the fissure I guess).
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Re: Debating LIS Surgery

Postby Rich44 » 12 Feb 2021, 17:41

I wasn't offered a choice and I had the full GA. That's what I would want anyway (I seem to tolerate GA very well). To be honest, I didn't even know people had issues with GA. They asked if I wanted medication to calm me down before the surgery. I asked, "Why?" I was totally calm and ready to roll. I was actually excited to get the surgery and put an end to the misery! They offered a pain med script. I told them I wouldn't fill it. There was no chance the pain of the LIS would be any worse than what I had endured for 6 years. Tylenol or Ibuprofen as needed is all I think I took. Maybe a few Ibuprofen. It wasn't fun going to the bathroom afterwards, but it was not that bad. Remember fundamentally what was happening. They are doing a teeny weeny cut of the sphincter. That is it. (Ok I had some skin tags removed too) So going to the bathroom should not be of much concern. You'll be fine, you will LOVE that you did this and you are almost fissure FREE!!!!!! By the way lately I've been using a squatty potty step stool to elevate my knees and align my colon to make evacuation much smoother and with less straining - it works. I don't really have to strain any more but it doesn't hurt to assist the body. As long as that sphincter is not too tight, you will reduce the chances of a fissure big time. I am not sure why you wouldn't have a manometry test first to make sure you can handle the LIS but it seems pretty obvious you are a tight a$$ like me!
Chronic Fissure June 2014 - October 2020
Botox, skin tag removed - February 2015
Levator Ani September 2014 - February 2016 (caused by stress - left my job, cured!)
Lateral Internal Sphincterectomy, skin tags removed - October 2020
Fissure 100% healed!
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Re: Debating LIS Surgery

Postby countrygirl49 » 16 Feb 2021, 17:41

I had surgery maybe 20ish years ago and remember feeling really sick after having GA. Ugh. I also read that it can linger in your system for a very long time, which can’t be good. Glad you handle it well. I’m hoping my anxiety turns to excitement the closer the surgery gets… So far it’s not.
I’m now having an exam under anesthesia as well because she can never do one because of the pain and tightness. I guess that’s a good idea. Now I’m just worried about being “torn a new one” with having an exam and everything spread much farther than it seems it can… I can barely get my finger in there to apply Nifedipine. I also now have a ‘roid right where it sounds like she would do the surgery, so I have no idea how that will work. Can’t be comfortable after the fact with that! I’m hoping that, like you, Tylenol and Ibuprofen will be all I need!
I’m definitely anxious for the first BM. I have irrational thoughts that if it is hard (never mind the pain!), that the rest of my sphincter will rip or some crazy thing. I actually have irrational thoughts about a lot of it… I need to refocus my thinking and be POSITIVE.
I’m happy to hear the squatty potty is working for you! I honestly think that’s what set off my latest flare up. And one previously as well. I have no idea what’s going on down there. But, the two times I’ve tried it, I’ve had flare ups. Just continuing to use it thinking that maybe my butt will be “re-trained!” Hahaha.
I think she said she cuts one quarter (to one third?) of the muscle. I asked: So it will be like a new fissure. And she said yeah, kind of. She also said that spreading my anus for the surgery (and exam I’m assuming) could re-tear my current fissure and maybe cause another? Not looking forward to that!
Regarding the manometry test, I was never even offered one. She analyzed my muscle tone and coordination with her finger during a non-flare period, but couldn’t do much more. Could barely get her pinky in there! I’ll ask about this one as well.
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Re: Debating LIS Surgery

Postby Rich44 » 16 Feb 2021, 18:38

Wait a second... 1/4 or 1/3 of the muscle?! They normally cut 6%. If you are a tight a$$ based on feel, then you are probably going to be fine with the LIS. Do you do sitz baths? They could relax the area (and help blood flow) to where applying medication would be easier. Either way, you won't need niphedipine anymore after the surgery. Just go with the flow and remember this is all going to be a memory soon.
Chronic Fissure June 2014 - October 2020
Botox, skin tag removed - February 2015
Levator Ani September 2014 - February 2016 (caused by stress - left my job, cured!)
Lateral Internal Sphincterectomy, skin tags removed - October 2020
Fissure 100% healed!
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Re: Debating LIS Surgery

Postby countrygirl49 » 24 Feb 2021, 18:21

Well, I talked to my doctor today and asked about the manometry test and she said I would be fine and that the test most likely wouldn't change what she suggests. I was reassured she'll "work around" my hemorrhoid. Also discussed CS vs GA and she said GA is the safest, quickest way due to the prone position and the fact that I would be asleep under CS, but the rest of my body really wouldn't be. (Possible twitching and said I might not tolerate the retractor.) So, GA it is.

Regarding the amount cut, from what I've read, surgeons sometimes cut up to half. I didn't see anything about 6%. She's done so many of these, though, that I trust what she's doing. Is it allowed to post a link to that info? I'm curious about it.

The doctor also said to use the nifedipine after surgery for a while. Now I don't recall why. Assuming it's to help keep things relaxed.

Had my pre-op COVID test today and I was told no news is good news and to self quarantine until surgery. So, it's the final countdown and my anxiety is not subsiding, unfortunately.
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Re: Debating LIS Surgery

Postby Pzgre » 26 Feb 2021, 14:34

Did you have your surgery?
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Re: Debating LIS Surgery

Postby countrygirl49 » 27 Feb 2021, 17:22

I sure did. Just over 24 hours post op now. I'll try to make this short because sitting isn't comfortable!

Surgery went well. Came out of general anesthesia really well. I don't remember talking to the doc after, though.

Pain yesterday was pretty limited. Started to feel twinges overnight. I had a three-day local numbing applied. However, I'm not so sure that's going to last three days! Definitely at least 50% gone now. Pain yesterday was probably a 1. Today probably a 7. (My normal posterior fissure pain was probably a 6.) And the pain is more anterior from being stretched out and I think maybe a slight new fissure there from the "spreading open." Incision pain not so bad. Hemorrhoid pain too.

I took a Colace yesterday afternoon to combat the effects of the IV fentanyl. Also taking normal Metamucil (which, for me, is quite a bit. Like 1 rounded Tablespoon with a normal sized meal.) Though, I only ate a bowl of oatmeal at noon yesterday and some broccoli and wheat cereal at 5pm yesterday.

Pooped twice this morning. First was just a couple apricot sized and only slightly soft. Took a quick lower body shower after. Second poop was loose, but more painful as the local is wearing off. Not as scary as I anticipated, though. Took a quick lower body shower and tried a sitz bath. The sitz seemed pretty uncomfortable to me, so I got off of it pretty quick. They aren't required, especially if I shower after a BM.

Swelling yesterday and today is DEFINTELY there. Especially where my hemorrhoids are. Kind of scary feeling. The doc told me not to look, though, and so I haven't. Said it would look purple and swollen all over. I also feel like I've been torn a new one, especially on the anterior side. :(

Been taking tylenol only today, but plan on doing the alternating tylenol/ibuprofen schedule recommended as so I don't OD on tylenol. Pain a little more than expected. I do have a script for oxycodone, but don't want to use those at all for fear of constipation. Will if I have to at night with a Colace.

Ate some oatmeal at lunch today, but that's it so far. No appetite and don't want my "normal" four poops tomorrow morning!

Really hoping pain lessens after the main 24-48 hour window. Will keep updating as I go, maybe not daily, but as I can.

Edit--Also, no real leakage today of poop. A little after going, but not before. Blood when I wiped, but no more than usual. And I'm not sure if it's from my fissure or the incision or both. Also, she "cleaned up" the edges of my fissure (cauterized some areas).
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Re: Debating LIS Surgery

Postby Pzgre » 27 Feb 2021, 18:17

Thank you so much for the update, its great to hear ! Seems like you are on track to healing. Don't worry about updates, just whenever you can is fine.
Also how did you choose your crs?
Were the certain questions you asked before deciding to go with her.
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