Aaauuugh, I'm in the same situation! (On Diltiazem, but want LIS after retearing a month ago). My CRS won't be swayed. I pushed to see her again today to try to convince her, but she said they don't do it unless you can't heal with the cream and stay healed. I know how frustrating it is, and now it's making me depressed that I don't think I can ever heal if I don't get it.

I wish I had advice, but I'm in the same stupid boat. If you ever find a way to convince someone, please let me know!!

CrayonOfDarkness wrote:Aaauuugh, I'm in the same situation! (On Diltiazem, but want LIS after retearing a month ago). My CRS won't be swayed. I pushed to see her again today to try to convince her, but she said they don't do it unless you can't heal with the cream and stay healed. I know how frustrating it is, and now it's making me depressed that I don't think I can ever heal if I don't get it.

I wish I had advice, but I'm in the same stupid boat. If you ever find a way to convince someone, please let me know!!

I've been depressed too. These doctor's just don't get it. It's taken over my life. My thing is, if I'm so wrong, how come they haven't fixed this yet? I've tried their creams, I don't want to give them 2 more months just to try Botox!! I'm not their test subject.

Hi there endfissure2013,

I know how frustrating it can be. I've been on Diltiazem for months with long periods of ups and downs, but have not achieved full healing and still get pain on and off. I'm going to see a CRS this month again and see what he has to say. I might be open to trying another type of cream, but at this point, I'm so tired and frustrated from all of this. It's been almost a year that I've had this and I'm so tired of it. I know I'm super tight down there and very prone to stress which makes it all so much worse, so I know LIS would help me. I wouldn't even bother with Botox at this point. As incredibly scared as I am about surgery (especially butt surgery!) and the pain afterward, I just want to end all of this, heal completely, and get on with my life. So, you're definitely not alone.

I wish you luck and hope you have success in getting the LIS. Keep us posted and take care.

Endfissure,

My CRS explained that when your anus is injured it will go into spasm to protect itself, but the actual internal anal sphincter is still not abnormally elevated. I too nearly healed using diltiazem but developed an intollerence to it... But apparently that's not enough to prove permanent elevated anal resting pressure.
I can completely understand your urgency to get LIS.... It's the miracle cure.... But I would still urge you to get the test done to actually measure your anal resting pressure. I would hate to think of you being in even more of a mess with a sore leaking anus.
Sorry to be the one to throw a spanner in the works, but it's seriously worth looking into.

OMB x

owmybum wrote:Endfissure,

My CRS explained that when your anus is injured it will go into spasm to protect itself, but the actual internal anal sphincter is still not abnormally elevated. I too nearly healed using diltiazem but developed an intollerence to it... But apparently that's not enough to prove permanent elevated anal resting pressure.
I can completely understand your urgency to get LIS.... It's the miracle cure.... But I would still urge you to get the test done to actually measure your anal resting pressure. I would hate to think of you being in even more of a mess with a sore leaking anus.
Sorry to be the one to throw a spanner in the works, but it's seriously worth looking into.

OMB x

I'm anxious because worse case scenario, in my mind, is that after 2 hemmorhoidectomies, my anus is so scarred that it wont stretch without tearing. The doctors haven't said that I have excessive scarring though. I just want this over with, and doctor's haven't been helpful. I promised myself if Diltiazem and waiting 6 weeks didn't fix things, then I was getting LIS.

endfissure -- same. I just want it to be over. I withdrew from university this semester so I could heal, not to try more creams for a couple months and then retear and then have to have surgery when I'm back in school. I just spent the entire last year trying to heal naturally, while under a lot of stress, and I'm just not into going through that again. Plus, surgery has such high success rates! I would think they'd understand how stressful grad school can be since they became surgeons in the first place, but she basically told me yesterday that if I start school and retear then "we'll just deal with it then," and she doesn't do surgery proactively (not that I'm even healed...). I feel like my only options are to A) keep on with my insane diet/supplement/exercise/etc. regimen and hope to never retear again, or B) slack off on my regimen so I can retear more seriously this time and then get surgery while I have time to.

It's such bull--. Phew for this forum, I vent enough to my husband!

endfissure2013 wrote:It's not that my 2 fissures aren't healing, it's that they heal (according to 3 doctors) and then re-tear. Doctor's don't know everything. Diltiazem relaxed my sphincter and healed my fissures, and I felt so much better. That same doctor later said that I didn't have an elevated resting pressure, by using his finger. So I'm thinking, why prescribe creams or botox that decrease anal pressure, if I don't have an elevated resting pressure? It makes no sense. My doctor is contradicting himself. I want LIS, and I'm not stopping until I receive it.

Couple of things here:
1) I don't think the finger test is adequate. To know your anal resting pressure, you should have a proper manometry done. They should measure ARP and maximum squeeze pressure. I really don't know if this is done on ordinary patients, or only for clinical trials.

2) The purpose of LIS is also supposedly to reduce ARP. If it's true that your ARP and maximum squeeze pressure are normal (which I doubt they could know from the finger test) then it's not clear how LIS will help.

3) You can re-tear after LIS.

I have been reading some scientific papers about how the various treatments work, and why some patients do well on "chemical sphincterotomy" (nitro, nifedipine, botox, diltiazem) and why some need LIS.

This paper: http://www.ncbi.nlm.nih.gov/pubmed/20127340 says that patients with a big difference between resting pressure and squeeze pressure do OK with drugs, and patients with less of a difference may need LIS.

This paper: http://www.ncbi.nlm.nih.gov/pmc/article ... 91162/#B74 is a review of treatments. It's hard to read, full of medical jargon, but as far as I understand, they relate healing to blood supply to the area. A high ARP will reduce blood supply to the posterior anus, where 95% of fissures are located. Reduced blood supply both makes fissures more likely, and makes them harder to heal.
Drugs like nitro relax the anal sphincter AND the local blood vessels, allowing more blood in. But the effects are short lived (couple of hours?). Botox lasts longer because it actually inactivates the nerves that control the anus. But it will not relax the blood vessels (as far as I know).

So how does LIS work? I can't make it out, and the second paper suggests that nobody really knows. It is successful, sure, but until we know WHY it is, we can't know who will really benefit from it and who doesn't need it.

Because LIS has the potential for some serious and nasty after effects (infection,incontinence, a lot of post-op pain), it makes sense to try non-invasive therapies first. And there is research going on to try to figure out beforehand who is likely to heal with chemicals and who is likely to need LIS. But they haven't got there yet.

Scientist -- Thanks for writing that. I didn't realize that LIS was so little understood.

Do you know how likely a re-tear is after LIS?

How likely is a re-tear after LIS? I've looked at a few papers, but it's hard to put a number on it, because some are talking about LIS with botox, some about LIS alone, and then there are different kinds of LIS, with purely external cuts, internal cuts, "customized" cuts etc. Every clinical trial seems different.

However, one I looked at today says: Forty patients underwent LIS and 19 had BTX + FIS (fissurectomy). Primary healing rate was 90 and 74 per cent in the LIS and BTX + FIS groups, respectively. The complication rate was 10 per cent in the LIS vs 0 per cent in the BTX + FIS groups. Complications of LIS included anal sepsis in one patient and flatal and/or fecal incontinence in three patients. During a mean follow up of 19 months; recurrence rate was 0 and 5 per cent in the LIS and BTX+FIS groups, respectively.
http://www.ncbi.nlm.nih.gov/pubmed/19886136

So in this study, 0 out of 40 who had LIS alone, had a re-tear over 19 months.

Here's another: http://www.ncbi.nlm.nih.gov/pubmed/23320551. I apologize if you don't have access to the full article. If you do, look at table 2. They assessed 22 studies and found recurrence rates to vary between 0% and 30% (!!!!). Eight of the studies reported 0% recurrence, 7 of the studies reported less than 10% recurrence. Follow-up was for at least two years.

Make of that what you will. The take-home seems to me, choose your surgeon well and wisely!

Thanks for this scientist..... You have managed to explain things really well.
I need a scientific translator though for a lot of the second link in your first post!! Lol

Xx