Diltiazem or LIS

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Diltiazem or LIS

Postby endfissure2013 » 26 Aug 2013, 19:46

Had a hemmorhoidectomy January 11th, 2013. Ever since then I've had 2-3 fissures that keep healing then re-tearing. Never had a problem with fissures before. Doctor put me on Diltiazem and it has closed the fissure within 2 weeks. However any normal dilation of the area will result in a re-tear. I'm seeing a new CRS on Wednesday, and my question for you all is. Should I stop messing around with these creams, and just get the LIS? It is the gold standard btw.
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Re: Diltiazem or LIS

Postby jr2 » 26 Aug 2013, 19:58

When you see the new doctor, in your case it would be worth knowing if the hemorrhoidectomy caused anal stenosis, which can be an after-effect of hemorrhoid surgery. If it did cause stenosis it may have left you more prone to fissures. The reason it's important to know is that depending on whether or not there is stenosis caused by scarring, LIS may or may not be the recommended surgery. Anal advancement flap is sometimes needed instead to repair the stenosis problem (and at the same time it repairs the fissure.) One member here, Suzy, had the advancement flap surgery due to stenosis caused by a hemorrhoidectomy years ago. She tried LIS first and in her case it didn't solve the fissure problem or the stenosis problem. So, it just means it's a really good idea to have a thorough evaluation done to determine what is best in your particular case. Suzy is really helpful and informative, is a moderator on the site, and if you have any questions, she would be a great resource for you to ask.
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Re: Diltiazem or LIS

Postby endfissure2013 » 18 Sep 2013, 14:20

Here's an update. I'm convinced I need LIS. I was using Diltiazem and it seemed to help. My problem is that I'm having trouble convincing doctor's to operate on me. What should I do? I've already went to a patient advocate. They say they can't force the doctor's to operate. I'm going to do whatever it takes to have this surgery done. It's my body and it's my risk. I've read all the stories here, and I'm not going to suffer for years with creams, and botox only to find LIS cures me.

In response to the admin, I have a tiny ulcer and a recurring fissure. There's no other issue according to my CRS.
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Re: Diltiazem or LIS

Postby Ever the Optimist » 18 Sep 2013, 14:51

Hi Endfissure,
It's a difficult one because it seems that it really depends on the CRS involved as to whether they want to perform LIS. Also, whether you are paying for your treatment privately or within a public health service, such as in the UK will make a difference - Financial reasons certainly have a lot to do with it!! In my experience, LIS was always my very final option and my CRS made that quite clear. I was initially given Diltiazem (which actually saved me!) but I was advised that Botox would have been my next option if that hadn't helped.....
Also, certainly for females of child-bearing age, LIS is generally always the final resort because of increased incontinence issues. Generally, it seems most CRS' tend to always try the creams & Botox routes first before LIS, especially if you are seeing them for the first time.........
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: Diltiazem or LIS

Postby endfissure2013 » 18 Sep 2013, 14:58

Thanks for the quick response. Um, I know in my heart that LIS is what I need. I've been praying about it. I'm driven to get it done. I'm a male in my early twenties. I live in America, and I'm in the military, so I have great medical coverage. I've looked at all the studies and it's mind blowing how sure shot LIS is for this condition. It's like if you have a fissure, get LIS and be done with it. It has a 96% success rate, and awesome long term results. I've looked at study after study.
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Re: Diltiazem or LIS

Postby Ever the Optimist » 18 Sep 2013, 15:24

Hi end,
The more I research and the more success stories I read, the more I am also convinced that LIS is a great way to deal with a fissure too. I've also read posts from others who have asked for the procedure but been put off every time and I'm certain here in the UK, it's because LIS is the most expensive route to take!!
I guess if you really want this, you could try convincing your CRS that the cream just isn't working for you?? (!) I'm actually surprised they are not pushing for LIS in your case, because of your career itself & the need to have you fit & well again to fulfill your military duties! Good luck - I hope you can figure this out soon.
Chronic Fissure diagnosed December 2011
Healed by Diltiazem around Feb 2013
Anal Fistula followed burst abscess in June 2012
2 internal troublesome piles remain & suspected, but undiagnosed, ongoing Levator Ani type symptoms & flare-ups
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Re: Diltiazem or LIS

Postby owmybum » 18 Sep 2013, 15:32

Just a word of caution...
I developed a fissure after having hem surgery. I have had a few tests to see why I was not healing, and they did an anal resting pressure test. It turns out my resting pressure is not elevated. I am not a suitable candidate for LIS, as this would just render me incontinent. I have had Botox ( which also hasn't worked) and I think I'm probably headed for advancement flap surgery.
I just think it's important to get the right tests done to see if LIS is actually the right surgery for you. If you just steamed ahead and had LIS with out establishing anything else, you might be opening a whole other can of worms!!

OMB x
fissure after hem banding and tag removal feb 11
Pelvic floor therapy
Diltiazem
Botox June 13
Nitro
Internal flap July 14
EUA and polyps removed Nov 14
Diagnosed with neuropathy Jan 15
Diagnosed with HS EDS type 3 (causes poor wound healing )
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Re: Diltiazem or LIS

Postby endfissure2013 » 18 Sep 2013, 16:34

owmybum wrote:Just a word of caution...
I developed a fissure after having hem surgery. I have had a few tests to see why I was not healing, and they did an anal resting pressure test. It turns out my resting pressure is not elevated. I am not a suitable candidate for LIS, as this would just render me incontinent. I have had Botox ( which also hasn't worked) and I think I'm probably headed for advancement flap surgery.
I just think it's important to get the right tests done to see if LIS is actually the right surgery for you. If you just steamed ahead and had LIS with out establishing anything else, you might be opening a whole other can of worms!!

OMB x


I understand. 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.
Last edited by endfissure2013 on 18 Sep 2013, 16:45, edited 1 time in total.
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Re: Diltiazem or LIS

Postby endfissure2013 » 18 Sep 2013, 16:43

Ever the Optimist wrote:Hi end,
The more I research and the more success stories I read, the more I am also convinced that LIS is a great way to deal with a fissure too. I've also read posts from others who have asked for the procedure but been put off every time and I'm certain here in the UK, it's because LIS is the most expensive route to take!!
I guess if you really want this, you could try convincing your CRS that the cream just isn't working for you?? (!) I'm actually surprised they are not pushing for LIS in your case, because of your career itself & the need to have you fit & well again to fulfill your military duties! Good luck - I hope you can figure this out soon.


So glad that you agree with me. Now I just have to get my CRS to! Yes, it's draining to deal with this and work at the same time. People generally don't understand how awful the pain can get. This it totally treatable. It's not like I have some rare-unknown-disease. It's really down to a science. I've even had LIS before-which was done by a general surgeon who thought it would treat the hemorrhoids I used to have. He didn't know what he was doing. But now, I actually need LIS and I can't find anyone to do it. It's agonizing.
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Re: Diltiazem or LIS

Postby endfissure2013 » 18 Sep 2013, 17:03

In addition, LIS is known for healing a fissure, and keeping it healed. There are studies after studies that back me up. I'm having the exact problems that other Diltiazem and Botox users have suffered from. Which is, a retear after treatment. LIS is known as the gold standard.
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