Fissure is back after LIS what are my options?

Fissure is back after LIS what are my options?

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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Fissure is back after LIS what are my options?

Postby Kingfish » 29 May 2018, 11:03

Hi Everyone,

I was hoping that after I had my LIS done about 10 years ago I would no longer need to visit fissure related forums but here I am!

About a year ago I began having pain after going to the toilet and I immediately recognized the pain. Fissure!

I had heard that some small recurring fissure after LIS were quite common and that they normally healed on their own with a little TLC since the muscle back there is already relaxed. Well that has not been the case for me.

Unfortunately this little bugger has not healed and ended up causing me quite a bit of pain and distress. So much so that I went to see both my proctologist as well as the Dr that had performed the LIS 10 years ago.

The surgeon told me to simply apply nifedipine and it should go away which it did not. Waiting time to see him again was 4 months so I decided to get a second opinion and went off to see my proctologist. By that time the pain had become quite severe.

He took a look and told me that my fissure had become infected and an abscess had formed. He gave me a round of pretty strong antibiotics to take for 2 weeks. I followed his orders and felt much less pain after about a week. I was hopeful that the fissure and infection were now healing.

After about a week of ending the anti-biotic treatment the pain came back! Back to see the Dr and he prescribed another 14 days of antibiotics along with Nifedipine and Cortisone cream, warm soaks and stool softeners.

I don't need to tell you guys what strong antibiotics do to your gut right? I'm now trying to keep my trips to the bathroom to once a day but that is almost impossible. I've begun taking probiotics to try and avoid any diarrhea.

Fast forward to today and the pain after a BM is pretty bad and can last all day long but no blood. The funny thing is the pain starts slow and just increases in intensity all day till it only levels off and then starts to subside at about 8PM.

I have a follow-up appointment with the Procto in about two weeks but he has already mentioned to me that if the fissure doesn't heal or the access comes back he would have to perform surgery to remove both. He told me this could be done under local anesthetic. He does not want to risk a second LIS surgery and has already tried to stimulate healing by cauterizing it.

I haven't heard much about other people here having the fissure removed like this. I'm really wondering if this is a good option or am I just heading for more trouble down the road?

I don't understand how creating a larger cut in the recutm would heal faster than the fissure that is already there...?

Any advice would be appreciated.


Thanks
Nifedipine over 2 months
Hot Sitz Bath
Cortisone cream
Lidocaine cream
Zinc Oxide cream
Coconut Oil
Doctor Butler's Hemorrhoid & Fissure Ointment
Manual Self Dilation
Mirolax
Metamucil
Pro-biotic
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Re: Fissure is back after LIS what are my options?

Postby Katie » 09 Jun 2018, 13:31

After my first op I got a fistula!!!!! The worse pain ever!!! Worst then fissure pain I had it for 4 months then my surgeon did an op to cut the fistula open and to let it heal I had it done! And it worked but still had my fissure in the end had the lis done that was back in Jan and I'm still healing from that
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Re: Fissure is back after LIS what are my options?

Postby Kingfish » 09 Jun 2018, 14:03

Katie wrote:After my first op I got a fistula!!!!! The worse pain ever!!! Worst then fissure pain I had it for 4 months then my surgeon did an op to cut the fistula open and to let it heal I had it done! And it worked but still had my fissure in the end had the lis done that was back in Jan and I'm still healing from that


Hi,

Its been 10 years since my LIS so I don't think a fistula is my problem. Although I did have an abscess which was treated with 2 rounds of pretty intense antibiotics. My pain starts after a BM and lasts all day with very strong burning pain. Pretty typical of a fissure.

So now I don't really know what to do. The pain keeps getting worst and the creams and sitz baths only help a little. The Dr mentioned possibly removing the abscess and fissure but I don't know how that would go! Seems risky and painful. I wanted to know if anyone here has the fissure removed like this?

Thanks
Nifedipine over 2 months
Hot Sitz Bath
Cortisone cream
Lidocaine cream
Zinc Oxide cream
Coconut Oil
Doctor Butler's Hemorrhoid & Fissure Ointment
Manual Self Dilation
Mirolax
Metamucil
Pro-biotic
Kingfish
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Re: Fissure is back after LIS what are my options?

Postby patience_and_healing » 10 Jun 2018, 13:46

Look for BumUK's diary on Botox and fissurectomy.
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.
Currently in pelvic physical therapy
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Re: Fissure is back after LIS what are my options?

Postby Kingfish » 20 Jun 2018, 12:59

Turns out my Dr says that he will not perform a fissurectomy after all since what he suspected was an abscess is gone after antibiotics. He was contemplating removing the fissure and abscess at the same time if required. He also doesn't want to perform the LIS as he feels it would be to risky. He also feels that most of his patients heal with Nitro if used long enough.
His treatment protocol of choise is as follows:
1) Nifedipine 2x a day for 6 to 8 weeks. If that fails then
2) Nitro 2 x a day for 6 to 8 weeks. If that fails
3) Botox injections. If that fails
4) LIS Surgery
So he sent me home with Nitro and told me to apply it every day and dilate with the dilator tool with every application.
More to come...
Nifedipine over 2 months
Hot Sitz Bath
Cortisone cream
Lidocaine cream
Zinc Oxide cream
Coconut Oil
Doctor Butler's Hemorrhoid & Fissure Ointment
Manual Self Dilation
Mirolax
Metamucil
Pro-biotic
Kingfish
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Re: Fissure is back after LIS what are my options?

Postby mike1971 » 21 Jun 2018, 18:06

Hi Kingfish.....

So if the nitro doesn't work you'll move on to botox?

But isn't botox just a temporary fix?

Is it possible to skip botox and go for lis?

I understand you've already had lis 10 years ago.....would there be any complications to another one?

Many people don't want surgery....but it sounds like your first one went smoothly.
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Re: Fissure is back after LIS what are my options?

Postby Kingfish » 21 Jun 2018, 18:25

I tried Botox the last time before having surgery and it didn’t help me. Now that my muscle has already been cut once i’m thinking another try with Botox my work. If not I would consider another surgery as a last resort.

Yes the first one went very well for me. Way less pain than any day with a fissure for sure.
Nifedipine over 2 months
Hot Sitz Bath
Cortisone cream
Lidocaine cream
Zinc Oxide cream
Coconut Oil
Doctor Butler's Hemorrhoid & Fissure Ointment
Manual Self Dilation
Mirolax
Metamucil
Pro-biotic
Kingfish
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Re: Fissure is back after LIS what are my options?

Postby boodles » 17 Sep 2018, 15:13

Just wondering how you are doing since then. I think I'm finding myself in the same boat, that is, 6 years after my LIS, and not being constipated, that now I'm constipated and today felt like a rip or tear. I'm going to look for more info. about a second LIS. I'm probably jumping the gun.
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