Hi all,
I finally saw my CRS on Monday after booking in for a full 30 minute appointment. She pretty much ruled out a colostomy (my chosen option), after saying it was unprecedented to have such an option for a fissure. Initially she wanted to refer me to a pain clinic and to see a psychologist over my food fear issues. I was at pains to stress that they were based on cause and effect and not just anxiety/phobia based, although I would agree I do have a bit of a mental block about this.

At first she tried to convince me to have Botox, but I made the point that with my history of endless rectal/anal issues, I may heal initially, but in all likelihood I'll have other flare ups in the future, having a tight sphincter. She did actually confirm that I had a resting pressure of 120 and that my pelvic floor wasn't working properly in conjunction with the sphincter. So after spending considerably more time talking around my options and me making it clear I wasn't happy with the status quo, she finally agreed to perform an LIS on the NHS for me. We get on well, but I was pretty forthright in my thoughts on the subject and stressed I'd had enough of tinkering with my issues and wanted to try something more radical. I think what swung it for me was the vehemence of my feelings. She did remark at the end that she'd never seen me so intent on getting the outcome that I wanted. I did apologise and made a point of saying I hope I'm not bullying you into this. She said no and that she was happy to do it. She did say the time frame is around 18 weeks on the NHS and that she'd contact my GP, as everything also has to go through them.

On the downside, she did an examination with a finger and a proctoscope and unfortunately it did a bit of damage at the posterior region which started bleeding there and then. Since then it's been quite sore and the 3 or 4 times I've been to the loo it's bled. I'm using Rectogesic at the moment, but with my tight rectal muscles, it's quite difficult to even insert a finger without too much discomfort. I'm also wondering how it's going to heal, as even narrowish stools are causing problems. I'm on Movicol (twice a day - about 80-90ml). I could up this, but the result is certain to be more trips to the bathroom, which is the last thing I want right now. Any tips on how I could settle this down a bit?
I'm dreading the operation or I should say, the post op condition I'm likely to be in. I just hope I've made the right decision, having read a few recent negative healing reviews by members on here. It's also quite a wait, which is a bit frustrating. I was hoping to be healing by the summer, but I'm likely to be laid up by then.
While I'm posting, could members offer some advice on what to and what not to do post op and answer a few questions.

1. What's the best pain medicine that isn't too constipating. My CRS said paracetamol, but would that really touch the pain?

2. What on earth do you do all day, post op? Watch tv, sleep and think about nothing but your pain lol? Are you able to move at all or is it just too painful?

3. If my fissure has a good degree of healing by the time I have the operation, would the recovery time be likely to be shorter? Incidentally my CRS said the actual op takes no more than 2 minutes to perform.

4. Do you have enema pre-op or don't they bother?

5. Can you have Botox alongside the LIS to make healing a bit easier and has anyone done that?

6. What can and should you realistically eat post op?
This will be my first ever genuine rectal operation and I'm not exactly looking forward to it. Any words of comfort or positivity will be very welcome! I just hope it'll be worth it.

So glad you have gotten what you wanted banjo.
I think you should read ouchies diary on LIS as it shows how the surgery is meant to be, pain free from day 2 and BMs just fell out.
Don't forget a lot of us who have longer healing periods have other serious issues going off too. My CRS said 97% of people are back to pre fissure state two weeks after LIS and I'm sure you will be one of those.
Pain relief if you need it I would ask for gabapentin as its the only thing that's has ever touched this pain.
I read a lot anyway so did that for the first two weeks and watched movies,then I was back at work so my life is pretty full everyday.
No bowel prep or enema is needed just no food I think 8 hours before
Nope you cannot have Botox and LIS trust me I asked lol
I can't advise about food as I'm very strange but for normal people the recommendations are to eat food you know will give you Bristol 4 BMs
Banjo I'm sure you will be fine most people who have LIS recover very quick and move on so see no need to post online hence unfortunately you end up hearing about the more complicated cases which gives a very unbalanced result.

Thanks MPB, I hadn't thought about the fact of most people who do well with LIS, simply no longer post. I can understand the need to close that chapter of your life. You'll be one of those too, even if it takes a little longer, I'm sure. On the plus side, although I'm pretty sore and dread every bowel motion at the moment, especially after sustaining a bit of damage in the examination, I'm not getting spasms and haven't done with this fissure. But I do remember very well what they are like, when I did my original one in 1997. I just lay on the bed, waiting for pain to pass and have to admit to shedding a few tears.

Another word of reassurance for you, if the LIS doesn't give you what you need (even though I think it eventually will), you do probably still have the fall back position of a colostomy, if it was offered before. That gives you greater bargaining power, should the need arise. Everyone on here in their own way is a real hero. Coping with this thing pain-wise will probably be one of the greatest challenges of their lives. I generally have a decent evening where I can relax a bit and not think about the bathroom. My daughter's in bed and I can immerse myself in some good television (generally movies and documentaries).

I had a feeling you couldn't combine the two (Botox and LIS). I guess when you think about it, it makes sense. No bowel prep, which is good, unless you're bunged up. I think I'll eat fairly light meals pre-op, though, as I don't want to have to pass too much if I can possibly help it, post op. I just wish there was a local anaesthetic you could inject into your behind that would freeze everything lol! I'd happily stick a needle in myself lol! Sadly, that's about as likely as three pound coin lol!

I think if your not getting spasms now then hopefully your recovery might be quicker. Oh gosh yes spasms are just the worst pain ever. I do still think the LIS will help me to get to a stage that I can live with, I'm no longer in pain after a BM as long as it's just the one and a Bristol 3 lol...picky or what.
I think I would only fight for the colostomy if the spasms came back after every BM, otherwise I'm willing to live with the burning at least for the foseeable future. Yes I totally agree everyone who has gone through the agony of a spasm and the all consuming thoughts of trying to get a good BM is a hero as you can't understand it until you have experienced it.
Oh yes please I would love an injection like that...we really do need so e research scientist to get a fissure then maybe something would get invented.

I am one who is still here after having had a very successful LIS. The pain afterward was only about a 5, and not anywhere NEAR the fissure pain, except for the first night (pain at a 100 out of 10), but that was my own fault. I had suffered for decades with prolapsing hemmies, and when I touched the anal area after surgery, I thought that the swollen tissues were the prolapsed hemmies that the surgical team had forgotten to re-insert into the anal canal. So, I tried to do it myself. I spent the first few hours after I got home, desperately trying to get the tissue (very foricbly), into the canal, and didn't realize that the swollen tissue wasn't hemmies at all. After that settled down, the pain was only about a 5 for the next couple of days and then tapered down to a zero gradually over the next 10 - 14. And while it was a 5, I did lie on the couch all day, but that was because I couldn't sit at my desktop computer, and wasn't in the mood for housework. I certainly could have done the latter though (with the exception of lifting, which was prohibited), if I'd been so inclined, lol. Oh, and I will add that I had a small (and new) skin tag, that remained tender for about another week, so I had to place a couch cushion on my computer chair in order to sit comfortably.

Paracetamol (acetaminophen in Canada), has never helped me with any pain, so I still took opioids after the surgery, but like MPB, I had chronic diarrhea, so constipation wasn't a worry for me.

I did have to have an enema, but if you're in the UK like MPB, perhaps your surgery (and lack of an enema), would be more like hers.

Good luck and keep us posted.

Thanks CCC. It's very reassuring to hear of a genuine success story regarding LIS. Can I ask you, has it helped with elasticity in the rectal canal? I've a particularly tight sphincter and rectal area - I think that's one of the main problems. Apart from my CRS saying my resting pressure was 120, she also said I had an uncoordinated pelvic floor, which I'm sure adds to the problems.

banjobuddy wrote:Thanks CCC. It's very reassuring to hear of a genuine success story regarding LIS. Can I ask you, has it helped with elasticity in the rectal canal? I've a particularly tight sphincter and rectal area - I think that's one of the main problems. Apart from my CRS saying my resting pressure was 120, she also said I had an uncoordinated pelvic floor, which I'm sure adds to the problems.

I'm not sure that I ever had an elasticity problem, so no, there was no difference on that front. I hope that you can resolve your issue.

Hi,

I’m 6 months today post LIS, pleased to say I’m in a good place, still the occasional bit of mild soreness around incision area which I put down to scar tissue, but other than that all good.

No pain and BMs so smooth & easy now even if I drink wine & eat steak (which used to guarantee a hard BM the following day), think the spasms had a significant impact on how I went to the toilet.

One thing I’d recommend is get your diet right now, before the op. I aimed to get fibre uptake up & cut out bad, high sugar/carb foods. Also get used to drinking lots of water each day, at least 3 litres. That way you’re in a good place to avoid constipation & post op hard poos.

Other advice is a get a sitz bath if you haven’t already, you’ll need them post op for sure to wash and sooth bum post BM. Also would recommend ice pack for 1st week or so to help with post op swelling. Found it very helpful myself as was getting spasm like pains post op for first few days which were in fact due to post op swelling, I’ve sorted it in a day or two.

First post op poo is psychologically toughest bit, though pain wise first few days weren’t too bad but had sharp pain post BM from days 5-10 as think I popped a stitch which opened up incision area a bit…,very painful but only got short time post BM & sitz bath sorted it quickly!

Good luck & hope it goes well!