Heading for LIS...scared!

Heading for LIS....scared!

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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Heading for LIS...scared!

Postby lilbopper88 » 06 Jan 2014, 13:27

Hello everyone, I am new here, but not new to the pain of anal fissures. I have 3 chronic ones that I have been dealing with for over 10 years now. I was able to manage them for years and they would flare off and on, but this past month things have gotten so bad that I cannot take the pain anymore. Have 2 appts set with 2 Colorectal surgeons. I am not sure what happened to flare all 3 so bad, but I can hardly take the pain during the BM's and all day afterwards. I guess the docs will recommend LIS since they have in the past.

I think I will have to do it this time. I have tried the Nif cream and it helped some,but not it seems to irritate the fissures. I have 3 skin tags at each fissure. They are at the 3, 6 and 9 o'clock position. So pain all the way around...I am afraid of the incontinence since I am only 36 years old. I am female and have other health issues such as vulvodynia, fibromyalgia, etc. Also I am afraid that one or all of the fissures will not heal since they are torn to the muscle fibers..I guess I have to get my mind wrapped around this surgery, not sure how to do that, it seems so barbarick to me..but I guess it is the only option.

Anyway, I am so grateful to this board, where I can go and people understand what kind of pain and issues I am dealing with. I just wanted to introduce myself and see what others had to say about the LIS...

Thanks
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Re: Heading for LIS...scared!

Postby jr2 » 06 Jan 2014, 15:36

Hi lilbopper

Welcome! I'm so sorry to hear about your ongoing pain with fissures. I can relate. Multiple fissures, torn down to muscle, periods of time where things are better and worse, and dealing with that alongside multiple other health problems (in my case, severe digestive problems, endometriosis, and also know the pain of vulvodynia). It makes the choice to have surgery more complicated when you have other types of health problems like these. In my case, the surgeons won't offer LIS because of my digestive problems and the higher risk of incontinence. But another concern is that when you are dealing with other chronically painful conditions, your central nervous system becomes kind of "wired for pain", so it can make surgeries tricky. You don't know if the surgery itself might end up causing some other kind of chronic pain cycle to kick in. I have had this happen first hand with three other surgeries (not related to fissures) and each one has left me with chronic pain to deal with as a result. I had to have removal of a Bartholin gland due to inflammation from the vulvodynia seven years ago and I was left with permanent nerve and tissue pain in the area. So, while the pain there is different now than the pain that led to the needed surgery, the pain level is very severe and is permanent.

It doesn't mean that you shouldn't consider LIS. Obviously, it is generally a very successful surgery for most people, and most people are really glad they had it done. It just means that in your case you want to go in with a more full understanding of potential risks. Have you ever been referred for any kind of physical therapy for your vulvodynia and fibromyalgia? Or a pain management specialist? I'm just wondering if a good physical therapist or pain management specialist might have some ideas for you. I'm going to be seeing someone for pain management this week, since I'm kind of out of options.

If you do decide to go with the surgery, if I were you, I would really want to consult with someone who really understands how fibromyalgia and vulvodynia put you at higher risk for other chronic pain syndromes and pain sensitivity that can be made worse by surgery, and come up with a good strategy for you specifically to minimize the risk of adding to what you already are dealing with.
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Re: Heading for LIS...scared!

Postby lilbopper88 » 06 Jan 2014, 16:11

Hi Jr2. Thanks for the reply. Sorry to hear you are suffering with all of this as well. Did you have a vestibulectomy? I had one about 15 years ago, back when we didn't know much about vulvodynia, not that they know much more now, but I was only 18 and very naive back then. Helped some with the throbbing pain from the inflamed vestibular glands, but also left me with some painful scar tissue and the burning pain remained.

I have had PT a couple of times, this last round about a year ago with someone very educated on the Pelvic floor pain. It helped some, but did not really make a dent in the pain. My fissures were not like this back then. They seem to be very inflamed right now, not sure why. I did not do anything different to trigger them to be so sore, tender and inflamed. The pain is getting worse by the day, I am afraid I won't have any other choice but the LIS at this point. I cry through every bowel movement it is so bad.

It is difficult when there are so many factors involved. I feel my case is very complex and often feel overwhelmed from all of it. I just want a break and for things to start getting better. I go to one of the CRS on Wed to see if he sees any infection, or anything that could be making these fissures so aggravated all of a sudden.

Thanks again for your reply, it helps to know that someone understands all of this.

Take care!
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Re: Heading for LIS...scared!

Postby jr2 » 06 Jan 2014, 16:27

No, i just had the gland removed on one side. The result of that surgery has just added to the chronic pain that has always been there anyway. It really is so hard when you're suffering so much to know what decisions to make. (My GI doctor and colorectal surgeon are asking me to consider a colostomy at this point. Still feeling pretty overwhelmed by that.)

I can so relate to what you describe about the pain with the fissures. When they are really deep and really inflamed and you've been dealing with them for seemingly endless years, it's absolutely draining.

Please keep us posted on what you hear from the surgeon.

:smilyhug:
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Re: Heading for LIS...scared!

Postby lilbopper88 » 06 Jan 2014, 16:33

Do they think it is the digestive problems causing your fissures? I can't imagine having to consider a colostomy too. You must be so overwhelmed by that. I have IBS, but it is not bad if I keep my diet consistent. I have read over and over that multiple fissures are from Crohns or some other disease, but I don't think mine are. Well i obliviously have sort of inflammation thing going on as well, but don't think it is from Crohns.

Well hang in there. Hope we both find some relief soon. I will keep you posted on what I find out.
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Re: Heading for LIS...scared!

Postby suzyljank » 06 Jan 2014, 19:01

Hi so sorry for all your pain. Your doctor may recommend advancement flap surgery instead of LIS. It's used in people with other digestive problems and where LIS isn't an option and with people with multiple fissures. If they do this they will clean up all three fissures, remove the scar tissue and use a skin graft to give you fresh tissue in the area. The new tissue would make it possible for the anal area to stretch again without tearing. I've had both surgeries. LIS failed for me but the surgery itself wasn't bad. I never took any prescription pain meds for that. I had the flap surgery last april and it wasn't as bad as I thought it would be. I had pain meds in the hospital but mostly took ibuprofen when I got home and sometimes a pain med at bedtime. Valium actually helped me more. I had a very large fissure with multiple skin tags and severe anal stenosis. With the flap surgery the skin tags were removed along with the scar tissue and the fissure. My CRS had to do 2 flaps because the stenosis was so bad. I kept waiting for the excruciating pain after surgery and while it wasn't the most pleasant experience it wasn't as bad as I thought. The charlie horse up the butt feeling I would get before surgery was way worse. Recovery was slow but steady. Sometimes I'd have a few set backs but I'm so glad I had it done. If you're comfortable and confident with your doctor then have it done. The moment you have the surgery you'll be on the road to recovery. All the best Suzy.
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Re: Heading for LIS...scared!

Postby jr2 » 06 Jan 2014, 22:24

There's a lot they don't really know about the recurrent problems with fissures in some more complicated cases like mine. I don't have stenosis like Suzy describes, and for all the deep fissures I've had over the years I also don't have a lot of built up scar tissue either. Most common fissures in most people are much simpler to sort out than they have been for me. In my case I have so many things going on in my abdomen/pelvis, it gets difficult to sort out what is related to what. Could fissures be a variant of Crohn's? They could be. Could they be related somehow to the inflammatory process with the endometriosis and vulvodynia? It could be. Could it be from the intense urgency that I experience with BMs and all that force is just too much for the muscle to deal with without tearing? Could be. I've seen lots of different doctors and nobody really has any definite answers and no one really has a "best" solution for me. The consensus though is that anal surgery wouldn't likely be a good idea for me, both for the risks involved and because with my degree of digestive dysfunction I'd likely just form fissures again anyway.

So yeah, mostly the colostomy idea feels pretty overwhelming. But then there are days when it feels like it could be an improvement.
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Re: Heading for LIS...scared!

Postby lilbopper88 » 23 Jan 2014, 18:34

So I went to my second CRS yesterday. She said I have a very chronic deep fissure at 6 o'clock and a fissuse at 12 o'clock and I know I have one at 3 o'clock, a smaller one. She suggested botox because of all of my other issues, she did not seem to want me to do a LIS. She said with botox it could allow it to heal, but I am not sure. I have had these fissures for many years, although something a couple of months ago flared them up where I cannot handle this pain much longer. I have not read very favorable outcomes on botox. I am still researching it. I also could try PT again. So I am not sure what to do now, but at least I have options I guess.
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Re: Heading for LIS...scared!

Postby hopefulbutt » 23 Jan 2014, 20:09

Ill bopper do what ever you are most comfortable with. I had Botox twice and I still tore with it. She said I should do a third round but I refused and said lis only and she was cool with that. I know they are more concerned because we are female but I would take a little incntinence over pain any day. Though I have had none with my lis so far. Do what you are comfortable with. Good luck in healing in which ever way you go. :)
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