How do you know if LIS has failed?

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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Re: How do you know if LIS has failed?

Postby coconut » 12 Mar 2013, 07:01

aimonaali wrote:Do you think it would be better not using any creams at all? My doctor told me to use diltiazem in the morning and white vaseline in the evening. But when I put on the vaseline it seems to irritate the tear and I feel burning. The BM's don't hurt but apparently the tear is not getting better. Does this mean I have to get another LIS? :( I also wonder why isn't this small tear healing but the whole fissure already healed once after the surgery...
Also I still have a little skin tag that the surgeon didn't cut when he did my LIS. HE said it's so small it wouldn't be a problem. But can it somehow keep this new tear from not healing?

I really can't answer this. I had an unusually bad reaction to the creams. I tend to have super sensitive skin. So honestly, I'm mostly selfishly praying that what you're experiencing does not happen to me. The whole reason I went with the surgery is so that I could stop torturing myself with the creams. From reading these forums, I think for most people, it wouldn't be a big deal. Anything to feel better, right?
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Re: How do you know if LIS has failed?

Postby jr2 » 12 Mar 2013, 09:24

LIS doesn't always solve the problem of fissures, unfortunately. There are a lot of reasons for this, but sometimes it is due to the level of quality of the surgery performed the first time. The surgery you had may have been sufficient to heal the fissure the first time but surgery doesn't guarantee anyone won't ever get another fissure. The hope is that the risk is reduced and also that if a new one does develop it will heal faster. But also, not all chronic fissure problems are due to a hypertonic anal sphincter. There are people who have them and have no associated hypertonia or spasms. In these individuals, LIS is obviously not expected to be very effective. Have you thought about a second opinion?
I posted this study awhile back in the references section that you might want to check out. I wonder if some sphincter testing might not be something to consider. Endoanal ultrasound and also a manometry test to determine muscle tone (pressure).
http://www.ncbi.nlm.nih.gov/pubmed/23253025
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Re: How do you know if LIS has failed?

Postby aimonaali » 12 Mar 2013, 10:32

My surgeon said that LIS healed the fissure and even though the fissure site might still tear a bit after hard stool, the fissure won't come back like it was before. So far that has been the case. It's now been two weeks since I got a new tear when being examinated by the same doctor. At first I couldn't feel anything wrong but now I feel a little burning in there. An I feel it's getting worse day by day:/
I'm so depressed because of this. I just got myself a great summer job today but I feel like crying. I can't imagine another summer with this fissure and this time the "last possibility" which was LIS has already been done. I feel hopeless... And if I go back to a doctor, who's to say the fissure won't tear even more.
I never had a huge pain with my fissure but my doctor said my sphincter was tight. After LIS it was apparently fine. He also said this little tear I have now will probably heal by it's own. I just don't know what to do anymore.
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Re: How do you know if LIS has failed?

Postby suzyljank » 12 Mar 2013, 11:13

Hi, I had a failed LIS. I knew pretty early on that is wasn't successful. It's true at the beginning if I had a re-tear it would heal relatively quickly but after about a year the re-tears would take longer and longer to heal. The area felt tight again and that was caused by the scar tissue from all the re-tears. I follow a high fiber diet and take miralax faithfully. The bms themselves don't really hurt but it's just before or after that does. My stool are very thin now so I'm going back to the CRS in a few weeks to discuss an anoplasty. Not looking forward to that but I don't think I have any other options. Give yourself some time, at least 6 months to fully heal. If you still feel LIS didn't work for you go back to a CRS and discuss your situation. If you are hurting you do not have to submit to a rectal exam in the office, they can do one at the hospital under sedation. I learned this the hard way. You're the manager of your own body and the doctor is someone your hire to help you. You have the last word and you also have the right to move on to another one. Some doctors, especially surgeons have terrible bedside manners and it's up to their patients to let them know they deserve to be listened to and treated with consideration. I've read some stories here where people with active fissures were given rectal exams that made matters worse. A good CRS won't do that. They will either send you for a colonoscopy (under sedation or suggest a rectal exam under sedation). Hope you feel better soon. Suzy
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Re: How do you know if LIS has failed?

Postby aimonaali » 12 Mar 2013, 11:24

suzyljank wrote:Hi, I had a failed LIS. I knew pretty early on that is wasn't successful. It's true at the beginning if I had a re-tear it would heal relatively quickly but after about a year the re-tears would take longer and longer to heal. The area felt tight again and that was caused by the scar tissue from all the re-tears. I follow a high fiber diet and take miralax faithfully. The bms themselves don't really hurt but it's just before or after that does. My stool are very thin now so I'm going back to the CRS in a few weeks to discuss an anoplasty. Not looking forward to that but I don't think I have any other options. Give yourself some time, at least 6 months to fully heal. If you still feel LIS didn't work for you go back to a CRS and discuss your situation. If you are hurting you do not have to submit to a rectal exam in the office, they can do one at the hospital under sedation. I learned this the hard way. You're the manager of your own body and the doctor is someone your hire to help you. You have the last word and you also have the right to move on to another one. Some doctors, especially surgeons have terrible bedside manners and it's up to their patients to let them know they deserve to be listened to and treated with consideration. I've read some stories here where people with active fissures were given rectal exams that made matters worse. A good CRS won't do that. They will either send you for a colonoscopy (under sedation or suggest a rectal exam under sedation). Hope you feel better soon. Suzy

Thanks for the answer. And thanks to all the other people who have given their opinios. Did you first experience some healing or did the retearing start right away? Is it as bad as it was before LIS? Is there blood? I think I'm gonna give it another week to maybe start healing before I look into maybe contacting another doctor. Maybe I could try using rectogesic instead of diltiazem.
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Re: How do you know if LIS has failed?

Postby suzyljank » 12 Mar 2013, 12:00

Hi, I never had the immediate relief a lot of LIS people do. It seemed to help a little bit but after I healed I'd notice a little tear and then it would heal. A few months would go by and I'd get another one and this past summer (about 4 years after LIS) I noticed it took a really long time to heal after a tear. I don't have blood though. Most chronic fissures don't bleed much because the tightness in the muscle cuts off the blood flow. You have to be really mindful of scar tissue. It's is the second complication of rectal surgery after infection. It's not talked about much but scar tissue can cause a host of problems. If you're feeling that uncomfortable don't wait, get an appointment right away and get a second opinion if your first doctor doesn't listen to your concerns. Good luck Suzy.
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Re: How do you know if LIS has failed?

Postby aimonaali » 12 Mar 2013, 12:15

It's not that the doctor doesn't listen to my concerns but rather that I don't want anyone doing any examinations on my butt since that's what caused the problem the last time. I also keep wondering why the fissure tore in the third examination after LIS and not in the ones before. It would seem logical that the fissure site would get stronger and not weaker...
The doctor explained that scar tissue can cause problems which is why he cut the scar tissue off with LIS. He said it was a good thing I had LIS done before more scar tissue was formed.
Well anyway, I might try another doctor if I don't seem any progress this week.
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Re: How do you know if LIS has failed?

Postby suzyljank » 12 Mar 2013, 12:17

Hi, so sorry you're having so much trouble, hope they can figure out why this is happening to you and fix it so you can get back to a more normal life.
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Re: How do you know if LIS has failed?

Postby aimonaali » 12 Mar 2013, 12:28

Thanks. With this thing it does feel like the whole life is on "pause". Just waiting to get better. I think people here know what I'm talking about.
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Re: How do you know if LIS has failed?

Postby aimonaali » 13 Mar 2013, 09:44

I'm gonna continue pouring my soul to this thread... It's almost four months since my LIS and the incision site is still hurting. Although it doesn't hurt all the time. Is this normal? Is there a change it might have something to do with the re-tearing of the fissure itself? I had a theory that the muscle is tightening around the incision wound the same way it tightened aroun the fissure before LIS. And now it's too tight and causing problems.
As always, if anyone has something smart to say I'd be happy to hear. Or maybe not even smart:) Just let me know if you have any theories of your own about this.
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