As subject says, i have little more to add. I've had a fissure for 7years i have a 7 year old a 4 year old and a 6wk old and this fissure has ruined my whole motherhood experience from the start and yesterday it fleared up an today is one of the worst days I've had. 2 rounds of botox did nothing in the long run. Im so miserable right now holding my baby crying in pain and feeling guilty for not being happy i don't want my baby seeing an feeling my sadness.

Sorry to hear about your pain - especially with a child on your knee, so to speak.

Have you ever heard of, or ever had suggested to you "advancement flap surgery"? It's generally done on women when LIS is not advisable (becaue women who hav already had children are at a higher risk of incontinence from the LIS surgery) and can be done on fissures in any position.

https://pubmed.ncbi.nlm.nih.gov/22488270/

Hey thanks for your reply. I think if wearing adult diapers is the worse that could happen sign me up, if it ment no more pain I'd go for lis tomorrow but it worries me because some people still have pain and lis doesn't work. I've heard advancement flap is a longer recovery and less successful then lis but I'll check that link now

Actually, from what I've read, advancement flap surgery is very nearly as sucessful, it simply has a longer recovery time and is more complex, so isn't used as often.

It's worth bearing in mind that advancement flap surgey does not PRECLUDE later doing an LIS surgery, because muscle is not being cut.

You sound like you're from the U.K., like me, and I strongly recommend you go to your GP asking to be referred to someone who actually DOES advancement flap surgery, and bring some pictures of the procedure. We vastly overestime how much the doctor actually knows in this country and doctor have, I have found, a massive reluctance to admit ignorance to anything, or accept how debilitating pain can be.

Advancement flap surgery is essentially pulling forward a lip of skin to cover the cut in the anus. You can see some actual pictures of it happening here: https://jcol.elsevier.es/en-evaluation- ... 6317305932
and a stylized drawing here http://gog.net.nz/AnorectalStricture.html also with some more data.

Most of the time you're being fobbed off is because they do NOT want to an LIS on a woman because they worry about being sued over causing incontinence (about 1% of men end up with some sort of incontinence, and this also counts "not being able to stop a fart" and about 10% of women - so the chances are still not very high) perhaps you could offer to sign a waiver of some sort.

It would not surprise me if no one has offered you advancement flap, because A) any surgeon or consultant you've been sent to see about it doesnt know how to do it and B) your gp doesn't even know it exists. Try being pushier is my advice.

Thanks stingeyringey
I just read about 5 pages what i couldn't find was woman with chronic anterior fissure and high resting pressure i read its a good option for woman with a chronic anterior fissure without a high resting pressure.

Hey thank you so much for taking the time to reply to me its helping me alot. I actually live in New Zealand and I've seen about 4 specialist and none have mentioned advancement flap

Oh yes sorry just checked the last link you sent it says regardless of tone advancement flap worked. After reading all this it sounds like the advancement flap is maybe even better them lis? Why has no one mentioned it to me, and hardly anyone on here has had one. I worry that since surgeons haven't mentioned it that not many know about it or aren't very experienced at it. I'd like who ever fixs my fissure to of done 100s of the procedure.

Oh yes sorry just checked the last link you sent it says regardless of tone advancement flap worked. After reading all this it sounds like the advancement flap is maybe even better them lis? Why has no one mentioned it to me, and hardly anyone on here has had one. I worry that since surgeons haven't mentioned it that not many know about it or aren't very experienced at it. I'd like who ever fixs my fissure to of done 100s of the procedure.

I daresay you will find that if someone has done one of them they have probably done many. Any competent general surgeon should find the procedure easy, as it is essentially a face lift for your arse (couldn't resist that, sorry) and is literally a cutting of dermal tissue, moving it, and sewing it down. I would worry about GENERAL surgeon doing an LIS, because, for the most part (and you can see videos on youtube of them doing it) they just FEEL for the halfway point along an inner sphincter, estimated by their best assumption, then cut the muscle. In a closed LIS you must bear in mind they cannot even SEE where the scalpel is. I would NOT be happy with someone who doesn't do that all the time taking his best guess as to what "about half" my internal sphincter is that he is slicing.

Advancement flap, by contrast, can be seen by the surgeon, and any surgeon who has treated any harsh slice or stabbing wound (which should be most) to a limb or anything like that should be more than capable of doing the "flap". He will be able to see exactly where it goes, and when the wound is covered. The dermis pulled up and over the wound has the same elasticity and properties of dermal tissue all over the body.

Do not be discouraged by nobody mentioning it. People are incompetent as a rule.

Thank you so much the site needs someone like you who has researched alot an so has alot of knowledge. Im 32 and I've had this for coming up 8 years its so all consuming i just want to move on and never look back. How are you doing with your fissure? Have you had anything done? Sorry jumping all over the place but i struggle to understand how a flap is better pain wise then a fissure and how it reduces the tone which fixes the original problem.

Missy, sorry things are so rough. Listen, if your main concern with having an LIS is incontinence, have an anal manometry test done to see if your sphincter is strong enough to handle the LIS without any issues. My CRS said I should have the test to see if I could handle the LIS. I was actually off the charts strong so there was never any concern. The LIS was done and bathroom life has been normal for 6 months since. Go ask a good CRS about this test.

FYI here is a little info on my CRS. Maybe you can compare his credentials (if it matters) to who you are seeing in your country. He was an early leader in laparoscopic colorectal surgery in Illinois (Chicago). He is an active teacher on the national and international level and has trained medical students, general surgery residents, colorectal surgery residents, and minimally invasive surgery fellows. His interests involve improvements in the surgical treatment of colon and rectal cancer, with special attention to minimally invasive surgery. He is a member of the American Society of Colon and Rectal Surgeon (ASCRS), American College of Surgeons (ACS), Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and Warren H. Cole Society.

In addition, he is:

Board-certified in Colon and Rectal Surgery, and General Surgery.
Author of multiple publications and book chapters in the field of colorectal surgery.
Clinical Professor of Surgery at the University of Illinois at Chicago.
Vice-Chair of Surgery and Chief of Colon and Rectal Surgery Division at Advocate Lutheran General Hospital.
Associate Program Director of Minimally Invasive Colon and Rectal Surgery Fellowship at Advocate Lutheran General Hospital.
Past President of Chicago Society of Colon and Rectal Surgeons
Fellowship at the Mayo Clinic, Rochester, Minnesota - Colorectal Surgery Residency (Mayo is the #1 hospital in the US for gastroenterology. Doctors send people there who can't figure out the problem)

Special Procedures & Techniques

Laparoscopic, robotic and open surgery for colon and rectal cancer as well as benign conditions
Advanced colonoscopy and transanal procedures
Complex anorectal procedures
Sacral nerve stimulation for fecal incontinence

In other words - being able to have an LIS with a doctor like this is why we in the US pay for private healthcare. You cannot see this guy with government insurance. I even referred a lady from Canada to him. Go ask about the anal manometry, see if you can handle an LIS, get it done and as my CRS said, "Get on with your life!" Boy was he right!

Rich44 wrote:Missy, sorry things are so rough. Listen, if your main concern with having an LIS is incontinence, have an anal manometry test done to see if your sphincter is strong enough to handle the LIS without any issues. My CRS said I should have the test to see if I could handle the LIS. I was actually off the charts strong so there was never any concern. The LIS was done and bathroom life has been normal for 6 months since. Go ask a good CRS about this test.

FYI here is a little info on my CRS. Maybe you can compare his credentials (if it matters) to who you are seeing in your country. He was an early leader in laparoscopic colorectal surgery in Illinois (Chicago). He is an active teacher on the national and international level and has trained medical students, general surgery residents, colorectal surgery residents, and minimally invasive surgery fellows. His interests involve improvements in the surgical treatment of colon and rectal cancer, with special attention to minimally invasive surgery. He is a member of the American Society of Colon and Rectal Surgeon (ASCRS), American College of Surgeons (ACS), Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and Warren H. Cole Society.

In addition, he is:

Board-certified in Colon and Rectal Surgery, and General Surgery.
Author of multiple publications and book chapters in the field of colorectal surgery.
Clinical Professor of Surgery at the University of Illinois at Chicago.
Vice-Chair of Surgery and Chief of Colon and Rectal Surgery Division at Advocate Lutheran General Hospital.
Associate Program Director of Minimally Invasive Colon and Rectal Surgery Fellowship at Advocate Lutheran General Hospital.
Past President of Chicago Society of Colon and Rectal Surgeons
Fellowship at the Mayo Clinic, Rochester, Minnesota - Colorectal Surgery Residency (Mayo is the #1 hospital in the US for gastroenterology. Doctors send people there who can't figure out the problem)

Special Procedures & Techniques

Laparoscopic, robotic and open surgery for colon and rectal cancer as well as benign conditions
Advanced colonoscopy and transanal procedures
Complex anorectal procedures
Sacral nerve stimulation for fecal incontinence

In other words - being able to have an LIS with a doctor like this is why we in the US pay for private healthcare. You cannot see this guy with government insurance. I even referred a lady from Canada to him. Go ask about the anal manometry, see if you can handle an LIS, get it done and as my CRS said, "Get on with your life!" Boy was he right!

Thanks rich44 i cant wait to live my life again ive had this fissure since 2013 you've had yours for just as long so i know you understand. I'm strongly considering going private atleast for a consultation to much sure i have a plan and to check anal tone then I'd likely go private for the procedure too although there is a general surgeon who I've met who is on the nhs so free and he specialises in colorectal hes like the head of his department an he teaches people. All of the general surgeons in new zealand also work in a private department too. So they split their time between private and healthcare system.