I am a 45 yr old male with a 20 year history of chronic pelvic floor dysfunction including chronic levator spasm, pudendal neuralgia and dyssynergia. A year ago I successfully applied for disability and since they time, I have been dealing with chronic anal fissures. I had Botox in June of last year and again in January of this year. The Botox does help but I inevitably have a series of difficult bowel movements and I retear. I had one such retear about a week ago and am in excruciating pain. My CRS has told me that she would do LIS if I chose but she has only done a handful of these procedures in the past two or three years because Botox works well for most of her patients. I could push for another round of Botox, I could just take my chances with my CarS doing LIS or I could pay thousands out of pocket to see a CRS in another state who is more experienced with LIS.

I am very worried that my pelvic floor issues will complicate LIS and I’m also worried about my CRS doing LIS given that she’s not very experienced with it. But I don’t want to keep living with this fissure pain and want to do whatever necessary to relieve the pain. Just curious what your thoughts are and what you might do given the above circumstances.

I (obviously) can't say whether or not things would not go well because of your other issues, but I would never allow a surgeon to operate on me, unless he/she was incredibly experienced with the procedure.

I do agree with you that it would be better to go with a surgeon experienced with LIS, but unfortunately, I live in New Mexico and CRS’ are in short supply. In order for me procedure to be covered through insurance, I would only have 2 options for CRS, neither of which have much experience with LIS. Any recommendations on a really great LIS CRS outside of New Mexico? Not sure if there are threads on here that talk about this.

We do have a forum called "Tell us about your doctor", that you might find useful.

tell-us-about-your-doctor-f31.html

Thank you. I will take a look at it. Unfortunately, any CRS outside of where I live would be out-of-pocket and seeing as though I'm on Social Security Disability, that would be a stretch. However, I guess you can't really put a price on our health, so I probably should do whatever I feel is best.

I agree, especially given your other issues. You really need someone with the experience to do the surgery for you.

The only "flip-side" to this whole situation is that my current CRS is very familiar with all my underlying issues as she has been my CRS for several years so she is very careful when performing exams and procedures on me. That could be something to consider going forward I guess.

Good point. It will be a hard decision for you to make.