Hi all,

I've had an anterior fissure for well over 2 years now. Unlike many here I don't seem to have spasms or intense pain. I have stinging and some blood during BM, some itching and discomfort throughout the day. Sometimes it will seem to heal up for a couple of weeks, but it always returns even though my diet is healthy, I never have constipation and I take a sachet of Movicol every day.

I had botox about 3 months ago but it didn't really do anything, as far as I can tell. It looks like I've got at least another 2 month wait before I can get back to see the specialist on the NHS. I'd just like to know what the best course of action is. I know that they do pressure tests to determine whether they will do LIS or advancement flap on NHS. I think I'd rather have the former from what I've read, but I don't know whether I will be a candidate for this due to my fissure location (anterior) and the aforementioned lack of spasms. I don't understand why it won't heal properly if I'm 'not having spasms' and I'm never constipated.

I think perhaps my anus is too tight, as my stool is never wider than 2-3cm - and usually much thinner. And when I was trying to apply GTN inside the anus I could rarely get my small finger in further than 1-2cm. Does this mean that there is spasming - even though I don't have the excrutiating pain that others have? Should I push for LIS, or any operation for that matter, if I'm not in a great deal of pain?

Perhaps many of you will say to wait and see what the surgeon says, but I'd like to go in there with some idea of what I should expect, and what I should be aiming for. Any advice would be very welcome.

Many thanks.

Nobody can tell you what to do, its a tough decision. If I was in your position I would make a plan depending on what the CRS says. So if he says it looks like it is healing from the botox I would wait before pursuing anything else. If he said it hasn't healed at all, you will have to decide if the discomfort you are having is enough to make you go through with LIS. For me I'm at almost 4 months after Botox and don't have those spasms anymore but was told 3 weeks ago it hasn't totally healed. Due to the fissure and BMS, I still need about 2 hours before I can get out the house in the morning and have some minor discomfort some/most days after that. If I continue with this i will leave it alone. I don't want to have LIS unless I'm in the severe pain that I had before Botox. What does disturb me is the fact that that not having spasms now and I'm not fully healed. it is amazing a little cut like this will not heal on its own let alone with medical technology. I hope this helped.

Worrier,

You need to do the resting pressure test. If the results of the test show that you have high resting pressure, I would recommend doing the LIS as you would be an excellent candidate for success. A two year old fissure is most likely not going to heal without some type of medical procedure and it can get worse and harder to heal. The location of the fissure with LIS should not make any difference. What the LIS does is reduce the resting pressure of the internal sphincter muscle. This will allow for a stool to pass with little effort and it gives the fissure a chance to heal.

LIS gets a lot of hype about incontinence, but the incontinence risk is low for most people and the success rate for LIS is high. Included in the incontinence risk totals are the inability to control gas and leakage after a BM. The leakage risk goes up if they are cutting out a tag near the fissure or cutting on or out the fissure as a key hole can develop that allows leakage. When I had LIS, they cut off a tag hood and the rounded skin edges and cauterized the base, but I never had an issue with leakage. After LIS I felt that my stools were almost falling out with little or no effort during a BM. I did have an urgency issue where I had to be near a restroom for a couple of months, but I never lost a stool. My internal sphincter has tighten back up a little, and I no long have the urgency issue.

My fissure has healed but I still get a little discomfort with a large stool or hard stool. I think this may be from scare tissue.

You need to get a manomentry test done to determine exactly what your resting pressure is. If it is normal to low no crs worth anything would offer to do LIS on you. It would have to be some sort of flap.

Have you got a follow up for your Botox??

Hi all,

Thanks for your replies.

@owmybum I had my follow up 4 weeks after the botox. The surgeon said that the "superficial" posterior fissure had healed and that the chronic anterior fissure hadn't. He also said there were some hemmoroids which might be a problem in the future.

After 2 years of going to doctors I don't feel that anything is getting resolved. I don't feel that I have any grasp on whether I'm making progress or not, and I don't even know what I should be striving for any more. Should I be aiming to find a level of discomfort I can live with? Should I be aiming to not have any bleeding at all? Should I be aiming to live a life where I don't need to apply creams and take movicol every day? What is a reasonable level of "healing" to strive for?

Just feeling a little frustrated with it all. Anyway, I've got a couple of months to wait until I can get to see the surgeon. So I'll just carry on as usual.

I appreciate all your advice, thanks.

Coming from hell, I'm happy with living a life where the discomfort only minimally effects my life. I can go on from there hope the rest resolves at some point. good luck