Well it paralyses the muscle to a degree and allows time for the fissure to heal think of it as a 3-12 dose of the muscle relaxing cream you put on the fissure it does the same thing but it slowly wears off lis is a permanent degree of relaxation in the muscle so you have the options of apply cream three times a day semi permanent and permanent if you were born with a tighter muscle then chances are you'll need lis but alot of people heal with either creams or Botox creams are pointless after having a non healing fissure for more then 6 weeks after 6 weeks the fissure is considered chronic and needs a more invasive fix ie Botox then or lis

I always recommend to try conservative measures before Botox and LIS only as a last option. LIS is for people who are in pain hours every day and cannot have a life. If you can handle the fissure pain and you can live without thinking about it every minute of the day, then for sure I would not recommend surgery. There are many cases of AF recurrence even after LIS so there is no guarantee for a forever fix.

In my experience and reading about this thing for years we will never be able to completely heal, meaning to be like we used to be before the fissure - not even with a successfull LIS procedure. If you think about this, then you can see which are the choices for your own.
I personally much rather keep it in check with conservative measure, with its ups and downs, and take softeners for the rest of my life than risk a surgery procedure that does not guarantee I can ween off those medicines and softeneres and supplements... Also, any surgery will put you on antibiotics so all the efforts made these years to build a healthy gut will go down the drain.
Again, this is only me. I am absolutely sure that people who live in pain every single day without any relief should be the first to request the procedure.

Abu wrote:I always recommend to try conservative measures before Botox and LIS only as a last option. LIS is for people who are in pain hours every day and cannot have a life. If you can handle the fissure pain and you can live without thinking about it every minute of the day, then for sure I would not recommend surgery. There are many cases of AF recurrence even after LIS so there is no guarantee for a forever fix.

In my experience and reading about this thing for years we will never be able to completely heal, meaning to be like we used to be before the fissure - not even with a successfull LIS procedure. If you think about this, then you can see which are the choices for your own.
I personally much rather keep it in check with conservative measure, with its ups and downs, and take softeners for the rest of my life than risk a surgery procedure that does not guarantee I can ween off those medicines and softeneres and supplements... Also, any surgery will put you on antibiotics so all the efforts made these years to build a healthy gut will go down the drain.
Again, this is only me. I am absolutely sure that people who live in pain every single day without any relief should be the first to request the procedure.

Aren't some people completely symptom-free after LIS?

I've read that laxatives (including PEG) possibly isn't a good thing long-term.

What other conservative measure do you use (beside the finger trick)?

Yep most people are completely symptom free after lis the chances of lis fixing you fissure is about 97% it's very successful the thing is is that after we have an anal injury the muscle goes into autopilot and does it's own thing I think it would be extremely hard to be able to mentally undo that auto function of the anal muscle most people who ever get anal fissure have a higher then normal resting tone I believe from childhood/teen years stress or even stress in adult hood should be to blame for most because stress causes tension in the body if you think of your anal muscle like I muscle you work out in the gym it gets stronger thicker and more tense now think about what the anal muscle is doing everyday when it freaks out and shuts off or has spasms it's at the gym getting stronger thicker and more tense it's rasing it's own resting tone more. This is only my theory but it makes sence so how to we stop it from working out and getting more tense we need to remove the pain for about a year and during that year we need to brake the mental connection between pooping and pain so we ourselves don't tense up when going to the bathroom, how do we stop the pain? Heal the fissure with soft stools till the fissure isn't sore to touch then start the finger trick to naturally stretch the anal muscle or get Botox or get lis to relax the muscle I don't know how to heal the fissure myself long-term obviously as I've had my fissure on and off for 5 years

So, which is it? LIS working 97% of the time or many cases of AF recurrence?

In a perfect world, I'd like to avoid surgery, but as you say maybe the first step is softening stool... Even there, the finger thing looks... gross... Maybe I need to see things differently I don't know.

John667 wrote:
I've read that laxatives (including PEG) possibly isn't a good thing long-term.

What other conservative measure do you use (beside the finger trick)?

Just to clarify, PEG or Miralax is not a true laxative. It does not stimulate the bowel. It's osmotic and increases water in the bowel.this behaviour is a stool softener not a laxative by definition. Stool softeners are ok long term and many doctors will recommend them if the person reports success. It's better than the risk of surgery and pooping oneself as there is a small chance of incontinence with surgery. A good CRS will test your muscle tone to determine your likelihood of success or incontinence.

But stool softeners are ok long term. They do not cause lazy bowel syndrome.

Okaybum wrote:

John667 wrote:
I've read that laxatives (including PEG) possibly isn't a good thing long-term.

What other conservative measure do you use (beside the finger trick)?

Just to clarify, PEG or Miralax is not a true laxative. It does not stimulate the bowel. It's osmotic and increases water in the bowel.this behaviour is a stool softener not a laxative by definition. Stool softeners are ok long term and many doctors will recommend them if the person reports success. It's better than the risk of surgery and pooping oneself as there is a small chance of incontinence with surgery. A good CRS will test your muscle tone to determine your likelihood of success or incontinence.

But stool softeners are ok long term. They do not cause lazy bowel syndrome.

I've read they can cause strange symptoms, especially to kids. They don't give them to kids anymore because of that. It's still... somehow plastic, and it's not 100% of the particles that pass through.

What are the definite chances of incontinence with the surgery? I can't find good numbers.

I don't believe in statistics. They very from 3-15%. I recommend seeing a doctor and having your anal muscles tested. If the resting pressure is high then surgery will help and the risk is very low.

If your resting pressure is low then your risk is much greater. As I said, a good CRS will test this. This way you will get personalised help tailored to you.

Okaybum wrote:I don't believe in statistics. They very from 3-15%. I recommend seeing a doctor and having your anal muscles tested. If the resting pressure is high then surgery will help and the risk is very low.

If your resting pressure is low then your risk is much greater. As I said, a good CRS will test this. This way you will get personalised help tailored to you.

If resting pressure was be low, I wouldn't have this problem it seems.. But yes I'll get it checked again. Just hope to get somebody competent.

I agree with okaybum but also the risks are sooo low with lis, John the list is very successful it's the best treatment for a chronic anal fissure hands down reoccurrence is extremely low with lis bit reoccurrence with Botox is almost certain if you can't keep bms perfect this is my opinion I've been reading about all this stuff for 5 years if you google lateral internal sphincterotomy (lis) you will read everything there is to know risks success rate chances of recurrence the whole procedure can be googled colorectal surgeons (crs) all see and apply this treatment as a go to treatment it's the gold standard other treatments have come and gone but lis has always been preferred and always has always been used for many years the risk of actually getting poop yourself incontinence is like 1% and that's in people with other conditions or already compromised anal muscle like I said earlier John there are people on this very site who have irritable bowel syndrome diarrhoea who need the toliet asap 10+ times a day and don't poop themselves even after having lis the biggest risk is not being able to hold gas but with most people even that corrects itself in the first six weeks after lis I'll try find a link for you