Hi all.. I have an appointment with my specialist on the 31st, and I have no idea what will come out of it. My family has recently been pressuring me to get surgery because I've been dealing with this fissure for quite a while now, and it's been interuppting everything normal about my life... I have half the energy as before and can't help that much around the house or go out that much without having an irritated bum. It's starting to bother my family to see me suffer so much with this & they keep on telling me to "get surgery and get it over with". Is surgery really that easy though?
I have a few questions.. please bare with me :oops: I'm not sure who else to ask..
1) With botox, is it just basically a relaxation of your bum muscles to HELP aid in healing? Does it usually even help with healing or reduce the irritation/pain/itchiness? Don't people usually re-tear after botox? WHY?!?! Haha
2) Is LIS the same thing as a sphincterotomy? (not even sure if I spelt that right!)... Is it basically just cutting off the fissure?
3) Doesn't cutting off the fissure create another wound down there that you have to heal from?
4) Can anyone else give me ANY details about the surgery (e.g. before/after/healing/whatever) : how long does it take to heal, does it really hurt afterwards?? Would you recommend going back to work/school after or do you need a few weeks of rest?
5) Now the fun question: After your surgery, do you still have to keep up with the same diet? No milk cheese dairy chips etc...? Or can you eat PIZZA (drooooling)...?
6) Do you still bleed or have painful BMs after surgery?
Any other advice about the procedure or just the entire ordeal altogether would be greatly appreciated... I sort of want to know everything possible before getting into it - I don't even know if I'll have the guts to go through with it...
all sooo much. I'm sorry for posting so many questions. & to Lecia especially I feel like such a cop-out for even thinking of surgery, I soooo wanted to let this heal naturally, & have been trying, but I thought I might as well consider surgery now to see whether it's worth it or not for me. Take care everyone

Sorry guys, I was just reading some of the other posts and realized that healing from surgery can be a very long process! Wouldn't it be better to maybe keep on waiting for the fissure to heal naturally?
Geez, I'm so confused about what to do .

it all depends sunshine.
i think that if you are totally not living your life - that you are truly becoming disabled by the fissure - that surgery may be a consideration to really think over.
there are many here who are better off now due to the surgery and others who are still healing but in time my guess is that they will be just as good too.
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i think everything has to be done in moderation. if you want to have pizza with cheese - ask for less cheese but still enjoy your pizza. perhaps eating 1/2 of what you normally eat and the rest of your meal should be salad without drenching fattening dressings or other oils and cheeses.
you can make pizza at home with whole wheat dough and simply look for the vegan cheese - non dairy cheese - that you can put on. it will come out yummy if you add on some mushrooms, green peppers, and onions and perhaps a dash of black pepper, basil, and oregano.
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how long have you been suffering with your fissure again?
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if you haven't visited the web site that i have in my signature yet, you may want to look into it. just read it all so you can get some ideas - you don't have to do a thing. but the more you read about it, the more it will make sense.
macrobiotics.
it's not for everyone but it's something everyone can do.
and in the end, i think your bum will appreciate it.
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with regards to having to eat a particular way after your surgery - trust me - if you don't change what you eat, then what makes you think you won't be where you were before surgery. you will have to make changes.
in eating.
in cleaning yourself.
in how you deal with stress as well.
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ask yourself this question - are you tired of waiting for this fissure to heal naturally?
that will be a big one that you need to consider. how many more days can you go on in pain?
how are your cycles in the sense that how many painful days vs non-painful days do you have? are they getting better or worse?

Hey Sunshine-just thought I would chime in here with any thing I can answer. As you know I did not have the surgery but that doesn't mean that I would not recommend it. I was not able to because I have some underlying neuropathic problems in that area that preclude my being able to heal properly. If I were a normal person I would have considered it.
1) With botox, is it just basically a relaxation of your bum muscles to HELP aid in healing? Does it usually even help with healing or reduce the irritation/pain/itchiness? Don't people usually re-tear after botox? WHY?!?! Haha Botox is a paralytic that temporarily paralyzes partially the sphincter muscle to reduce resting pressure so that more blood can get to the area for healing. It doesn't heal the fissure per se. And neither does the surgery.
2) Is LIS the same thing as a sphincterotomy? (not even sure if I spelt that right!)... Is it basically just cutting off the fissure? My CRS does not do fissurectomies where they actually cut out the fissure. She does the LIS (sphincterectomy) to reduce the tension in the anus so healing can occur.
3) Doesn't cutting off the fissure create another wound down there that you have to heal from? Yes. That is why she doesn't do it but I know there are other doctors who practice differently.
4) Can anyone else give me ANY details about the surgery (e.g. before/after/healing/whatever) : how long does it take to heal, does it really hurt afterwards?? Would you recommend going back to work/school after or do you need a few weeks of rest?
I will have to defer on this one!
5) Now the fun question: After your surgery, do you still have to keep up with the same diet? No milk cheese dairy chips etc...? Or can you eat PIZZA (drooooling)...? I would say yes, since you still have the fissure. I would recommend a modified diet for a year even. I miss some things but I miss the pain less! I think you can have some of the goodies you want if you balance it out with other foods and fiber.
I think the appointment will be good. You don't have to decide but you can at least get your options and see where you are in terms of healing!

Thanks guys. I didn't know that the surgery didn't completely eliminate the fissure - that seems strange to me... I thought they cut the fissure off?
Anyhow, I'll ask my specialist all these questions but it's getting hard for me to wait. Today I had such an awful bout with the itchies that I just broke down into tears. I don't even do that when I have pain - pain isn't even a big thing for me anymore cause I'm so used to it now... It's just the itchies or when my bum really starts ruling my life to the point where I can't do things that I really really want to do.
I'm nearing the edge because I think I've had the fissure since AT LEAST December, and for at least 3 or so months I either didn't deal with it or used hemm medicine, still having "passing glass" type of BM's every single day. Actually, I've been having the occasional painful BMs for even longer than that, it just wasn't everyday before, so I probably had hemmies before the fissure came, or something else. Now things have improved because of all of your guys' help and Miralax, all the other hints i've gotten, etc. but it's still really taking over my life... I can't exercise anymore (which is making me feel really really unhealthy), I can't go out w/ friends and goof around or play sports anymore, can't really sit down properly anymore, can't run around and play with my little cousins, can't help out as much at home, heck i can't even concentrate on school as much, and September should be my final semester. I feel guilty for not being able to do all the things I should be doing (e.g. helping out, studying & making sure I get awesome grades, etc). I don't even know if I'm just being extra careful by avoiding things, or if I've just become so lazy after this whole fissure, or both!
I don't wanna be at the mercy of my ass forever. At this point, I don't even know how I'll wait til July 31st. God give me strength :D :D :D
love you guys
sunshine :

I think giving yourself from now until the 31st will give you an idea of where you want to proceed. It will either strengthen your resolve or confirm that it may not be time to proceed.
I know none of us can really advise you what to do ( I guess we could do a poll though ) but I think come the 31st you will know in your heart what needs to be done.
I guess if I were a young woman who was being limited from living a normal life and the surgery was an option I would probably consider it. You won't wake up from surgery without your fissure but it can get you over the hump in your healing process. It is worth considering. Surgery is a hard decision unless it is necessary. I have never elected to have surgery but have had 2 surgeries that were indicated and am scheduled for surgery on Friday (for hernia repair). I hate having to put my body through it but I hate living with pain more and it is a situation that won't improve on its own.
So, anyway, that wasn't very helpful but I am hearing your words and understand the struggle. Prayers and hugs to you!
Lecia

Hi Sunshine,
Neither of the procedures are a quick fix for the fissure. Sorry. I soooo wish they were. either way you are going to have to heal the fissure. The procedures just help you to heal it.
I think you might be talking about a fissurectomy rather than a sphincterotomy. A fissurectomy is where they cut out the "diseased" tissue in hopes of stimulating healing. sphincterotomy is where the surgeon partially cuts the sphincter muscle. The reason it is called a LIS (LAteral Internal Sphincterotomy) is that the internal muscle is cut on one of the sides of your anal canal. The sides, they say, have greater blood supply than the front or back and so they heal quicker. The internal muscle is involuntary and responsible for the painful spasms. For some reason, LIS often stops the spasming. I suspect LIS also widens the anal canal. Sometime surgeons do both LIS and fissurectomy at the same time.
I got botox because I realized that the majority of my problem stemmed from the spasm, both during and after my bms. Botox paralyzes the internal sphincter, effectively giving one a chemical sphioncterotomy for 3-6 mos. Nitroglycernine, nifedipine and diltazem also give chemical sphincterotomies but for much shorter periods of time or not at all (for me it was usually 20 mins or not at all). The botox paralysis encourages healing because 1) the blood supply is not further reduced by clenching muscles, 2) one can't involuntarily clench from pain while pooing and thus cause more damage. (one can still get big hard poos if one does follow a good diet, though). The best benefit I found was no more painful spasms. The cut itself still hurt, stung more like but...what was the metaphor I used before...it didn't feel like someone was ripping out my anus.
The botox procedure is surprisingly simple. I was in an out in an hour, needed no numbing, didn't need to take a day off of work, and drove myself. It did aggravate a newly appeared roid though. ARGH!!!
So pizza will have to wait no matter which route you choose. (I think you might be able to manage half a slice, provided you surround it with a huge salad and some beans. when I have a craving that's what I do. Teenie, weenie bit of bad for me food, with all kinds of fiberous, nutritious foods. oh and lots and lots of water/gatorade.)

I want to thank everyone who just replied to Sunshine, you saved me a lot of work!
I don't want to just repeat what Buttgirl has just said, but if you are still uncertain, go back and re-read her post carefully. She is spot-on...the LIS *IS* a spincterotomy and it is NOT a cut into the fissure itself. It is a way to reduce the spasms (immediately, in my case) to allow blood flow back to the fissure and healing to occur.
You are YOUNG sunshine and you SHOULD recover from an LIS in just 2-3 weeks, and your fissure should be healed in 6- 8 weeks after that. THEN you can bring on the Pizza!!
I cannot explain why some people do not recover as fast, but it would appear that in some cases, the surgeon does not cut into the sphincter deeply enough...but you cannot blame the surgeon too much for that...too deep a cut will cause incontinence!!
I got my life back through the LIS. The pain was over with the day I had the surgery, for the most part, but it still took me three weeks to feel better and a month before I felt I was having normal BMs again. After two months, I was back eating lots of foods I hadn't had in ages. Now it is six months out and I can eat anything I want, as much as I want, but I don't, because I learned new eating habits while on my fissure diet and I will never be a completely unhealthy eater again. But I will have a burger, steak, or pizza about once a week.

Sunshinehope,
I amg oing to the CRS on 7/18/07. I am going to ask about surgery. I agree with Gareth(happyass)......
He said "think that if you are totally not living your life - that you are truly becoming disabled by the fissure - that surgery may be a consideration to really think over."
So I am going to ask all kinds of questions about surgery. I don't want to do this for 3/4 months. I want to start school in the fall. So when you go just ask your CRS it can't hurt right??
I am right with ya sunshinehope good luck and I will let you know wht happens.
Patty

sometimes we think asking the doctor to look at or even help us diagnose something will be negative.
i sure was scared going to the CRS my first time as i was dreading an evasive anoprobe and being told that LIS was needed. instead, he was a very great guy, funny, and very easy going and he didn't even bother inserting anything as he could see the fissure from just a little peek.
however, what impressed me the most was his advice on doing some very conservative things first and leaving surgery as a fourth or fifth option.
for some people, waiting for the fourth or fifth option is just not an option - they will want to skip to LIS. however, for those of us who for some reason still have hope to deal with this without surgery, we are happy to learn that LIS is not necessarily an immediate solution - but that there may be other alternatives to try first.
this of course comes with a price to pay because not all of us get relief with creams, meds, or even simply changing our diet. however, we follow our hope that creams, meds, and diet changes will provide us with relief quicker than what we are willing to endure. and some of us, will endure longer than that, living in constant pain and misery.
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in any case, the choice is always up to the patient with what should be done. the doc could always say yes lets schedule LIS now but if you are not ready, you are not ready. ask for other alternatives.
for some, the doc will want to try, x, y and z before LIS but the patient has had enough of the pain. book me STAT!
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personally for me, i don't know how i did it but i never got to the stage of getting those creams. and i wondered if they would have really helped me any quicker.