LIS a second time?

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LIS a second time?

Postby AnalEngineer » 12 Jun 2020, 12:40

Short version: Sphincterotomy in 2010. Went great, completely resolved my fissure. Pain came back last year and has intensified to as bad as it ever was before. Hoping that another sphincterotomy is an option.

Long version:

I spent the better part of 2010 in extreme pain. Tried the conservative treatments (some compounded ointment) prescribed by my CRS, but they didn't resolve the issue. In December 2010, he performed a sphincterotomy. After a month or two of healing I was in a good place, and within 6 months or a year I was fully healed.

It really was a smashing success - in 2012 I embarked on a six-month assignment in India. I've always been prone to constipation from long travel days (delayed bowel movements + dehydration is a terrible combo), and I made the trip back and forth to India (20+ hours) plus multiple bouts of "Delhi belly" (diarrhea), and everything held up perfectly.

For years, I haven't given it a second thought. But then last summer I started getting bright red blood when I defecated, and a slight aching inside my rectum that reminded me of the fissure.

Wanting to get out in front of it but living in a new city now, I went to my PCP who referred me to a gastroenterologist. I explained exactly what I'd been through and what I thought it was, he examined and said there's no fissure but some internal hemorrhoids, and he wanted to do a colonoscopy (my first; I'm early 40s). Did the colonoscopy, all clear, but definitely some large, ulcerated hemorrhoids. Nothing seemed like too big a deal, so I sat on it for a while (I broke my arm in a cycling accident in the interim, then screwed up my shoulder, so it wasn't a priority).

The pain (which really hadn't been too bad) had started to get a little worse, and that prompted me to finally make my followup with him in December last year. He suggested banding for the hemorrhoids, and referred me to a colorectal surgeon. I figured that would resolve the pain, so I made it a priority.

When I got to the CRS for the banding appointment, he did a digital exam and found the anal fissure (that I'm sure had been there all along). [As an aside, I had begged him to be as gentle as possible in the exam because at this point the pain had crept up to the regularly bothersome stage, and I was nervous. He wasn't. Even after he saw the fissure and I told him I was a in a lot of pain. That led to one of my worst days -- few days, even -- in a long while.]

He prescribed lidocaine ointment and Calmol 4, which I've been using since January. I keep going up and down -- I'll have a really bad bowel movement, then things slowly get better over the course of a week, and I'll maybe go two or even three days in a row with no pain and then boom out of nowhere it just rips back open (and not even because of a hard stool or diarrhea even). Last Sunday I had my worst day since 2010, and it kinda came out of nowhere -- right after a stretch of really good days. There was no way of finding comfort for about 8 hours after my bowel movement, just constant pain. No help from hot shower or sitz bath or anything. I spent most of the day in bed, although it didn't help any. And now it's been a bad whole week. It's 2010 all over again.

I have an appointment with the colorectal surgeon on Wednesday. I'm really hoping for a fix like I got the first time around, but worried that there isn't one. Is it even possible to have a second sphincterotomy?

Any input appreciated. Thanks!
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Re: LIS a second time?

Postby MarkM » 12 Jul 2020, 11:20

Did you got any update, how it is going now
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