LIS questions I didn't get to ask my CRS

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LIS questions I didn't get to ask my CRS

Postby banjobuddy » 02 Feb 2017, 05:05

As I've written a few times now, I'm scheduled to have my LIS sometime in the next few months. I haven't had a date yet, but hopefully will do soon. During my last visit to her, I spent so much time convincing her I really needed the LIS that I didn't actually get any time to ask any pertinent questions regarding what happens etc. Any advice or info gratefully received.

Q1. When people talk about the recovery time, is this the time for the LIS to heal up or the fissure to heal as a result of the procedure? I also wondered how long the actual incision site takes to heal?

Q2. I think I'm having the closed LIS. Does this involve just a nick in the sphincter muscle that's left open or does it have stitches?

Q3. I've looked at a few diagrams of the LIS and it looks as if the cut happens behind the wall of the rectum and not in the actual rectal wall, unless I'm misinterpreting the diagrams. If this is the case, is the incision for entry into the muscle stitched up after the muscle is cut? Excuse my ignorance here!

Q4. I'm expecting a world of pain after the operation. How quickly does the pain set in and what's the best thing to take for it? I'm a bit worried about strong pain killers causing constipation and or hard motions.

Q5. What did you eat after the operation for the first week or so? My problem has always been balancing my food intake so I don't get hard motions (not happening at the moment!) or having so much fibre and stool softeners that I'm in the loo 3 or 4 times a day. Neither is great.

Q6. How long before you can sit in a chair after the op? I just dread the thought of weeks of lying on a couch or bed watching daytime telly, reading or sleeping. I fortunately work from home as a writer and designer, but it does involve a lot of computer-based work on a desktop computer.

Q7. Similar question, but how long before I can go for a walk, however limited in length?

Q8. Our bedrooms are upstairs. Will I be able to move sufficiently to walk up the stairs to bed following the op, or should I think about sleep on the couch downstairs for a while?

Q9. I haven't even had the op yet, but my big fear is that first bowel motion after the op. The whole idea scares me to death.

Q10. How quickly is the area likely to stop bleeding and if I have stitches (?) do they need removing?

Q11. What's the normal time frame for a follow up visit to see my CRS after the op?

Q12. I read about totally different healing periods (anything from a week or two to a year). What is considered fully healed as opposed to feeling a lot more comfortable?

Q13. Can anyone recommend a good soft cushion or padded seat that might be useful for an office chair during my recovery? I currently use an inflatable ring, which I know not everyone thinks is a good idea with a fissure. Would a pillow be as good as anything?

Q14. Would I be well enough to prepare my own meals or would I need to rely on my wife for a while? I'm a pretty independent person and hate relying on other people.

Apologies for all the questions!
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Re: LIS questions I didn't get to ask my CRS

Postby chachacha » 02 Feb 2017, 10:05

I will answer what I can, through my experience, which will be very much different from the experiences of others. Yours will also be very different, because we are all different and have different surgeons and fissures.

Q1. When people talk about the recovery time, is this the time for the LIS to heal up or the fissure to heal as a result of the procedure? I also wondered how long the actual incision site takes to heal?

I was fully recovered by the end of 3 weeks. My incision site was healed within days, my fissure seemed healed immediately, but it was new tags and my fissure tag which caused me some pain during that time.

Q2. I think I'm having the closed LIS. Does this involve just a nick in the sphincter muscle that's left open or does it have stitches?

My guess is that "closed" means that they stitch it up, but I'm not sure. You should be able to determine that by looking it up on Google.

Q3. I've looked at a few diagrams of the LIS and it looks as if the cut happens behind the wall of the rectum and not in the actual rectal wall, unless I'm misinterpreting the diagrams. If this is the case, is the incision for entry into the muscle stitched up after the muscle is cut? Excuse my ignorance here!

Some surgeons hold your anus open with a tool of some sort and go up through there to the inner sphincter and make a cut on the inside of the sphincter, and other surgeons make a cut just to the side of your anus (about a centimeter away) and cut the backside/outside of the sphincter (as mine did). Is that what you mean by "behind the wall"?

Q4. I'm expecting a world of pain after the operation. How quickly does the pain set in and what's the best thing to take for it? I'm a bit worried about strong pain killers causing constipation and or hard motions.

My pain was mid-level for the first few days and then gradually diminished to a zero by about the end of one week. The pain set in as soon as I woke up, and I used narcotic painkillers to quell it. I have a very high tolerance for painkillers though, so others may have been able to use an OTC painkiller for the level of pain I experienced. I also didn't have to worry about the constipating effects of the drugs though, because I had always suffered from chronic diarrhea. After that first week, I only had pain from the tags if I sat on them on a hard surface.

Q5. What did you eat after the operation for the first week or so? My problem has always been balancing my food intake so I don't get hard motions (not happening at the moment!) or having so much fibre and stool softeners that I'm in the loo 3 or 4 times a day. Neither is great.

Can't help you with diet, because I've never had to limit any foods or eat more of others to keep my fissure happy.

Q6. How long before you can sit in a chair after the op? I just dread the thought of weeks of lying on a couch or bed watching daytime telly, reading or sleeping. I fortunately work from home as a writer and designer, but it does involve a lot of computer-based work on a desktop computer.

I hated lying on the couch too, but had to do it for the first week. After that, I used a couch cushion to sit at my desktop computer, because a pillow just wasn't thick enough.

Q7. Similar question, but how long before I can go for a walk, however limited in length?

I could probably have gone for a walk after one week.

Q8. Our bedrooms are upstairs. Will I be able to move sufficiently to walk up the stairs to bed following the op, or should I think about sleep on the couch downstairs for a while?

I could walk carefully, anywhere in the house, on the first day home.

Q9. I haven't even had the op yet, but my big fear is that first bowel motion after the op. The whole idea scares me to death.

My first BM slid painlessly out, and I've never had a peep of pain since.

Q10. How quickly is the area likely to stop bleeding and if I have stitches (?) do they need removing?

I had a pad placed over the incision and that came off when I got home (and it had a minor amount of blood on it). I don't recall any bleeding after that. I had no stitches, so can't help you with that.

Q11. What's the normal time frame for a follow up visit to see my CRS after the op?

I had my first follow up at the 6 week mark.

Q12. I read about totally different healing periods (anything from a week or two to a year). What is considered fully healed as opposed to feeling a lot more comfortable?

It felt as if my fissure was healed immediately, but I imagine that it took a lot longer for it to actually be fully healed. And because of that, I guess that I have no idea when it would be considered fully healed.

Q13. Can anyone recommend a good soft cushion or padded seat that might be useful for an office chair during my recovery? I currently use an inflatable ring, which I know not everyone thinks is a good idea with a fissure. Would a pillow be as good as anything?

I used a cushion from the family couch. It made the "decor" look odd, but worked for me. The ring is not only bad for fissures, but causes hemorrhoids too. And as mentioned above, a pillow wasn't thick enough for me, but could be for you, because we're all different.

Q14. Would I be well enough to prepare my own meals or would I need to rely on my wife for a while? I'm a pretty independent person and hate relying on other people.

I was, but because my husband likes to pamper me (lucky me!), I probably didn't cook or prepare much food for myself, for the first week.
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: LIS questions I didn't get to ask my CRS

Postby banjobuddy » 02 Feb 2017, 10:23

Thanks CCC,

Sounds like you had a really good experience with LIS. With question 3, I think that's the answer I was after. I'm probably not explaining it too well lol! I'll try a rephrase. I mean would the surgeon make the cut on the actual inner wall of the rectum or would he/she enter at a point near the anal opening as if to slip something into a pocket - in this case, the scalpel blade, so there would no actual incision on the inside of the rectal tunnel, unlike a fissure which is on the inside of the rectum. I'm still not making this question super obvious am I?! Before today I just imagined they cut through the wall of the rectum, but that doesn't look accurate on some of diagrams. To put it another way, imagine the rectum could be removed like a cardboard tube - I'm interpreting the diagrams as the fissure would be on the inside of the tube and the surgery nick would be on the outside (or more accurately beyond the outside to whatever it was encased in). Okay, I'll stop there, it's getting too weird lol!
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Re: LIS questions I didn't get to ask my CRS

Postby chachacha » 02 Feb 2017, 10:36

As I tried to explain, some surgeons open up the anus and cut on the inside of the sphincter (on the inside wall of the rectal area) and some, like mine, make an incision on the outside of your body, very close to the anal opening, and then go up into that hole and cut the outside of the sphincter, on the outside of the rectal wall. I hope that this explanation is clearer. And the answer to your tube analogy (and it's a good one!), is that some surgeons do the cut on the outside of the tube and some do it on the inside. I guess that you'll have to wait to see which one your surgeon prefers.
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: LIS questions I didn't get to ask my CRS

Postby banjobuddy » 02 Feb 2017, 11:12

Thanks CCC, I think we're both on the same page here. Explained very clearly. I wonder if the method you were given had some bearing on your quick recovery? I only discovered today that there was more than one way to carry out the procedure.
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Re: LIS questions I didn't get to ask my CRS

Postby GilmoreGirl » 02 Feb 2017, 11:28

This was super helpful!!! I'm seriously considering LIS right now so it's a relief to read your responses! Thanks for posting banjobuddy.

Just some suggestions about the diet - if your worried about large hard motions after the surgery, maybe ensure/smoothies for a couple days before and after surgery would be good? You can add in a little bit of fibre and miralax if you want and you won't even taste it. Just something I've been thinking on trying.
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Re: LIS questions I didn't get to ask my CRS

Postby chachacha » 02 Feb 2017, 14:01

Before I had my LIS, I had ASSumed that the CRS was going to open the anus and go up that way. And because of that, after the surgery, I kept trying to stuff the swollen tissues up into the anal canal, as I had always done after a movement because I had prolapsing hemmies. I thought that the doctor had forgotten to push them back in, but it turned out that the swollen tissue wasn't my hemmies at all, and I was actually pushing and messing around where the incision site actually was! It caused me horrendous pain for the first 24 hours, but it was all my own fault. I only learned later on, that there were two ways of doing the procedure (inside the tube and out). I didn't mention that pain in my answers above, because it would never have happened if I hadn't been so stupid, and uninformed!
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: LIS questions I didn't get to ask my CRS

Postby banjobuddy » 02 Feb 2017, 15:01

CCC,
We've all made seriously bad decisions when it comes to AFs. I think it comes with the territory lol! It's one of those things that fogs up your thinking and sets you into panic mode. I'm sure we've all been through the 'what ifs' as well. In certain moments I retreat to the 'if only' scenarios, but it's completely pointless of course.

GG,
The smoothies idea is certainly worth considering. I could even put in some well ground up pecans to get a few more calories into me. That's where I really struggle, trying to maintain or gain weight. I'm already way too skinny and have been for a while this whole business started. I used to be a normal weight, but food phobias and unpleasant bowel motions have changed all that. Oh how I long to eat normal food again. Glad you found my questions useful :-)

I passed a pretty thin normal looking stool this evening - just one insignificant sausage (if you'll excuse the description lol!), but I could feel the fissure site immediately. No spasms or bleeding this time, just discomfort and feeling depressed and wondering if it'll ever feel better. How I hope the LIS will at least be a partial solution. I'm starting to bore myself with this whinging lol!
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Re: LIS questions I didn't get to ask my CRS

Postby mamafizz » 02 Feb 2017, 23:10

GG How did your appointment turn out?
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