LIS Scheduled

Are you having, or have you had a Lateral Internal Sphincterotomy (LIS)? Please share your experiences here, or ask any questions.

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LIS Scheduled

Postby mysorebutt » 24 Mar 2018, 16:45

Hello Group,

So, after having failed with two rounds of Botox, my CRS has given me the option of having LIS on April 20th. My CRS does not have a lot of experience with LIS as she primarily treats chronic fissures with Botox, but she is an experienced colorectal surgeon who has done a handful of these procedures. Obviously, this concerns me, but because of insurance and financial considerations, my options are limited.

My biggest concern with the procedure is whether or not it positively affects the ability to pass stool without straining. I have a very severe chronic pelvic floor condition where my pelvic floor muscles are very tense and it causes me to strain, even when my stool is very soft. Can anyone share their experience of how LIS did/did not affect your ability to easily pass stool compared to pre-surgery?

Any input would be very appreciated. Thank you.

Mike
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Re: LIS Scheduled

Postby chachacha » 24 Mar 2018, 17:47

After surgery, my ability to pass stool improved dramatically, for about the first 18 months. After that, things tightened up again (which is the norm, apparently), but my fissure did heal. I wish that I could have had that "just dropping out" action for longer, but am still happy about having had the procedure, because it permanently removed the pain.
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 Scheduled

Postby patience_and_healing » 24 Mar 2018, 21:21

I think you will find that the fissure will heal with surgery, but your pelvic floor will require different treatment. Does your insurance pay for physical therapy? It might be worthwhile to be examined by a pelvic floor PT before heading to surgery.
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Re: LIS Scheduled

Postby mysorebutt » 25 Mar 2018, 09:32

Chachacha, thank you for your response. It is good to know that LIS did help with muscle relaxation during BM’s.

Patience, my insurance does provide some coverage for PT, however, my pelvic floor dysfunction actually started almost 20 years ago and I have been evaluated/treated by numerous pelvic floor physics therapists both locally and at the Mayo Clinic and a specialized pelvic floor clinic in San Francisco. Unfortunately, other than confirming my diagnosis of chronic pelvic floor tension and pudendal neuralgia, the treatment I have received did not resolve the issues. Anal fissures are a secondary condition to my pelvic floor dysfunction and something that I would like to have reaolved, if possible. Do you also have pelvic floor issues and if so, have you found relief through PT? Did you have LIS too?
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Re: LIS Scheduled

Postby mmklinemm » 25 Mar 2018, 11:29

I can't really say if LIS helped me with straining less during BM. I started using a Squatty Potty stool a few months before my first LIS. I know for a fact that took away any need to strain. Check out their website. It explains really well how it works. You can try a regular stool to test if it helps you. I ended up ordering the nice wooden ones from their website, which worked better than a regular stool. I've also seen the white plastic version at my local Target.
Helpful:
Nifedipine, Coconut oil/lavender essential oil, Lidocaine before BM, Aveeno Anti-itch Cream, Squatting, Finger support method, Bidet, Hot baths, Heating pad, 30g fiber/day, Wheatgrass juice
Status: LIS 20 Oct 2014, 2nd LIS 05 March 2018.
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Re: LIS Scheduled

Postby mysorebutt » 25 Mar 2018, 14:22

Thank you mmklinemm. I actually started using the Squatty Potty a few years ago and still use it every day. I agree that having the legs elevated during a BM is much better (and easier) than sitting the traditional way. Even with the use of the Squatty Potty, I often find myself having a difficult time defecating properly because of the dyssynergia that I have. Dyssynergia is when the pelvic floor muscles do not function properly during a BM so that the muscles will relax while other muscles simultaneously contract so that one can have an easy bowel movement without the need to strain. My muscles will often not relax properly and therefore I have to strain to pass even a very soft BM.
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Re: LIS Scheduled

Postby patience_and_healing » 25 Mar 2018, 18:23

I do have an overly tight pelvic floor, but nothing as bad as what you are describing. Do you live in the bay area? I could direct you to a good PT in the South Bay. I haven't had LIS because botox helped heal my fissure. I've found PT to be very helpful so far. I get twice weekly ultrasound and trigger point release, plus do daily home massage and dilation.
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Re: LIS Scheduled

Postby mysorebutt » 25 Mar 2018, 20:49

Patience, unfortunately I do not live in the Bay area. I traveled to San Francisco for treatment back in 2010 and stayed for about a month and then went back every 3 or 4 months for the following year. I am open to traveling out of state for treatment, but based on my previous experience, it is not very effective to only have sporadic treatment. I believe it is much more beneficial if you can find a PT where you live who can do ongoing treatment, such as what you are doing. Unfortunately, I live in New Mexico and there just aren't very many PT's who specialize in pelvic floor issues. I've had Botox done 3 times over the past 2 1/2 years and it worked the first and second time, but my fissure recurred quickly after my second treatment wore off and I do not believe the Botox has worked well this third time. I feel that if I were able to figure out how to relax the pelvic floor during BM's, then my fissure would heal and I could avoid surgery, but I just don't know that I have the resources available where I live to accomplish this. Surgery scares me, given my chronic pelvic issues, but I don't know what other option I have and I hate having to live with this fissure pain all the time. Just out of curiosity, who is the PT that you are seeing for your pelvic floor issues?
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Re: LIS Scheduled

Postby patience_and_healing » 26 Mar 2018, 14:47

I agree that seeing a local PT is always best. Did you ever have botox for pelvic floor? There is a forum user called msimon who had similar issues to yours, but ended up getting LIS after all. You can find more information about my PT here: https://www.kirstenwightman.com
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Re: LIS Scheduled

Postby mysorebutt » 26 Mar 2018, 19:12

Thank you for all the help patience. I have heard of doing botox directly into the pelvic floor muscles, but I do not believe that there is a surgeon/physician where I live who is experienced in this procedure. I would definitely be open to having that done, but only by a very specialized surgeon who has experience injected pelvic floor muscles. I have sent a message to msimon to see if I can get more information regarding Botox for pelvic floor dysfunction. Thanks again.
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