LIS Success

LIS

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 Success

Postby ksaco18 » 02 Jun 2020, 15:54

Hi everyone,

I had my LIS and tag removal surgery 2 weeks ago yesterday and wanted to update you on my progress. Just some brief info about me: female, 27 years old, plant-based/whole food diet for the past 2 years with an active lifestyle. I got my first AF in January of 2019 which healed in 4 weeks with nitroglyercin ointment. Fast-forward a year later and that same fissure reopened. I believe this happened both times after some over-indulging during the holidays.

My fissure pain the second time around was both physically and mentally debilitating. I suffered with pain for 4 months. I was unable to stand for more than 5-10 minutes and my pain would last 5+ hours after a BM. I tried Rectiv and used Miralax and stool softeners. I also did multiple sitz baths a day and tried acupuncture for a few weeks and barely exercised. I even saw a GI and he told me that there was nothing related to my diet that was causing the AF not to heal.

Fast-forward to three weeks ago when I decided enough was enough. I'd read a bunch of different reviews about LIS (some positive, some negative) and was terrified that I'd experience incontinence or leakage if I got the procedure done. I plan to have children one day in the next few years, and I was afraid that the surgery would make me completely incontinent during pregnancy.

After talking to my CRS, telling her my concerns and asking a million questions, she told me I was the perfect candidate for the LIS because I was young. Despite my fear, I knew that I'd exhausted all other conservative options. My CRS has been practicing for 27 years and said that LIS was the most common procedure she does. She said her success rate was 95% and she's rarely ever had a patient with incontinence or leakage. She said if anything, there might be a little leakage when passing gas, but said I wouldn't just lose control of my bowels at any time.

On May 18th, my CRS did a partial, closed LIS and also removed a large skin tag that was hanging out of my anus. Past doctors thought it was a hemorrhoid but my current CRS said it was caused by the AF. Aside from extremely tight internal sphincter muscles/uncontrollable muscles spasms, I believe the skin tag blocked the fissure from getting enough oxygen and therefore, it couldn't heal (that's just my opinion but who knows). After my procedure, my CRS prescribed me Vicodin but I took Tylenol instead, as Vicodin can cause constipation. I resumed my normal diet which is high in fiber and continued drinking plenty of water with stool softeners and half a cap of Miralax. I did not drive, exercise or drink for a week.

Needless to say, the surgery was a success. While I did experience quite a bit of pain post surgery (which was expected), it was not worse than the pain I'd been experiencing from the AF. I was terrified of my first BM, but aside from some discomfort from the incision site and tag removal, the pain was minimal. Throughout the week, I noticed that my AF pain was non-existent (it was on the top left side of my anus, the incision was on the right side, so I could tell the difference). I still continue doing sitz baths after each BM and take stool softeners and Miralax even thought I probably don't need them, but better safe than sorry. I have my 3-week follow-up next Monday.

In terms of BMs post-surgery, there was a decent amount of blood for the first week or so after each BM, but that dissipated over time. It's normal to have some blood/discharge on the wipe or in the toilet after the procedure. I haven't had any blood for almost a week now, nor have I experienced any pain from a BM for about a week and a half. I've been able to exercise (I worked out 5 days last week!) and resume a normal life again and have not felt sore or uncomfortable at all. The only side effect I've noticed is that occasionally after some BMs, I have muscle soreness that radiates up my right butt cheek. It's not debilitating but just a bit uncomfortable, and it doesn't happen after each BM.

This is all based on my personal experiences with AF and LIS, but I just wanted to share my story with you all. I truly understand how mentally and physically crippling an AF can be. I felt like a shell of myself for months and was severely depressed. I'd forgotten what it felt like to feel normal and pain-free. While there are potential risks to LIS, maybe it could work for you too if you've exhausted all of your options. Just make sure if you do decide to get it done, it's by CRS that is experienced with the procedure. Of course, do what is best for you and your mental/physical health! Every body responds differently to various treatments.

I hope all of you are on the road to recovery, and if you have any questions, I'd be happy to answer them as best as I can!
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Re: LIS Success

Postby StarrySky » 02 Jun 2020, 19:00

Thank you for posting your story. I'm 36/female and I have LIS scheduled for next Wednesday and I am beyond terrified. I have been suffering with this since November and I can't seem to heal. When it seems like it's healing, it just re-tears again. I have no problems with constipation, so that isn't the issue. My CRS just says the muscle is so tight and in spasm that it never fully heals and just re-tears again even with soft movements.

I'm so tired of this never-ending cycle. I just want it to end. I'm just scared of surgery and the recovery. I've heard such horror stories about it and it scares me. I just don't think I have another choice since my fissures are not healing (I've tried all the creams) and I've exhausted all my options. I'm tired of fearing using the toilet each and every morning.

In how much pain were you post-op? I'm really scared of that. Did you take any narcotics at all? My CRS said to stay ahead of the pain, even if it means taking narcotics. I just fear constipation due to that.
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Re: LIS Success

Postby ksaco18 » 02 Jun 2020, 20:40

Hi StarrySky,

I'm sorry to hear about your pain. I understand your nerves but I promise you it's not as bad as you're building it up to be. Trust me, I don't have the biggest pain tolerance and I got through it. I panicked the entire week leading up to it and it was way less scary then I imagined it to be.

When I first left the hospital post-op, I was at about a 3 on the pain scale. By the time I got home and the pain killers the doctor gave me wore off, I was at about a 7. The pain was different than the fissure pain, though. It's almost as if your fissure doesn't exist. Plus I got a large skin tag removed down there. If you don't have that, your pain could honestly be much less.

I was prescribed Vicodin but didn't take it because it can cause pretty bad constipation which you want to avoid. I took 2 extra-strength Tylenol religiously every 4 hours to stay on top of the pain for about 3 days, then I weened myself off. It's all you need for the pain. Post-op, I also continued with drinking tons of water, 2 colace a day and 1/2-1 cap of miralax depending on the consistency of my last BM. It's also crucial to continue taking sitz baths after the surgery because the goal is to keep the area as clean as possible so that you don't get an infection down there. Tuck's wipes from Walgreens have witch hazel on them and can help with any stinging or itching. I didn't use them after the surgery but I did the day after and it was fine.

I would say my fissure pain subsided within a day. After that, I just felt some pain and mild discomfort from the incision but that's totally normal. Last week, I was so insanely itchy down there, I felt like I wanted to rub my butt across the rug like a dog haha. That's a good sign if you feel itching after a week or so, as that means the area is healing. Also, you will see blood for a few days after surgery and that's normal. I saw a lot of blood the first two days then it slowly went away. I've been blood-free for about a week now. I'd say if it doesn't stop after a week/week and a half, call your CRS.

I, like you, had insanely tight internal sphincter muscles along with a large skin tag, so there wasn't enough oxygen getting to the area to allow it to fully heal. I totally feel your frustration and fear. Again, everyone is different, but I really think you'll be so happy you got the procedure done. I look back and can't even believe that I lived every single day in pain for 4 months straight. I don't know how you've been dealing with yours for 2 months longer than I did! Just make sure your CRS is experienced in the procedure. You'll have a much higher chance at a successful procedure if your doctor does it frequently.

Do you know if your doctor is doing a closed or open LIS? Mine was closed which means they stitch the incision at the end of the procedure so it could heal. Also, are you being sedated for your procedure? I'm not sure if all doctors do that but mine did. I felt, saw and heard nothing and had the best nap ever lol.
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Re: LIS Success

Postby chachacha » 02 Jun 2020, 21:13

Thanks for posting your success story. They can be really helpful to those who are thinking about having the procedure.
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 Success

Postby StarrySky » 03 Jun 2020, 12:57

Thanks so much for your reply back, ksaco18. I really means a lot having you share your experience, along with others on this website.

I have been suffering on and off these past few months. It hasn't always been constant pain for me. Was it constant for you? It just depends on how I go to the bathroom. Sometimes, like yesterday, I was in a lot of pain and some days I have blood, but today I'm doing okay. The fissures are still there, though, since I feel them. Having pain-free days some days makes me not want to do the surgery, but I know those pain-free days will not last. The problem always comes back no matter what creams I use or how soft my stool is. It's just so exhausting and I'm tired of it.

I just worry about how I will do with the post-op pain. I am such a baby when it comes to pain. I just worry about the severe pain people seem to get right after surgery and I worry about that lasting. This whole situation has just really gotten me very depressed. Some days I just go to sleep wishing I would never wake up and have to deal with this anymore. I know that's horrible, but that's how I feel some days.

My CRS said that he has done thousands of these operations, so I trust him. He has been practicing for close to 30+ years. I am not sure if he is doing closed or open LIS. He didn't tell me. He said the incision would be right near my anus. He also said he would cauterize any fissures there to help them heal. I'm guessing that will just make the pain worse. : (

I am assuming I will be sedated since I will be getting it done in a hospital. I had an exam-under-anesthesia years ago for another issue and I was put out for that.

Did you have to do any prep before the operation? Like an enema or just something to flush out your system? My CRS didn't want me to endure putting an enema tip up there since the muscle is so tight. He said it was fine if I just took some Magnesium Citrate.
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Re: LIS Success

Postby StarrySky » 03 Jun 2020, 13:11

Also, when were you able to finally sit after surgery? Did you mostly just stay lying in bed? I worry about being bed-ridden. My CRS said I wouldn't be, but other people's experiences seem to suggest that might be the case. Thankfully, I work from home, so I don't have to worry about going back into work.
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Re: LIS Success

Postby ksaco18 » 03 Jun 2020, 13:19

Hi StarrySky,

It seems like your CRS knows what he's doing. I'd just make a list of all of your questions and ask them prior to your procedure, just to give you some peace of mind. So maybe ask "do you do open or closed LIS and why", "what is your success rate with this surgery?" "have any other patients experienced incontinence or leakage post-op?", "how long does it typically take for my incision/AF to heal post surgery?", etc.

I had to do 2 fleet enemas, one the night before and one the morning of. That was my first time doing those and they sucked haha. Not because of pain but from holding the fluid in. I had to hold each enema for five minutes, so I put a towel down in the bathroom floor and laid next to the toilet so that I could go as soon as time was up. It's definitely tough to hold and is a weird sensation, but it's definitely necessary to do before the procedure just to avoid any accidents. The tip of the enema is skinnier than a pinky and did not hurt at all going in despite how tight my muscles were (I was nervous about that being painful but it wasn't in the slightest). It's whatever you're comfortable with/what your CRS recommends though. I've used magnesium citrate before and it clears you out, but an enema gets EVERYTHING out. I also had to stop eating and drinking (including water) by midnight before the surgery.

In terms of my AF pain, it was pretty consistent for the 4 months I had my fissure. I did have a 2-week period of no pain or blood, then it reopened and that was when enough was enough for me. I had throbbing pain and muscle spasms pretty much after every BM lasting for up to 5 hours, even if they were super soft. I have not experienced any muscle spasms or throbbing since before my LIS.

I wasn't bed-ridden at all. I chose to lay on my left side (since the incision was on my right side) for the first day or two post-op, then I was back to sitting normally. Honestly, I think I was sitting by the next day but I'm not 100% sure. It just depends on how you're feeling and what you're comfortable with. Definitely ice the area when you get home from surgery though. Despite how sensitive the cold might feel down there, it totally numbs out the area and helps alleviate some pain.

Don't worry about your post-op pain. It's not going to feel the best at first, but it's not going to be worse than your fissure pain during bad flare-ups. My CRS didn't cauterize my fissure so I'm not sure how long that takes to heal/what that does in terms of pain. All I know is that I 100% understand how you feel emotionally. I felt depressed 24/7 and was constantly crying and negative about life. I felt like I was bringing my fiance down, as he felt helpless. Since my LIS, my quality of life is back to normal. Of course LIS doesn't prevent future fissures but it reduces the recurrence rate. I honestly think you'll be so happy you got the procedure done once you've healed after a few days.

There's a light at the end of the tunnel, I promise. You're almost there! I know it's easier said than done, but keep a positive attitude and try not to worry about the procedure. It legitimately took my CRS 5 minutes to do the incision, stitch it up and remove my tag. You won't see, hear or feel anything during the procedure. You will be fine and feeling good as new in no time! :)
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Re: LIS Success

Postby StarrySky » 03 Jun 2020, 19:05

ksaco18 - That's a good point about asking my CRS more questions. I'm not sure if he will let me come in to see him again, though, before the procedure (I saw him last week). He did say not to worry about incontinence. He said this would fix the problem permanently, which I hope it does because I never want to deal with this again. He also said something about cauterizing possible hemorrhoids, but I don't have hemorrhoid problems (that I know of) so I hope that won't be the case.

I'm glad I don't have to do the enema. I think the magnesium citrate will be enough. It sounds like it will just cause me extra stress.

With my AF pain, it throbs and burns for hours after a BM when it's really bad. The pain travels through my pelvic floor region and down my legs. It feels like stabbing at its worst. I just pray the post-op pain won't be worse than that.

One last question: Did you take sitz baths using the little basin in the toilet thing or did you take regular baths? I don't have a bath tub, so I'm stuck with the sitz bath on the toilet. I also heard a handheld shower head is good to get the area clean. Did you use that?

Thank you for the tips and advice. I really appreciate it so much. : ) I just hope I can stop worrying so much. Easier said than done!
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Re: LIS Success

Postby ksaco18 » 03 Jun 2020, 22:23

StarrySky-

I primarily use a sitz bath with a hose. It's great at cleaning the area after a BM, as it has a pump so you can control the water pressure down there. I felt like getting in and out of the tub was a lot of work considering the pain I was in, so the sitz bath worked much better for me. Here's the link to the one I got:

https://www.amazon.com/gp/product/B07XT ... UTF8&psc=1

I called my CRS and asked her all of my questions over the phone (didn't feel like an in-person trip was necessary). She was very patient and answered all of them for me, which was extremely reassuring. I'd just give yours a call to set up a quick phone meeting so you can ease your mind a bit and get some answers.

I was nervous when my CRS said she was going to cut off my skin tag because I didn't want any unnecessary pain, and she agreed to only remove it if it was hindering my healing. Turns out it was. Maybe your doctor has a reason for wanting to cauterize possible hemorrhoids, but you won't know unless you ask. Just express your concerns-maybe that doesn't have to be done if it's not absolutely necessary.

I doubt your pain will be as bad as your flareups. I was fully expecting my pain to be unbearable post-op and it wasn't even close-it was just uncomfortable from being poked and prodded at by doctors. Again, this was my experience but it doesn't mean yours won't be the same or better!

Just think that by this time next week, you'll be on the road to recovery. Be excited if anything! :)
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Re: LIS Success

Postby StarrySky » 04 Jun 2020, 13:08

ksaco18 - That's a good point about calling my CRS with questions. I will call them either today or tomorrow. I still haven't gotten a call from the hospital yet about my pre-registration, so I need to call them anyway. I'm just worried because I don't want anything unnecessary done. I just want what will be done to heal the fissures and that's it. I have no issues with any hemorrhoids to my knowledge.

Thank you for the link to the sitz bath. : ) I have a similar one, so I'll be using that since I don't have a tub in my bathroom. I'm debating getting a handheld showerhead, as well, but I'm not sure which one would be best.

In the meantime, I will try not to freak out. I've been having some decent days without much pain, so that makes this whole thing even harder to face.
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