LIS Surgery

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 Surgery

Postby Karinann » 20 Jul 2013, 15:41

I'd like to post my experience with my LIS surgery. First off let me say I'm really not sure if I just had LIS by itself or a fissurectomy in addition to the LIS. I've called my CRS docs office every day for the past week to get some questions answered and every time I've called the person on the other end of the telephone keeps telling me the doc will call me back, but it hasn't happened. Anyway, on to the surgery. Back in April of 2013 I had an extremely hard bowel movement that caused the fissure pain to start up again. I say again because about 25 years ago I had my first occurrence of the dreaded fissure. So this time I knew exactly what was going to happen. My experience 25 years ago sent me to the hospital for 5 days and nothing was really done while in the hospital except they put me on a soft food diet, and told me to continue the diet and take Metamucil three times a day. After that the fissure basically healed itself. So here I was 25 years later and another fissure. I went to my primary care doctor and she gave me a script for Anucort suppositories. They seem to help a bit with the pain but after a month of using them I did not notice any movement in the direction of seeing a healing process taking place. So my primary care doc referred me to a CRS. She gave me a list of things to do and a script for Diltiazem (5%) and Lidocaine (2%). Take probiotics, Metamucil. My follow up appointment with the CRS was in 3 weeks. During this time I started to document when my bowel movements would occur (ie: how often). Looking back at that record I see now that my BMs were about every 3 to 4 days. I only eat two meals a day as I don't often feel hungry enough to eat three meals a day. During that period I probably was not drinking enough water also. When I would have a BM my stools were probably a Bristol state 2. I didn't know about the Bristol scale then. So now I'm dealing with the pain of a new fissure, not drinking enough water and having painful BM with dry stools. Great. I will admit this was all my fault. A lot of it through shear ignorance of what a good BM feels and looks like. This time around I'm getting a real education. So here I am at the 3 week follow up visit with the CRS after she gave me the script for the cream. I had not had surgery just yet. During the 3 week follow up visit, after I told the CRS that the treatment she suggested did not seem to produce any results, her immediate response was "Let's schedule surgery". Now the nasty bits. A few years ago I had some surgery for some other issues and the docs then follow a process called "Informed Consent". They gave me a lot of detailed information on the surgery process. What was going to be done, what to expect post-op, the recovery process. This CRS did none of that at all.
My best advice for anyone planning on having LIS is to first before you have the surgery may sure your BMs are producing very soft stools, at least Bristol state 3 but state 4 being more desirable. My CRS did NOT query me at all about the type of BMs and the type of stools. I did not know to ask any better. The CRS did not also explain what was going to be done. Nor did the CRS explain the recovery process in detail to me. I think if I had known more about the process I would have elected to be more proactive with the preliminary treatment she suggested and stuck with that for a longer period. So from the 3 week follow up visit to the surgery date was less than one week. So the day of the surgery I'm still constipated from hard stools and now I'm expected to deal with it while also dealing with the painful BMs. My first BM after surgery wasn't until six days after surgery. I now know that I probably caused a lot of this myself. I'm posting this to hopefully pass along some information for others so that they take to heart the instructions of their doctors and pay attention to good BM habits. You can't go into surgery expecting painless results without the good BM habits. Loose BMs are very important prior to having surgery. I'm now three and half weeks post op and am now on a stool softener(100mg) four time a day, Metamucil twice a day, eating good fiber, good veggies, and my stools are now Bristol 3 to 4. BMs are still painful after the stools pass, as I think that one of the fissures the CRS doc found ( I had two), has reopened. During that first BM I had six days after the surgery a massive amount of poo came out with probably about 3 to four ounces of blood. If I did have a fissurectomy or if the fissure site was cauterized, that BM may have scraped of and healing scabbing. I still don't know what was really done during the surgery.
So again for all contemplating surgery. Ask a ton of questions, do your research, follow the good BM habits, drink plenty of water.
I do honestly hope this missive might be able to help some one else contemplating LIS surgery.
I'm on the mend and realize that this is going to be a bit of long journey. Keep up the happy thought.
Karin
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Re: LIS Surgery

Postby Savaici » 20 Jul 2013, 19:19

Hi Kariann,
Good luck with your healing!
Just thought I would give you the link on the forum for information about your rights when it comes to medical records. I always get mine, by the way.
http://anal-fissure.org/t6102-your-medical-records-rights-usa-uk-australia?highlight=Records
All the best to you.
Last edited by Savaici on 21 Jul 2013, 17:38, edited 1 time in total.
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Re: LIS Surgery

Postby Karinann » 20 Jul 2013, 22:09

Thank you for the link. I kind of knew what was included in the link already. I do intend to ask for a copy of the surgical notes for my surgery. I've always done that in the past. In fact one of my surgeons actually mailed them to me without me even asking for them. Thanks again, Karin
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Re: LIS Surgery

Postby Karinann » 23 Jul 2013, 10:17

Rather than start a new post I thought I ask a few questions here. If I don't get any responses here I'll then make the new thread.
1 - What is the difference between LIS and a fissurectomy?
2 - My CRS doc suggested taking Benedryl to help with sleeping. Any known side effects? Since Benedryl tends to dry up my sinus what other parts of the body does it affect?
Since I have been unable to have my CRS call me back after more than a week of phoning her every day, I'm asking here.
Karin
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Re: LIS Surgery

Postby GeorgeTheCatMan » 23 Jul 2013, 16:48

Karinann,  I haven't had surgery yet, but I can try to tell you what I've been told by the CRS that I've seen.  
The purpose of LIS is to relax the internal anal sphincter.  It is supposed to stop the spasms and promote healing.  
A fissurectomy is when the anal fissure is surgically removed with the surrounding tissue.  This is help promote faster healing and, according to my CRS, allow the fissure to be biopsied.  In fact,  he only does LIS and fissurectomy together, neither just one of them alone.  I really  don't know how common this approach this is.  Here's a link to a site that explains it all in detail:
http://www.webmd.boots.com/a-to-z-guides/tc/anal-fissure-treating-anal-fissure
As for the Benedryl, I've only used it once.  It was given to me by an emergency room doctor after being bitten by a spider.  I can't say that it made me very sleepy though.    I hope that some of this information helps.
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Re: LIS Surgery

Postby Please go-away! » 23 Jul 2013, 17:21

Hay Karinann.
Benedryl is an antihistamine, it reduces swelling as in George the cat mans spider bite, it can also cause drowsiness, help you sleep, but it can be constipating...Please check the link below for through info.
Hi George, Is that your cat, so cute,Image 
http://bodyandhealth.canada.com/drug_info_details.asp?channel_id=0&relation_id=0&brand_name_id=1874&page_no=2#AdverseEffects
Hope that helps..Image
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Re: LIS Surgery

Postby GeorgeTheCatMan » 23 Jul 2013, 17:31

Hello Please-go-away. No, that's not my cat, it's one that was up for adoption at the shelter. I help with feral cat colonies and if any of them are friendly, they are put up for adoption. That one was just adopted. Your cat is beautiful, I like the color patterns in the tuxedos.
You're right, and I did forget to mention, the doctor in the E.R. gave my Benedryl to reduce swelling after the spider bite. My arm swelled up and it did help.
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Re: LIS Surgery

Postby Please go-away! » 23 Jul 2013, 17:43

That's a beautiful thing helping to adopt out feral cats, glad that one was adopted.
Thanks, her name is Sterling, shes a med/dark grey (appears darker) and 3 years old.Take care.
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Re: LIS Surgery

Postby Karinann » 02 Aug 2013, 07:51

Hello all: I haven't posted anything here in a while, so here is an update. Today is 5 weeks and two days since my LIS surgery. Overall I'm feeling pretty well. I am somewhat back to a regular schedule of getting out of bed each day instead of feeling sorry for my self. I try to walk as much as I can each day as I've found that moving the muscles around helps with making the BMs a bit more smoother. I don't understand the medical reasons for this but for me the more I walk around the more comfortable I feel. My BMs now happen regularly each day, whereas before my surgery they were not happening for sometimes every 3 or 4 days. Also I have managed to hit on my secret recipe for smooth BMs. Metamucil twice a day, Colace 3 times a day. Breakfast is usually Oatmeal, Orange Juice and piece of fruit or yogurt. I try to have a bowl of bran cereal every two days. Plus lots of water. I try minimum to get 64 ounces a day many time more. I have a water bottle that contains 33 ounces and if I drink two of them a day I know I'm getting my fill. There have been two or three very strange episodes of what I call radiating pain, usually if I have been on my feet for an hour or more. It starts out with a small irritation around what I believe to be the internal fissure site. Then radiates outward to my left butt cheek then down my left thigh about 3 or 4 inches down. It is not debilitating but very bothersome until it subsides about 4 hours or so after it first starts. My daily and sometime twice a day BMs do cause me some very minor irritation, but the pain usually go away within 10 to 15 minutes after the BM. I have a follow up visit with my CRS in five days, so I will discuss some of these issues with here at that time. One thing which is kind of different, is that any pain I feel now related to the original fissure site, which was towards the front of my anal opening, is non-existent. Any pain I feel now during BMs is on the exact opposite side towards the rear. My CRS said during the LIS surgery she found two fissures not only one. So maybe that is what I am feeling. She did not tell me where they were located. Another question for the follow up visit. I suspect that give the time since surgery I am exactly where I am supposed to be with healing. Karin
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Re: LIS Surgery

Postby Karinann » 08 Aug 2013, 08:36

A bit of an update.........
Tuesday of this week I had my six week follow up visit with my surgeon. I am in a much better state both mentally and physically. She did a visual exam and pronounce that the surgical site is healing very nicely. I still have what might best be called an itchy feeling when I have a BM. Nothing at all like the pain during the first couple of weeks following surgery. I continue to watch what I am eating and am getting what I think is the right mix of soluble and insoluble fiber in my diet. I'm also finding that salad's tend to slow down my digestive process, which I did not know before. I also lost 10 pounds over the last six weeks, so that was a very happy surprise for me. I've cut out quite a few carbohydrates in my diet. Except last night for dinner desert ,I treated my self to one half of an йclair. Still taking stool softeners, four per day (100mg), and drinking plenty of water. One thing still concerned me a bit, which I discussed with my surgeon, was that I still have a bit of spotting on the toilet paper after each BM. She said not to worry as the healing appears to be progressing. It is not much at all just a few speckles, and occasionally a spot about one half inch in diameter. Continuing to use Diltiazem/Lidocaine cream. All in all I'm satisfied now with my progress and especially happy how the change in dietary habits have helped in healing. Karin
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