I am at a crossroads once again and am really thinking about going for LIS but have a million questions. Please help:

1) will the LIS stop me from tearing when I go to have my BM? I feel my BM come out of a tight ring and is very narrow as a result and this is when the damn thing will give me a sharp feeling (lately every couple of weeks followed by a few good days once it settles only to start again). Like will it open the diameter for my BM? Or is that some other muscle?

2) Why is there such swelling down there after LIS? Is the swelling mostly the incision site or the whole hole? How long does it last? Will it flare up hemmies? Did you get any new skin tags.

3) Should I have the sentinel tag removed? It often gets very irritated and inflamed so I would like to get rid of it but don't want to make a bigger problem. I have also asked him to take care of some hemmies if he sees them (just ligation or cauterization). Is this a mistake?

4) How long did you stop eating before your surgery? I have IBS and can't trust that something won't want to come down there, right up until they wheel me in (especially since I take so much stool softener and magnesium now and my nerves get things going). That would not be good. How do they do this surgery if BM comes down there when you are under?

5) Do you have to be in spasm to get LIS? Sometimes I feel spasm but sometimes it feels pretty relaxed all day. Does that mean LIS is going to be too much for me? Even when I feel relaxed though, I still don't think I'd ever get a finger up there!

6) Did you Doctor make you do an enema/prep prior to surgery?

7) Did you get spasms after the surgery? What pain meds did you take after and for how long? Did they help the spasm?

How did you keep clean without injuring the area? I use a squirt bottle now. Can I squirt that right at things (gently of course)? How did you absorb the oozing/leakage?

9) How did you ever get the courage to do it? I have chickened out twice already. Thinking maybe I could just live with it. But then I tear again and cry for days and get new courage, but I don't know if it is enough. I have such severe anxiety by this point I think I'll have to be dragged there.

That's plenty for now. Thanks so much in advance. This is such a major thing for me as I have pelvic floor issues (and weakness) that makes me worry how I will fare.

1) Probably. If you do have some degree of a stricture or stenosis, LIS should help with that, and allow for thicker stools to pass. For more severe cases, anoplasty (flaps) are typically used to provide more tissue to let the whole thing stretch open better for a BM.

2) I think swelling is just from the trauma of the incisions. Some people have more than others. I didn't have much after LIS at all honestly. You can get aggravated hemmies or tags I guess, not really sure.

3) Usually surgeons will remove the sentinile tag because it allows for better healing I believe. They kinda scrape out the fissure, getting rid of the old tissue, and I believe this includes the tag too. I don't know about the hemmies...it's really up to your symptoms and the whether the CRS thinks its necessary.

4) I stopped eating at midnight before, as per my instructions. I know what you mean about the nerves, happens to me too. Just follow your doctor's instructions on prep and don't worry about the rest. I never asked this, but I'd imagine that if they stick in the retractor and find a BM waiting to happen they just suction it right out. You can ask your surgeon this to confirm if you want, but I have been in the same situation many times and never had a problem. Being so nervous, I always kinda have that urge as I am heading into surgery, it's impossible not to be so nervous. Also, with LIS, you are not getting stitches or flaps that are delicate and need to be left pristine for a time. You're wound is usually left open, as is the lateral incision (usually). Even if they were stitched closed, a same day dump, i.e. a few hours later that day, wouldn't ruin anything. It might be bloody as all hell, but it's not like you are going to cause damage. Since the LIS is just really snipping the tail end of that muscle ring, you can't really ruin it the same way you can damage a flap.

5) No. You do not need to be in in 24/7 excruciating spasm for LIS to be effective. It could just be that you have a high resting pressure that is not allowing your fissure to heal, even when you do not feel those dreadful spasms. Also, as you mentioned in section 1, if you have some degree of stenosis from the banding, then LIS can also help alleviate that.

6) My doctor did. 2 small fleet enemas a few hours before. I hate to say it but I had so many surgeries and instruments in my butt that it doesn't even phase me anymore.

7) Yes, but weirdly, they did not hurt as bad as before. You're anus will be offended of course after surgery, but the appox. 1 cm section of the IAS that would be clamping down on the surgery sight is clipped, and therefore incapable of squeezing. The rest of your IAS will surely squeeze as well, but that part is not squeezing onto your fissure, so it shouldn't hurt as much. People are different with pain though, so you'll have to see how you feel to decide on meds. For LIS, I did not take anything. Some people take perks or advil though. Get the meds your doctor prescribes just in case you need them in any case.

Water. Sitz bath and a squirt bottle. No wiping for a while. The sitz baths that you buy at CVS actually come with this bag that has a little spray hose attached... that's what I use. but stick with what works. I just stick a piece of gauze between your cheeks till the oozing/blood starts to let up. I had flap surgery 33 days ago and I still got a piece of gauze in my butt as a I type this...

9) I didn't have a choice. I couldn't poop right because of my stricture and I had at the time very severe fissures. I guess, like you, I just could not live with it and had to try for a way out. I was very nervous though, and my anesthesiologist gave me drugs to calm me down as soon as he saw me for that operation. Maybe they'll do the same for you.

Msimon, I have not had the surgery, but one of our moderator's who does not come by any more (healed...YAY) is a good read:

my-lis-diary-march-2012-fully-healed-in-4-weeks-t4589.html?hilit=Davo

The very best of luck to you for the surgery!!!!! Will be rooting for you.

I'm booked for surgery on Friday and I too am pretty nervous about it. I generally feel fine unless I am using the restroom, so I too was wondering if LIS would be too much for me. I am not one of those in constant pain. Only extreme pain while passing stools. However, I have had fissures of varying painful intensity for going on 8 years now and they haven't responded to ANY treatment. They come and go as they please, leaving inflamed skin tags and discomfort. My concern is, obviously, being incontinent. I could live (uncomfortably) with what I have going on, but I am tired of the run around, tired of trying everything under the sun, and ready to get this issue resolved.

I still might chicken out though...

Hi msimon, I am sorry that you're going through this. I haven't had LIS yet, mine is next week. I have pelvic floor issues too so I know that can be a concern, my pelvic floor therapist tries to discourage people from getting LIS. But she's had a few patients who had it and their fissures healed and they had no side effects.

Keep us posted!

Still Hoping, Can I ask if your therapist gave you a reason for discouraging LIS?

Thanks for the replies everyone.

ASDF, since you have had both the botox and LIS, can I ask you if you noticed any difference between the two treatments? Mainly, did they give you urgency and if so, did one more than the other? Did they make you feel loose (again, one more than the other). I am really trying to determine if my experience with the botox will be how LIS would be for me. Honestly, I did not feel so good after the botox, and I had a small amount. I feel bad urgency and then when it was time to go, after holding it in, was very difficult to let out gently. Must be due to my weak pelvic floor Problem is, having a weak pelvic floor won't heal a fissure, especially when you have a tight sphincter.

My stenosis is functional as when the muscles relax it does open up quite wide...at least it used to. I believe my Doctor is going to use stitches, at least he mentioned this for the sentinel tag (which I think it quite small so 'A' stitch). I feel I don't have a choice either as I can hardly pass anything. I am just so worried that the real problem is my pelvic floor and weakening my IS is going to make things worse. How are you doing these days? Do you have a next plan of action?

SAVAICI, thanks for Davos diary. I had read this before. It's a good one o read when feeling nervous for sure :)

RUSHJET, I know what you mean about thinking whether you can just live this way or not. For me, it has often seemed that the more I do the worse I get so I'm petrified things are going to go wrong somehow. Mostly, because I am so different (with the pelvic floor issues and IBS). Have you come any closer to a decision?

So I had 2 shots (100Units each) in the few months prior to LIS, then I tried again with 2 shots (100 & 70 units, respectively) in the months following the surgery. I really can't speculate on what the control sensations will be like for you, however, because it's all personal and it depends on how much you got, when and where you got it, and how much of your IAS they will cut. Have you had manometry done and/or a sonogram?

I'm just waiting around to heal enough from this operation to try something new. It's only 5 weeks for me, so I'll have to give it for time before considering what few options I have left.

So my pelvic floor therapist was concerned that any trauma (surgery) to the sphincter could cause the pelvic floor muscles to tighten up. My pelvic floor issue may be different than yours though. My pelvic floor muscles are overly tight and we are trying to get them to relax.

Still hoping, This is what really scares me. Mine tend toward being really tight but I have had botox regularly for 5+ years so there are few left that are really tight. But it is still very hyperactive and a lot of the time I cannot tell if my pain is from the pelvic floor muscles or the sphincter. I have tended toward sphincter pain now I think, especially since the fissure (almost 1 year now). I recently got botox into the pelvic floor muscles and that made my fissure so much worse, in fact I got a new one. The botox into my internal sphincter made my pelvic floor cranky. I just don't know what to do. I have chickened out of surgery twice already. Sometimes I think that if the sphincter continues to spasm it will make the rest of me tense anyway so ultimately I just really need to heal this fissure. I just don't know what is going to happen and I am so worried as it is permanent!

So you say your therapist had some clients that did well with the surgery? DId she have any that didn't do well with it?

ASDF, thanks for the info. I have had a lot of botox into the pelvic floor over 5+ years but never more than 160units in a 6 month span. I just don't have a lot of strength back there so I am very sensitive to change and further weakening. I have not had manometry done. Once CRS I saw thought it would just be too painful to try and honestly I don't see how meaningful this test can be since one will be more tight due to anticipating pain and being anxious anyway. This is just such a wild card for me but almost a year is enough of this already! How long have you suffered from your fissure?