My Fissure and LIS Experience (Long Story)

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My Fissure and LIS Experience (Long Story)

Postby Okie Dokie » 21 Nov 2018, 15:37

First off, I want to say thank you to all those individuals who have contributed their stories/advice/support on this forum. This forum has been a great resource for me and I’m certain it has been extremely helpful to others. I’ve probably read 75% of this forum’s topics dealing with fissures and spent hours online reading about fissures/LIS/recovery/etc.

Generally speaking, I love online forum discussions, but I rarely post. It just isn’t something I do. However, I felt compelled to detail my story below in hopes that it would be of some benefit to others. I know it is a long story, but I wanted to provide all the details I could to help those who may be interested. Please keep in mind that this is only my experience and nothing I share is intended to be medical advice. Your path forward to healing should be something decided by you and your doctor(s).

Personal Info (provided because I always find it interesting who is dealing with this issue):
Age: 36

Ethnicity: White
Gender: Male
Weight: 205
Overall Health: Good to Excellent

I started to encounter fissures in ’17, but I don’t know what it was or why it was happening. Symptoms may have started due to a larger sized BM, but I’m not 100% certain. I did nothing to prevent them going forward and it would eventually happen again. The initial fissure symptoms in 2017 tended to “heal” on its own. Around April/May of ’18 and as the fissures continued to persistently occur, I decided to start researching to determine what this ailment was. The obvious concern was possible cancer since there was blood involved during my BMs. After some research, it became very apparent that it was fissure related. Anyone who has ever had a fissure knows the exact feelings (i.e. BM feels like shards of glass, some/a lot of blood, ongoing spasms throughout the day). Once I figured out what was happening, it was too late. The fissure had become chronic in nature. I started researching CRS in the area and found one that was local. At this point (May/June/July), pain had escalated to anywhere from a 5-8/9. The fissure was starting to impact my mental health and I felt like I was on the verge of depression. During this timeframe, I discovered that Aleve was a life saver! I was taking 1-2 daily, and rarely 3, to ease the pain. It was an absolute game changer for me. This, however, was not a cure but helped my mental state immensely.

Journey with CRS:
After finding a doctor in my area, I decided to schedule an appointment. I can’t recall exactly when that appointment was, but I believe it was early/mid July. During the office exam, he took a very quick peak and diagnosed it as a fissure. He did cause some very manageable pain, because he had to “open” me up to see what was going on. However, there was no probing. That would have been unnecessary, since he was very familiar with this type of issue. He put me on nifedipine cream and told me to use this for a few weeks to a month, and also take a daily dose of Benefiber. Due to the chronic nature of the fissure, the doctor was not very optimistic it would work. He did acknowledge that it was worth a shot for a few weeks/months to see if I would have any progress and then requested that I set another follow up appointment in August. As he predicted, the cream did not work. During this timeframe, I was getting a little desperate. In conjunction with the cream, I also tried the following (which also did not work): fasting (3 days straight), aloe vera application, fissure oil from Natures Force), coconut oil application, vitamin E oil application, diet changes other than fasting.
I went back to see my doctor in August and my pain had increased. I confirmed with his PA and the doctor that there were no other options and they said that surgery is the only way to cure this issue. I reluctantly agreed to surgery and scheduled a date later in August. I had a vacation planned the week after my doctor’s visit and I asked if there was anything they could recommend for pain in order to get me to my surgery date. The PA said take Miralax and prescribed me Toradol for the pain. The PA said there was no issues taking Miralax long term and that some people are on it for their entire life, but she said I needed to stop taking Aleve, if I were to take the Toradol.
I started using Miralax and it was an absolute God send! It reduced my pain level from 7-9 to 2-5, depending on the day. I also decided to not take Benefiber during this time, since Miralax was working by itself. This gave me sooo much hope that maybe this will be my ticket to a cure. In light of this discovery, I decided to cancel my surgery to see if I could heal on my own. What I soon discovered was that Miralax kept my stool to a very manageable size, but I could always tell the fissure was there. It seemed like every time I thought I was healing and had very little pain after a BM, I would have a random re-tear or my BM was just a little bit bigger than I needed it to be. Every time I had a bad day, it was a week or so setback. The all familiar pain was a constant reminder that the fissure was still present and the muscle involved was not as relaxed as I needed it to be.
Around October, I reluctantly decided to re-schedule my surgery for Friday, November 16th. Shortly thereafter, I requested leave from work for two weeks. No way, was I going to have this surgery and take off any shorter than 2 weeks.

Surgery Prep:
The doctor told me there is no special diet needed before or after the surgery. I just couldn’t eat/drink anything after midnight the night before surgery. Yeah, right! I made the decision to start a very reduced diet on Tuesday. I kept every meal light and didn’t eat much of anything Tuesday or Wednesday and had just a little more food on Thursday to make sure I had enough energy for the surgery. I did buy a couple of Ensures and had a total of two (one on Weds., one on Thurs) leading up to the surgery.
My LIS was scheduled for 10:30 on Friday, which was perfect. I wanted so bad to have a BM the morning before, because I knew it would buy me some time after the surgery. The last thing I wanted was to have surgery in the morning and a BM later that day. Sure enough, I had one in the morning! I felt like I hit the LIS lottery!

Surgery Day:
I was fairly nervous, but I tried not to show it. I was also frustrated that it had come to this, but I told myself that it could be much much worse so I should be thankful for my overall health. I also took a little comfort in knowing that I had tried anything/everything to heal this fissure. It was very apparent that it wasn’t going to happen for me without surgical intervention.
I was called back around 9:00 in the morning where I went through all of the normal hospital stuff. The IV was put into my arm (after 3 attempts! Yay, me!) and my wife joined me shorty thereafter. I was also given 4 pills (2 extra strength Tylenol, a nerve blocker, and a Toradol). The nurses told me that my doctor uses a numbing agent that lasts approximately 3 days! He started using this medicine in August. I was super thrilled about this, because all the stories I read said that day 2-3 were the worst from a pain standpoint.
I had some conversations with some nurses and my doctor prior to surgery. He was adamant that recovery would be very manageable. He advised me to take it easy the day of surgery, but not to baby it and start getting up and around on Saturday. He also had the following answers for me during my questions/discussion:

Me: How long do I need to take Miralax after surgery? Doc: 80 years was his response. He said that I either need to take Miralax (essentially a synthetic fiber) or Benefiber for the rest of my life. He also said my wife should also take Benefiber.
Me: How do I clean myself after BM? Doc: Take a bath and clean as much as you can. You can’t clean that area completely anyway. He didn’t seem to concerned about infection. No, you will not be placed on antibiotics after surgery.
Me: I joked about not wanting to do the surgery: Doc: You don’t have to do it. Fissures aren’t going to kill you. It just depends on how long you want to put up with the constant pain.
Well, for me, the choice was clear. I was not going to keep living like this. It was having too big of an impact on my daily life.
Shortly after our conversation, I was put under general anesthesia and on my way to surgery.

I believe my doctor performed and open LIS procedure. He told me prior to the surgery, that he likes to make the incision about the same length as the fissure, instead of cutting the entire muscle. He said it has a higher chance of a fissure re-occurring, but a much greater chance of not having any incontinence issues. In honor of Thanksgiving, the doctor stuffed me like a turkey with a small piece of gauze to contain the bleeding. I was told it would come out during my first BM or I could take it out sooner if it was bothering me.
The procedure didn’t last long (maybe 15-20 minutes). It took much longer to prep and come out of anesthesia. Once I was awake, I did my best to get out of the hospital. I proceeded to get dressed and have my wife take me for ice cream (ha!) and take me home. At this point, pain was at about a 0-1. I was pleasantly surprised!

Day 1: The day of surgery I was drowsy from anesthesia. I didn’t do much of anything. To my delight, the pain was very manageable. Maybe 2-3, but like everyone else, I was more concerned with the 1st BM. No BM this day. I was prescribed Hydrocodone and took 1 around 4 PM and 1 around 10, prior to going to bed for the night. Probably didn’t need either, but I didn’t know how the pain was going to feel as the anesthesia wore off and I wanted to rest as much as possible. One thing I noticed right away is that incontinence was not going to be an issue for me. I could tell my muscle was weaker, but I could also hold in gas if I wanted to. This has been true during the entire time of recovery thus far.

Day 2: Saturday was more of the same. Very manageable pain, but I made it a point to walk around the house. I could easily aggravate the incision by bending over, moving a particular way, or sitting on my butt. However, it was very easily avoidable. No BM today. My light eating prior to surgery, plus anesthesia and pain killers the day before delayed the inevitable. 2 baths taken today to help keep the area clean. During my 1st bath I pulled out the gauze that the doctor had placed. There is no way that I wanted the incision to start healing around the incision and cause pain during removal. Removal of the gauze was very pain free, to my surprise. After my bath, I put more gauze on my incision. I bought two boxes of 2”x 2” anti-bacterial gauze squares that work perfect. I press the pad gently against the incision site and the pads stay there on their own. I have been replacing the gauze 2-3 times a day to keep the area clean.
I decided not to take any pain killers (hydrocodone) today, because I didn’t feel like it was necessary. Pain was still in the 1-3 range. I’m sure it was because I was still numb and the meds were still in my system.

Day 3: Sunday was essentially the same as Saturday. However, I did have my 1st BM in the morning. I was a little nervous, but immediately started the bath. To my surprise, there really wasn’t much pain while going, maybe 1-2 on the pain scale. It was significantly less pain than a BM with a fissure!! There was some blood involved, but nothing too alarming. There was no sign of spasms after, which was also encouraging. One thing to note, is that I didn’t change my normal diet post-surgery for the most part. I wanted to make sure my body was getting the calories/protein it needed for recovery. If I didn’t feed myself properly, I imagine healing would take more time than I wanted. Overall pain wasn’t an issue. I had 4 total Aleve to get me by (2 in AM, 2 in PM).

Day 4: Monday was still good, but I was starting to feel a little more pain. Nothing alarming though. Maybe on the scale of 1-3. My 5 year old son was back to school, so it was just me and my wife at the house. I decided to take the advice of my doctor and not baby this surgery, so my wife and I went to a local mall and walked around so that I could get some exercise. I ended up walking a little slower than normal, but pain was not an issue. Overall pain wasn’t an issue. I had 4 total Aleve to get me by (2 in AM, 2 in PM).

Day 5: Tuesday the pain started to ratchet up a bit. It was 1-3 while laying down, but walking tended to be in the 4-5 range. I did have a morning BM and to my surprise, there was more blood than the two days before. It wasn’t a lot, but I was a little surprised. I kept in mind that I was still 5 days out of surgery and had a cut to very sensitive area. There is going to be some blood involved. Took a bath shortly afterwards. I decided that I wasn’t going to do much of anything today but watch tv and lay around. I had 4 total Aleve to get me by (2 in AM, 2 in PM). I contemplated taking a pain killer prior to bedtime, but decided against it.

Day 6: Wednesday morning I felt a lot better than Tuesday. The morning BM had significantly less blood, but still a very tender area. I hopped in the tub afterwards for a soak. I decided to add some Epsom salt this time. It wasn’t necessary, but figured it couldn’t hurt. Pain today is in the 1-2 range. Really nothing of concerning. I am still replacing the gauze routinely, to hopefully prevent any infection.
I feel like I am really on the path to recovery barring any crazy setbacks. My post-op appointment is scheduled for next Thursday where I fully expect to be released back to work.

My plan is to take Miralax for the next few weeks. I will then slowly transition to Benefiber, which I fully intend to take for the rest of my life to hopefully avoid any fissure re-occurrence.

Below are some thoughts that I have had during this very difficult time dealing with fissures that someone may find useful:

If I knew what a fissure was the first time I had one, I would immediately start on a daily dose of Miralax

If I had been dealing with fissures for more than a month, I would find a credible CRS immediately and setup an appointment.

Miralax and Aleve were my two best friends at one point in this long journey. Those items bought me some time, but weren’t going to heal me.

If an experienced CRS told me that I had a chronic fissure, that’s about all I’d need to hear to know that LIS is likely in my future.

I would not hesitate to have a LIS surgery performed by an experienced CRS. Recovery has been so much better than what I could have ever imagined. Pain has never been over a 5ish and I feel pretty normal today (day 6 post surgery).
I really had confidence in my doctor which is extremely important. Probably the most important decision you will make regarding treatment of a fissure. If you need a recommendation and are in the Oklahoma area, feel free to PM me or look up a CRS in Norman, OK and you will find what you need.

I hope everyone dealing with this painful issue finds healing! Good luck to all! If you have any questions at all, please let me know. I'd be happy to answer anything about my experience. I'll continue to update my experience in the coming days, but I'm hoping the next few days/weeks will be very uneventful.

Thanks for reading!
Okie Dokie
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