NEED RESPONSES PLEASE

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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Re: NEED RESPONSES PLEASE

Postby thisfissurecankissmybutt » 19 Apr 2012, 12:00

Hi jr2:
Unfortunately, other than basic Kegal exercises (to help you you become more aware of how it feels to completely relax the pelvic floor muscles), there aren't any other exercises you can do at home that I am aware of.
The real benefit of biofeedback is the fact that you can instantly see on a computer monitor whether your pelvic floor muscles are relaxed or not. For example, when I was told to bear down (i.e., to "push" like I was having a bowel movement), my muscles were actually TIGHTENING, which completely shocked me because I would have bet you a million dollars that I was relaxing those muscles. This explained why I was having to strain to have a bowel movement. Through several sessions, I was able to learn how to really relax those muscles, and I haven't had to strain since.
Sorry . . . I wish I knew about a "do-it-yourself" method, but I do think going to someone who is thoroughly trained in pelvic floor dysfunction is the best option if you can someone swing it. There are non-invasive ways to perform biofeedback if you are concerned about it making your other problems worse.
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Re: NEED RESPONSES PLEASE

Postby jr2 » 19 Apr 2012, 12:47

thisfissurecankissmybutt
Yes, I do remember that about the biofeedback. I remember my big problem was with how tense my muscles are all the time, even without my knowing it. She would ask me to squeeze as tightly as I could around the probe, and even squeezing as hard as I could there was very little indication of response on the biofeedback monitor. Given that the muscles are already so tight, there isn't much room for them to tighten any further, hence the lack of difference between a resting state and a squeezing state.
I'm so glad you were able to overcome your straining problem with biofeedback! That's great! Eventually, I hope to be able to try biofeedback again, now that there is more knowledge out there and specialists. For now I have to stick with the stretches and self massage at home.
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Re: NEED RESPONSES PLEASE

Postby jr2 » 19 Apr 2012, 12:54

mm
It's a really tough call because you could have the LIS done, only to find that the tension in your pelvic floor impedes the healing of both your surgery and the fissure and then you have an even bigger problem to deal with. That isn't to say it will happen but in people who have pelvic floor problems I've heard of a lot more troubles with the LIS than in people who don't have pelvic floor problems.
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Re: NEED RESPONSES PLEASE

Postby mm92599 » 21 Apr 2012, 09:15

ThisFissure......I had a few different types of injections into different areas. The first injections were for my issues with pudendal nerve pain and they were steroid injections that were supposed to be nerve blocks aimed at the pudendal nerve. However, the most accurate way to target the pudendal nerve is to do the injections using the assistance of MRI guided injections. The doctor that I went to did not use any image guidance, but relied on manually locating the injection site. This is much less accurate, but also much less expensive. Each nerve block was about $600.00 and I had one on each side. The other injections were just lidocaine injections and those were aimed at the levator muscles on either side. Less expensive than the nerve blocks, but were not effective for me. If the nerve block works, you would know right away. For me, none of the injections had any lasting effect. The physical therapy was the most effective treatment I received, but I was only able to be at the clinic for 3 weeks and I would have needed ongoing therapy for several months to really know if the treatment could have had lasting effects. The manual physical therapy consisted of the doctor inserting his finger into the rectum and stretching the muscles on either side. I could definitely feel a difference after he finished as the muscles loosened up quite a bit. The therapy didn't hurt much at all. There are actually several of these types of pelvic floor dysfunction clinics in Northern California. If you or anyone else is interested in contact info. for some of these clinics, let me know. There is another book on pelvic floor dysfunction that was written by a psychologist in Northern California who runs a clinic by the name of David Wise. The book is called "A Headache in the Pelvis". It actually has quite a bit of good information, but it doesn't really give you the tools to treat at home. It is more of a book of general information, but if you want to actually learn relaxation and physical therapy techniques, you have to attend one of his 6 day clinics. I had actually signed up for a clinic, but then decided to visit a different doctor in the same area.
As for my situation, I understand the risk of having LIS with underlying pelvic floor dysfunction. Most people on this group are only dealing with fissures and once the fissure issue is dealt with, they feel normal. In my case, I had the chronic pain from pelvic floor dysfunction develop 12 years ago and I didn't get my first fissure until about 6 years ago, so even if I can treat the fissure, I will still have problems with the pelvic floor issues. And, you are right that my risk of complications from LIS is greater because of this. But, on the other hand, I am in terrible pain with the fissure issue and I feel as though I'm getting to the point where I need to at least try the surgery to see if I can get the fissure healed and then move on to seeking treatment for the pelvic floor problems through biofeedback. I'm very torn on this decision and really don't know what to do. Just can't really wait this out much longer. I am really scared of the idea that I would be getting surgery away from home and the expense involved with that. Also, follow up appointments would be very difficult since I live so far away. Thanks again for all the responses. I appreciate them.
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Re: NEED RESPONSES PLEASE

Postby thisfissurecankissmybutt » 21 Apr 2012, 10:04

Thanks for the response!
To me, it sounds to me like you have made your decision to go forward with LIS, but are just looking for confirmation that it is the right decision. You and I have been in the exact same position (a fissure AND pelvic floor issues - lucky us, huh?) so I can certainly understand your desire to at least take care of one of the issues. If my CRS had told me that I still had a fissure at my last appointment I would not have hesitated to schedule LIS.
However, how about finding a CRS that can tackle both issues at the same time? My CRS recommended LIS and steroid injections (as opposed to simply lidocaine) directly into the levator ani muscle at the same time. The mixture he uses is Kenalog, Triamcinolone and a long-lasting anesthetic. My CRS said this "cures" levator ani syndrome in about 85% of cases.
I also corresponded with one of the top colorectal surgeons in the country (according to Castle Connolly) and he confirmed to me that he has had success giving patients steroid injections for LAS into the levator ani muscles, as well. He also confirmed that many patients with LAS benefit from physical therapy, as you suggested. Interestingly, he uses a different approach for fissures - he uses controlled anal dilatation instead of LIS. In this way, there is no cutting involved. Here is the link to his website, as well as information on anal dilatation:
http://www.colonandrectalsurgeons.com/AnalFissure.html
I would also highly, highly, highly recommend you order "UNLEARN YOUR PAIN" from Dr. Schubiner. It only costs about $25 and MAY change your life. It will not help with your fissure pain, of course, but it could help you with the pain associated with your other pelvic floor issues. One great thing about the book is that you can complete the entire program at home in 28 days using his step-by-step process (all you need is some free time and a pen or a pencil). Note: I have absolutely no association at all with Dr. Schubiner (other than ordering his book and corresponding with him via email).
Good luck!
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Re: NEED RESPONSES PLEASE

Postby mm92599 » 22 Apr 2012, 08:49

I do agree that I am hoping for confirmation that LIS would be the right option for me going forward, but I have not yet decided to go through with it. I have dealt with this fissure issue for over 6 years (off and on) and I have tried to avoid surgery at all costs. I am now getting to the point where I just feel like I've run out of options and surgery might be my only hope of ridding myself of fissures. I do realize that treating the fissure problem won't fix my underlying problem and the surgeon that I have been corresponding with understands that as well. He has told me by email that anal fissure disease and levator spasm are two separate issues that would need to be treated separately. He actually suggested that I look into steroid injections into the levator muscle along with biofeedback and possible diet alterations to treat the levator problem. He did say however, that LIS would cure my fissure disease and prevent any future recurrence. He seems overly-optimistic about the surgery as he stated that he has never seen a fissure not heal and has never seen a recurrence of fissures going forward after LIS. He also stated that I would only need to plan on being gone for about a week and then I could return home. He said that he does about 30 LIS procedures per year and has been in practice about 25 years or so. He almost seems to good to be true.
My biggest fear is that I would have LIS and not heal or have recurrence again in the future. Or that I would have complications from the surgery or my LAS would impede the healing from LIS. AND, all of this is compounded by the fact that I would be receiving treatment out of state. So, if I were to have complications, I am not sure how I would be able to deal with those issues. I cannot stay in Texas indefinitely and I don't really have anyone locally that I could follow up with after surgery if complications arose. Follow up appointments would be difficult too, because the expense of traveling to Texas for follow up would be more than I can afford. It's such a tough spot to be in. But this morning was a reminder of how much I want to fix this problem as I have not had pain during bm's for awhile and this morning I had two bm's and the second time I felt that stinging pain and now I am feeling alot of pain in the rectum. I don't want to live each day with the fear of possibly tearing my fissure again. I just want to have the opportunity to move on from this. I really am completely confused as to what to do. It would be so much easier if I had a really good CRS that was guiding my treatment and who was willing to do LIS. Not having that is making me feel like I am self diagnosing and self treating.
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Re: NEED RESPONSES PLEASE

Postby thisfissurecankissmybutt » 22 Apr 2012, 09:39

Hmmmmm . . . did your CRS say why he can't do the LIS and the steroid injections at the same time? I have spoken with several CRS's and they have all recommended doing both at the same time since you are already under anesthesia. The recovery from the steroid injections, from what I'm told, is minor (similar to the soreness following a flu shot). Personally, I would try to find a CRS that can do both at the same time, as that may solve all of your problems. If the steroid injections work, you may not even need biofeedback unless you are still having problems relaxing the pelvic floor muscles. However, at least the steroid injections would help with the pain and inflammation, IMO.
I know I have said it before, but I strongly recommend "Unlearn Your Pain." In fact, I feel so strongly about it that if you give me your address, I will buy a copy for you and send it to you at no charge.
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Re: NEED RESPONSES PLEASE

Postby jr2 » 22 Apr 2012, 10:30

I can totally relate too to the frustration and not knowing what to do. If I lived near the east coast I would definitely give the controlled dilation a try, especially given the member here named wecc who had such a positive experience with his treatment. But traveling that far for me is pretty much out of the question and there isn't anyone here who offers dilation. And with the severe underlying pelvic floor problems it makes it even more difficult. And complicating things further are other health problems in the pelvis that just cause even more muscular tension (endometriosis, adhesions, bowel problems, longstanding complications from three surgeries, etc.) . It makes me very very nervous about surgical knives ... The hell of surgical complications is something I cope with every day, years and years later. But at the same time one is left asking what they are supposed to do. I have multiple fissures, not just one, and living this way is just unbearable.
I hope you both don't mind a question, but since you both also have pelvic floor problems it seems to make sense to ask it here. The other night for the first time I had a spontaneous severe pain rip through the anorectal region. It lasted for about 5 or 10 minutes then went away. I've not had pain like this with my fissures before. It was so severe I couldnt breathe. With no obvious hemorrhoid that I could see I figured it must have been a severe muscle spasm. The weird thing is, it left behind a soreness that has not dissipated. The soreness only spikes when the sphincter muscle under my control is squeezed, for example, when my bladder is full. As long as I voluntarily relax the area there is little pain, similar to when you have a strained muscle anywhere in your body... it only hurts when you move or use the muscle. There is no more spontaneous, out of the blue pain. It only hurts to squeeze. Does this make any sense? I'm in bed all the time now with all this pain.
Gosh, I am definitely going to pick up Unlearn your Pain! I had planned on doing it anyway, but I think I'll speed it up now :)
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Re: NEED RESPONSES PLEASE

Postby thisfissurecankissmybutt » 22 Apr 2012, 17:22

jr2:
While I am not a doctor (unfortunately), it sounds to me that what you experienced is called proctalgia fugax.
Here's a link:
http://en.wikipedia.org/wiki/Proctalgia_fugax
This happens to me about once every month or so. It comes on suddenly (there is absolutely no warning) and the pain is severe for several minutes (in my case it usually lasts about 15 minutes, although the lingering soreness can last for hours). When it happens, I immediately jump into a hot bath and the pain begins to dissipate. It is definitely a different kind of pain than either a fissure or levator ani syndrome, and is probably the most severe pain I have ever felt. Thankfully, the pain is usually short lived.
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Re: NEED RESPONSES PLEASE

Postby jr2 » 22 Apr 2012, 17:40

thisfissure...
Yeah, that's what I was thinking too. I guess it is the continued soreness, even days after it happened, that has me confused. It definitely was far worse spasm pain than I've ever had with fissures before. Have you ever been left with soreness for a period of time after the attack?
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