jr2:
Yes!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
My biofeedback nurse explained to me that when something traumatic or painful happens "down there" (like proctalgia fugax), most people unconsciously keep their sphincter muscles tight as a natural protective measure, which makes perfect sense. Unfortunately, this can keep the muscles tense, which causes lingering soreness, especially if the area is already sore from other issues. I have had to learn how to consciously relax my sphincter muscles all day long. Since then, the soreness doesn't stay around nearly as long after an attack (maybe an hour or two).
Of course, you may want to have you CRS take a look to make sure nothing else is going on. Personally, I have my CRS on speed dial!

Thanks! That makes a lot of sense. And since I've got fissures anyway that cause me so much misery, this PF attack has just made an already sore situation worse. I'm thinking of getting yet another CRS opinion. I really like the one I have now, who is really open minded, gentle, and creative in her thinking, but we're kind of at the end of the road with things to try so I guess it couldn't hurt to see someone else just to see if any new ideas come of that. Waiting times to get in to see anyone are just crazy around here.

I would definitely recommend getting a second (or even a third!) opinion. I personally have been to three different board-certified CRS's and it amazed me how all three of them had completely different approaches to my treatment.

was there anything that surprised you by any of the ideas thrown out there? My CRS and I have tried some really off the path stuff together, and I'm just wondering if you have had anything novel and different suggested?

Thisfisure...
I appreciate the offer to send me a copy of the book, but I don't want you to have to do that. I will definitely order a copy this week as I am always open to new ideas and approaches to this problem. In response to your question about why my CRS can't do both LIS and injections together, I'm not certain that he can't or won't, but this is not actually my CRS who is recommending this treatment plan. This particular CRS is one that I've only communicated with by email a handful of times. My initial CRS who had been treating me for several years and the one who diagnosed my fissures to begin with, has recently informed me that he no longer wishes to treat me because I had also saught opinions from another CRS and GI doctor. I tried scheduling an appointment with him last year and after being put on hold for a few minutes, I was told by the receptionist that the doctor said to "have him contact the other doctors who is treating him from now on". Unfortunately, the "other doctor" who I had seen on a few occasions, just to get another opinion, is a general surgeon and I don't really care for him much. He also has never actually diagnosed me with a fissure, but he also only examines for fissures by spreading the butt cheeks apart, which for me doesn't work cause my fissures are generally only visible with an anoscope. And, there are really non other colorectal surgeons in the state, so I'm pretty much stuck. After reading the posts on this threads, I am really envious that you all seem to have good CRS' that you can call when you're having problems and they don't get hurt egos when you seek other opinions, etc.
I also agree with thisfissure on the cause of the severe rectal pain being the result of pf. I've had this many times and it can be so severe that I've ended up in the fetal position for several minutes. It then lingers for several hours sometimes. I've never had the soreness stick around for more than a day though, so I think it would be worth having your doctor take a look at. There really is no treatment for it though. It is most common in the middle of the night, but I've usually had my episodes during the day or evening.

mm...
that is just so sad to hear ... that your doctor would take such offense at your getting further input... Ive had many doctor experiences like that too, and it is especially devastating in your case since you have so little in the way of local options. If you're pretty sure you're going to have to travel to get treatment, would travel to the New York area be at all feasible for you? The link above that "thisfissure" posted is to a top colorectal surgeon who prefers standardized dilatation for fissures and has had high success rates with it, so high that many people around the country travel to have treatment with him, some who failed to heal with LIS. The benefit of course being no surgical incision to heal.
Thanks for the input on the PF attack. I'm pretty sure now that's what it was and I think the soreness has stuck around because of the fissures. I've had these attacks before too, but never when I've had fissures, so I think the double whammy has just made it that much more painful. But yeah, the next time I can actually get in to see a doctor I will have it checked out. Even with the CRS I like so much, it's usually a month before I can get an appt. with her, even as an established patient. My GI doctor is about the same.

thisfissurecankissmybutt wrote:I would definitely recommend getting a second (or even a third!) opinion. I personally have been to three different board-certified CRS's and it amazed me how all three of them had completely different approaches to my treatment.

thisfissure - Soooo true! I've been to FOUR crs docs at this point, and they've all been different. I'm not going back to #1 or 2, ever again -- and #3 did my surgery (he really seemed to understand the problem and how to solve it, but he's now overseas) -- and #4 is whom I've been seeing since then, and I like him, and his office manner is a little different from #3's.
That's good advice - to keep searching, until finding a good and understanding crs.

As many of you know, I am the indecisive one who has been contemplating LIS for a few years now, but has always opted to "wait it out" and avoid surgery. In the past, this strategy has worked as my fissures have healed within weeks, but this latest episode that began in early December does not seem to be responding the same way. I'm not sure if I am doing something wrong with my diet, miralax, medications, etc., but I just don't seem to be getting better and everytime that I do feel as though things are getting better, I end up having a major setback. One concern that I have is that I have two bm's each morning. The first bm is usually soft and fairly easy to pass. But, about an hour or so later, I have the urge to go again, and this time the bm is usually loose and my rectum is in spasm so doesn't really open up enough to let things out easily. I wonder if this is the result of too much miralax as I take a dose in the morning and one in the evening. I would cut back, but I'm afraid that it will cause my stools to become firm. Anyway, I have consulted by email with a surgeon in Dallas who recommended LIS based on my medical history and I emailed him again this week with some specific questions on recovery for LIS. He said that I should plan to be in the Dallas area for at least a week and that I should also plan to be off work for a week on average. He said that he does follow up at 2 weeks and 6 weeks post op. He said that he does LIS without fissurectomy as he doesn't feel it is essential to the success of the surgery. He also said that he has never seen a fissure not heal with LIS and has never seen a patient have recurrence of fissures going forward after LIS. I have an underlying pelvic floor dysfunction issue that causes chronic rectal pain in the absence of fissures and also causes difficulty with bm's because my muscles don't coordinate properly to allow for stool to pass easily. The surgeon said that LIS will not address this underlying issue and that would require other treatment options, but that this underlying condition would not affect the outcome of LIS for the fissures. He seems overly confident about LIS fixing my fissure problems forever, although he only does about 30 LIS surgeries per year and has been practicing for about 25 years. I don't really have any other options at this point for LIS unless I continue to search for other out of state options, but I don't really even know where to start with that. No local CRS will do the surgery on me.
So, I'm at a point that I need to decide what to do, because if I opt for surgery, I need to try and schedule it for later this month so that I can have my wife attend the surgery and post op with me. In order to get this scheduled this month, I need to contact the surgeon this week. I'm just very scared to make the decision for LIS for fear that it won't work or that it will make me worse. I hear horror stories and just don't want to make a bad decision. Given my history with chronic pain in the rectum, it makes me nervous that this procedure wouldn't work for me or would backfire on me. I just don't want to regret the decision, but I guess there's no way of knowing what the outcome will be until it's too late. Guess, I'm just hoping for some last minute insight, encouragement or discouragement :)

I totally understand your dilemma... I've had the similar dilemma about my own treatment, and all I can offer is that it comes down to what your own heart and body are telling you. Even through my greatest, deepest suffering, my heart, mind and body tell me that LIS is not an option for me. It isn't easy for me to stick with this, but from past experience of so many times going against that little voice inside of my own heart with treatments and even surgeries for other conditions, it has turned out to be a mistake. It does leave me in a very tough position though with no treatment options left for me locally. So I'm left to live with it the best I can.
You could hear as many different opinions on this board as there are members. Some who will tell you that surgery was the best decision they ever made. For others this hasn't been the case. Since there is no way to know beforehand for any given individual you are left with listening to your own gut feel about your decision, and if you do decide to go for surgery being fully committed in your mind that it will heal you.
As far as the Miralax and the muscular coordination problems, I have the same difficulties with my pelvic floor, and I tend more toward loose stools. So I too struggle with the right balance that will ensure the first stool in the morning is soft enough. But that usually means diarrhea or multiple loose stools throughout the day. I've pretty much tried every combination I know to try and nothing is perfect. But so far, I've found the best combination is a 100 mg stool softener and a very small amount of Miralax (between one half and one teaspoon). But advising on this is so hard from one person to the next because everyone's system is so different. All I can say is it takes a lot of experimentation. And just when I think I've got something that works I have the added problem of hormonal menstrual changes and those effects on the bowel, so it all changes from week to week. You might want to try out some different combinations and keep a notebook of what you try and the results you get to see of you can figure out a regimen that works best for you.
I wish you the best of luck with your difficult decision, and healing days to come with whichever way you choose.

As with any surgery, there are potential side effects (as mentioned by jr2 above). However, the success rate for LIS is VERY high, especially when it is performed by a board-certified colorectal surgeon. Personally, I wouldn't let the fact that your CRS only does 30 or so LIS procedures a year concern you. My CRS said it is the easiest procedure they do, so your CRS probably spends most of his time doing more complicated procedures.
Statistically speaking, according to my CRS, if your fissure hasn't healed in 6 weeks, it probably isn't going to heal, which means you are probably just delaying the inevitable. In addition, you mentioned that you have had fissures in the past, so in all likelihood, even if your current fissure heals, it is likely to come back. Do you want to live the rest of your life worried that your fissure is going to return?
You have the chance to take care of at least one of your issues, which can then allow you to focus more time and energy on your other issues.
I also think the horror stories you hear are the exceptions, rather than the rule. Most people who have a positive experience move on with their lives and don't come back here to post about it. There are exceptions, of course. I highly recommend you read all of the posts by DAVO, if you haven't already.
If it were me, I would go for the LIS with confidence.