Opinions and help!

2 LIS procedures and not sure its helping.

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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Opinions and help!

Postby RockingSoreBum » 23 Sep 2013, 14:53

Hi, as most newbies on the board - i'm a long time lurker. Had a fissure since July 2012 and reading this board has given me way more information than my doctor ever did. I'm a 36 year old male.

A (hopefully!) brief summary of my situation!!!

Reported the problem back in Aug '12 with a mild pain whilst going to the toilet and was told I had an anal fissure and given the GTN cream and told to use that for 8 weeks. That didn't help and the pain was getting worse. Was moved onto Diltiazem (sp?) and shortly afterwards had intense pain which lasted for about 12 hours. This happened before I came off the GTN but after I saw the doctor, and looking back I imagine the pain was the fissure re-tearing and maybe even as a result of the doctors examination. Not sure sticking a finger in there is really the best thing to do.... anyway....

From that point I tried the Diltiazam cream for 2 x 8 weeks and the pain was getting unbearable. I'm self employed and was juggling my work around whether or not I needed to use the toilet that day because I knew if I went then i'd be having my usual 8 hours of spasming pain.

When this didn't work I was referred on for surgery and met with my surgeon in Dec '12 and I was distressed about the whole situation. He briefly examined me and said his best course of action was to actually examine me under anasthetic and perform the LIS procedure if it was required. He talked to me about the fissures etc and luckily i'd been reading about LIS on this board so knew what was involved, but he then talked to me about laxatives. My doctor has prescribed some but the surgeon said that they were not good enough and put me on Movicol.

Within about 4 days of taking that my pain became manageable. I don't even want to ponder too much on how much time i'd spent in pain when I could have been on better laxatives....

So, I had LIS in Feb '13 and all seemed to go fine, turns out I have 2 fissures and very deep ones. Spent a few weeks in bed and took laxatives again for 3/4 weeks (I came OFF laxatives pre op as I wanted to see if the fissures were still there...... ). By the time my 6 week post op check up came by then I was already bleeding again and the pain was ramping back up. The surgeon said he would have to perform the surgery again and cut more aggressively - he said he tends to try and cut as little as possible to lower the chance of incontinance. We agreed to wait a few months to see if it healed.

It didn't.

Had the 2nd LIS procedure at the beginning of August '13 and took 5 weeks off work. Again all seemed fine, 2 fissures as before and so far everything seems better than before. This time around I did not come off the laxatives and I'm staying on them until I know everything is sorted.

Had my post op check up today and pretty much the same as last time, as its not healed yet we're giving it 3 months and then a further check up - but it sounds like there's pretty much no plan b.

Sorry - that wasn't that brief!

I'm obviously a little concerned, and here's the worrying thing. Post op I only have the 6 week checkup with my surgeon, no kind of progress report etc - which I guess is fine (i'm going NHS in the UK) - but my surgeon always refuses to actually examine me and just asks me how it is feeling, the first time i thought it was quirky but now i'm concerned that I've had 2 procedures and the only time he looks at my bum is when he's about to cut into it! I have no idea if its healed in anyway.

I am fairly pain free when I go to the toilet and most of the time I can sit down, but sometimes it still hurts to sit down and drive. Plus when I cleaned myself post toilet last night there were a few spots of blood on the tissue.

My girlfriend is suggesting I get a second opinion and i'm starting to think she's right, but is that going to actually change anything? In my opinion its clearly still there! Does my surgeons aversion to my bum sound odd to anyone else?

Also my girlfriend has always thought that the main problem with my fissure is that i'm a very stressed person, not helped by self employment and we're currently living in a house which we are renovating. I really do think she has a point and have been wondering if the house was finished and I took some time off then maybe things would heal a bit quicker...? Has anyone ever had any experience with the mental side of fissures?


PS. Nice new forum - had to double check i'd come to the right place!
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Re: Opinions and help!

Postby Deleted User 2950 » 25 Sep 2013, 11:20

Well RockingSoreBum

You've said a mouthful. And we understand your concerns. But I can assure you that what your going through is typical here and we have seen and heard most of what you've described.

As you have touched on, getting a second opinion sounds like a good idea in your case. Though some Dr's can be pretty rough down there it would be nice to have one who is not afraid to look. Perhaps he did not want to do any further damage to you down there, but not even try while being very careful, hmm. Another Dr. may also be better able to assess whether or not your two LIS was necessary and what steps to take now forward.

But as you say Dr. or no Dr. you are the best judge on whether or not your think things are improving down there. What you want to do now is to take all the preventative measures to help heal and prevent any recurrences. For one you noticed your tissue was spotted, so if your wiping with this, a good thing to do is not to wipe but to dab. A better thing to do is not to use tissue at all but to use wet wipes.

Learning what foods tend to make your stool harder is another area you must work to control. The taking in of more water and fruits and veggies is always a good start too. Yeah it sounds as though your trying to ditch those laxatives as soon as possible. Unless your sure you can keep those stools soft without them, I would not chance coming off too soon while healing. That healing process can take several months to become really strong again down there.

Yes indeed stress can and will play a big role on our digestive system, perhaps making a big difference on whether you become constipated or otherwise have to strain or not. The renovation may be a factor and taking a vacation should ell be in the card for you. The mental side plays a huge role buddy, no doubt about it.

As you found out with the movicol, you now want to do all you can to keep your stools nice and soft, this is about the time that many here realize they must watch closely what they eat or else!!

So, we hope that you will fare better in the future and good luck to you if you go the second opinion route. In the mean time start to incorporate all the good advise you're getting here and keep asking and searching and things will get better for you.

Goog luck...
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Re: Opinions and help!

Postby sue30uk » 13 Oct 2013, 13:07

Hmm, difficult to say what to do now, but the main thing is not to give up. There is always a next step. I would give the operation some time to work to be honest. I am a 30 year old female from the UK and haven't had LIS but in the last 3 years have had an abscess, 2 lots of botox, fissurotomy, fistulotomy and extra botox so far (last part a month ago)!!! On top of that I have IBS just to complicate things. I think you need to give yourself at least a couple of months to see if the operation has worked. What works for me: using wet cotton wool balls to wipe after a bm, I also sit in a portable bidet I bought off amazon (my doctor said this is the best way to keep clean), drinking lots of water and herbal tea (I use chamomile as its good for muscle spasms), really eating healthily which has been hard but worth it, going for gentle walks each day. I have also used 2-3ml of lactulose each day and half a sachet of movicol, and trust me this is good considering what I had to do!! I was worried about the long term use of laxatives but asked at the hospital and they said that in the amount I have them its not a problem. Buttastic is right, dabbing is muhc better than wiping.
Like you though, I have got to the point of despair!! Yes, emotional state of mind does play a part. This caused me to be depressed, I didn't want to be on medication though so had counselling which worked for me. You don't realise the amount of stress you carry round with you. I would suggest making at least half an hour a day where you refuse to think of any house stuff and do what you enjoy. My attitude now is to step back on things and think in the grand scheme of things is it really worth getting worked up about what happens. You need to put yourself first, if something doesn't get finished does it matter? It will get finished in the end and thats what counts (if you see what I mean).
I have been for 2nd, 3rd and 4th opinions. If after a couple of months things aren't right then I'd definitely go for a different point of view. In my experience, you have to find the right surgeon for you who you can work with. I've been to see private and NHS consultants. Anyway I have babbled! If you want to ask anything, feel free! I hope things have improved for you in the time lapsed since you wrote this :)
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