Pain Returned 1.5 yrs after LIS

Question about Pain Returned 1.5 yrs after LIS

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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Pain Returned 1.5 yrs after LIS

Postby CoffeeDream » 31 Dec 2022, 19:55

:~!@: Hi,
I had an internal lateral sphincterotomy in April of 2021. SOOOOOO GLAD I FINALLY DID IT!!!

I had previously tried an ointment that lowers the blood pressure locally as well as Botox shots (1 on each side, I think), but neither treatment did much. I got to the point that the pain from the AF was preventing me from falling asleep, and woke me up many nights when I did manage to get to sleep.

I got a very expensive memory foam cushion for my work from home office, and I would take five-minute warm baths every hour since I was able to do only that amount of time while working from home. I am grateful that the most painful times occurred during lockdown because I would’ve had to have taken off work or leave work, then drive an hour home, and that would’ve been torture, of course. (We’re 100% back in the office since sometime in 2021 with no remote option.)

I know that I had a skin tag or maybe more than one, and I don’t know if the surgeon removed it. I don’t know if he performed a fissurectomy too, but I think so. I now think I only had one AF, but before surgery, I would’ve sworn I had 2 or 3.

When I woke up after surgery, I was moaning in pain. They gave me something IV that they won’t send home. The surgeon said it all went very well and that for pain, I was to use ice packs (which seemed to relieve the pain for a few moments, then make it even worse), warm baths, and/or acetaminophen. He refused to give me any higher type of pain killer because he said it could constipate me.

My mother and father had me stay at their house after the surgery. I was to take warm baths 4-5 times daily for 1-2 weeks, but I didn’t need them for that long (at least, not for pain). I did the warm baths for several days, but I think I was back at my own house after day 3, maybe even earlier. (I hate sitz baths on the toilet; they don’t seem to work at all for me and make me feel like I’ve gone to the bathroom on myself.) I had the surgery on Thursday and was told I could return to work on Monday. I think I took that Monday off, but if I hadn’t had any full-pay sick days left to use, I could’ve made it through work that day.

After that, I would still occasionally have some pain. The surgeon said that does happen sometimes, that some people still have pain after the ILS. I would just take warm baths and acetaminophen or ibuprofen or both when that would happen. BUT any pain I’ve had since the surgery has been much less than what I had before surgery.

My verdict: it was well worth it. If I acquire incontinence when I’m elderly, I hope that I will be happy that I had thirty or so years without all that pain and deal with it as gracefully as one can.

HOWEVER: In the ensuing time period, I’ve gone from obese to even more obese. Up to 250 pounds at 5’7” (113 kg at 170 cm). I’ve finally found a (different) doctor who is helping me work effectively on losing weight. The diet plan is very extreme: I eat very little. But since stopping eating all the food I used to, I’m also getting basically no fiber. Maybe that is why I’ve been having anal pain again. Maybe it’s the hemorrhoids? My CRS didn’t want to remove them because he said it would inflict ten times as much pain as I was experiencing with the AF. Yes, I would prefer to have the external ones removed, but I didn’t want any more pain, so I followed his advice to leave them alone.

Anyway, my weight loss doctor and I have agreed on 2 tsp Metamucil per day to try to prevent my stool from getting hard.

On this very restrictive diet, I’ve had very small BMs every one or two days. They usually don’t hurt before or while coming out, but a few hours later, or at what seems to be unrelated times, I’ll have anal pain that will make me take NSAIDs, and today, for the fist time in months or maybe even a year, I’m sitting in a warm bath as I write this post.

I’m still glad that I got the ILS surgery because the pain I’m having now is nothing like what I had before. It’s about 50% less or maybe even less than that.

But now I’m wondering if people ever get second ILS surgeries, what’s different from the first surgery, and whether the chances of incontinence increase with a second ILS.

I don’t know where my AF was located.

I feel foolish when I see other posts by people who seem to know every detail of their surgery. I kind of want to go back to my CRS just to ask these questions.

If using 2 tsp Metamucil (psyllium husk) daily doesn’t help the pain, I’m going to have to go back to my CRS.

Again, I’m very glad I got the surgery and wish I hadn’t put myself through a year and a half of pain trying more conservative methods, but you don’t know what you know until you know it.

Anybody had a second LIS a year or more down the road? Why? How did things turn out?

I still don’t understand why my BMs rarely hurt while coming out, even before the ILS, but a few hours later or at seemingly unrelated times, I will get anal pain and throbbing. Does anybody know why it has a delayed onset?
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Re: Pain Returned 1.5 yrs after LIS

Postby patience_and_healing » 01 Jan 2023, 12:17

Hi coffeedream, sorry that you are dealing with pain after getting the surgery. I suggest you get evaluated by a pelvic floor physical therapist. Your pain may be caused by muscular dysfunction, not an AF.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter, fissure healed
9/19: Trigger point injections and pudendal nerve block
11/19: Botox to pelvic floor
8/20: Botox to pelvic floor in new location.
On and off in pelvic physical therapy
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Re: Pain Returned 1.5 yrs after LIS

Postby CoffeeDream » 01 Jan 2023, 21:36

@patience_and_healing
Thank you so much for your reply! I will ask about that if the pain continues.
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Re: Pain Returned 1.5 yrs after LIS

Postby CoffeeDream » 16 Jan 2023, 17:32

Just got out of the CRS’s office. I finally had to go back because I was having painful muscle spasms again. He said that I have a bit of a recurrence of the AF. I’m back on a high fiber diet and 0.2% Nifedipine, which didn’t work the first time around.

I feel very angry. I’m in pain after the exam and the only solution is to repeat something that didn’t work the first time. He said that I’m in a better position to heal the AF since I already had the surgery and the muscle isn’t able to spasm as much as before the surgery.

He said he could do a second LIS, I think on the other side, but that he does not want to do that. He wants to try conservative methods first.

I left the office and broke down into tears. The Nifedipine is very expensive ($110) and not covered by my health insurance. I’m having to wait around in my car while the doctor’s office’s contact calls the pharmacy again to ensure the special pricing of $45, which is what it was in 2021 at my other pharmacy. Now, my pharmacy charges $65 for 45 g. I thought that was expensive until this new pharmacy said $110 for 45 g!

I’m just so angry!!!! I wish I could just die!!!
I hate this!!! I don’t know how in the world I’m going to work looking forward to all the pain that I had before. Before, I was able to sit in the bathtub because we were on pandemic remote work. Now, I don’t have that option. I don’t know what I’m going to do, but I think I’m going to call my HR department and ask about about remote work.
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Re: Pain Returned 1.5 yrs after LIS

Postby CoffeeDream » 25 Mar 2023, 22:09

Well, it’s getting worse. I’m still glad I had the surgery, but I still feel really angry that there seems to be no solution. I’ve asked my general doctor to give me a referral to a pain doctor. I refuse to be given the choice of only either live with level 7-8 pain a few times a week and 4-5 pain constantly otherwise or get a surgery that might relieve the pain but will leave me pooping on myself if I can’t get to a toilet immediately when I need to defecate.

I finally got the CRS to prescribe a few Norco. I only take 2.5-3.75 mg, and only if 800 mg ibuprofen plus 1000 mg acetaminophen doesn’t work after two hours, and I only take another small dose if I’m still in pain after more hot baths and another two hours again.

Wow nothing seems to work. Is this Maybe pelvic floor spasm? My CRS referred me to PT but he said they might find the fissure and refuse to treat me. I’ll just have to find out.

I’m now losing time to work due to the pain. Sometimes I come in late because I had a BM and then have to sit in the bath to hope the pain goes away. Sometimes I have to leave work early because the pain prevents me from concentrating.

I am so sick of this. [Removed by moderator]. I just want to be out of the pain!!
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Re: Pain Returned 1.5 yrs after LIS

Postby dmcff » 28 Mar 2023, 12:12

I'm really sorry that you are having to go through this. I hope that the pain doctor will be able to bring you some relief. What I want to say is - if acetaminophen (paracetamol)) and ibuprofen don't help, then perhaps an anti-convulsant like pregabalin could be more effective. For some years I've been taking pregabalin on a regular basis, prescribed by my GP under supervision of a hospital pain management team, and have found that while it doesn't eliminate pain altogether, it keeps it under control, reduces spasms, and lets me sleep at night. In my experience it has almost none of the constipating effects of opioids. Maybe you could ask the pain specialist about this.
2014 Anal fissure
2015 CAT, EUA, sigmoidoscopy, 2 MRI
2016 Pain severe then moderate to low
2017 Moderate pain
2018 Physical therapy, pain management
2019-20 Living with it
2021 Still AF
2022 Therapy, meditation
2023 Onward, up
2024 CT scan
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Re: Pain Returned 1.5 yrs after LIS

Postby MartinB » 30 Mar 2023, 17:58

Do you feel the spasms or is your pain now of a different variety? I ask because I had LIS in early 2015 and was then pain-free for about a year. After that, the pain returned and I ended up getting a full hemorrhoidectomy at the end of 2017. I was then good for 3 years, and then have been suffering with serious pain ever since. My CRS and I have been trying to figure out what is causing the pain. I had a flexible sigmoidoscopy and all my new internal hemmies (that had been removed during the hemorrhoidectomy) were banded late last year and early this year. To me, the pain has been the same over all of those years, and we're both confounded by the fact that surgical treatment works for a while, and then returns. The pain is not a spasm though, but feels like I have a burning golf ball sitting inside the anal opening. I only have bowel movements every 3 days (thank goodness!), and my pain registers as a 9 on the pain scale. After finishing with the multiple movements on that day, which takes 4 -5 hours, I take 1 and a 1/2 oxycodone pills, which drops the level down to about a 7. A huge relief, but still leaves me unable to sit on my bum, so I can't comfortable do what I need to on my computer (too hard to lean up on one arm on a laptop too, and I have to read by lying on my side). Very uncomfortable, and I can't do math and crossword puzzles on my side either, which are the few things one can do while lying down for 8 - 10 hours! I'm scheduled for a CT scan with contrast dye in April, because I wondered if there could be some scar tissue that pulls hard, but can't stretch properly, that is the source? At first the CRS dismissed the pain as just "you're probably just really sensitive down there", but I pointed out that why then would the surgeries have helped for a year and then 3 respectively? None of it makes any sense whatsoever. I will report back after my CT scan next month, and see if anything they tell me can help you too. We're clearly in very similar situation, so I hope that one or the other of us will find the cause of our pain.

CoffeeDream wrote:Well, it’s getting worse. I’m still glad I had the surgery, but I still feel really angry that there seems to be no solution. I’ve asked my general doctor to give me a referral to a pain doctor. I refuse to be given the choice of only either live with level 7-8 pain a few times a week and 4-5 pain constantly otherwise or get a surgery that might relieve the pain but will leave me pooping on myself if I can’t get to a toilet immediately when I need to defecate. I finally got the CRS to prescribe a few Norco. I only take 2.5-3.75 mg, and only if 800 mg ibuprofen plus 1000 mg acetaminophen doesn’t work after two hours, and I only take another small dose if I’m still in pain after more hot baths and another two hours again. Wow nothing seems to work. Is this Maybe pelvic floor spasm? My CRS referred me to PT but he said they might find the fissure and refuse to treat me. I’ll just have to find out. I’m now losing time to work due to the pain. Sometimes I come in late because I had a BM and then have to sit in the bath to hope the pain goes away. Sometimes I have to leave work early because the pain prevents me from concentrating. I am so sick of this. [Removed by moderator]. I just want to be out of the pain!!
CoffeeDream wrote:Well, it’s getting worse. I’m still glad I had the surgery, but I still feel really angry that there seems to be no solution. I’ve asked my general doctor to give me a referral to a pain doctor. I refuse to be given the choice of only either live with level 7-8 pain a few times a week and 4-5 pain constantly otherwise or get a surgery that might relieve the pain but will leave me pooping on myself if I can’t get to a toilet immediately when I need to defecate.

I finally got the CRS to prescribe a few Norco. I only take 2.5-3.75 mg, and only if 800 mg ibuprofen plus 1000 mg acetaminophen doesn’t work after two hours, and I only take another small dose if I’m still in pain after more hot baths and another two hours again.

Wow nothing seems to work. Is this Maybe pelvic floor spasm? My CRS referred me to PT but he said they might find the fissure and refuse to treat me. I’ll just have to find out.

I’m now losing time to work due to the pain. Sometimes I come in late because I had a BM and then have to sit in the bath to hope the pain goes away. Sometimes I have to leave work early because the pain prevents me from concentrating.

I am so sick of this. [Removed by moderator]. I just want to be out of the pain!!
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Re: Pain Returned 1.5 yrs after LIS

Postby CoffeeDream » 05 Apr 2023, 22:13

TL;DR: it was pelvic floor spasms, as @patience_and_healing wondered on 1/1/23!!!

Perhaps my CRS couldn’t figure out what was wrong because I was already taking a muscle relaxer (Baclofen) 30 mg/day for an unrelated condition and I never went in when stressed.

When I would go in for the exam, he’d test for pelvic floor pain, but it wouldn’t occur or be too bad. This is why doctors should always review meds prescribed by others. My conclusion is that the little bit of relaxer I was on kept the pain down.

What gives me spasms is work stress and didn’t realize it because I’d never go to the doctor during busy times because I felt I couldn’t leave work to care for my health.

As the deadline for submitting the next fiscal year budget approached, the pain got worse and worse over the last two months until I was in bed for 3-4 days straight, and even Norco didn’t cure the pain all the way. I finally had to take off work to go in to the doctor.

Again, my CRS couldn’t figure it out, and I felt very frustrated. So, I made an appointment to see my general practitioner and requested a referral to a pain doctor. The day I saw my GP, I happened to forget to take my muscle relaxer. I may have forgotten to take it the day before, as well. I don’t know. So, when the GP did the digital exam for pelvic floor spasm, he said, “That is not a fissure, that is a spasm!“ He increased the amount of muscle relaxer I was on, and that solved my problem about 95%!

Also, I have heard the golf ball symptom being described as a symptom of pelvic floor spasm. I might be wrong about that. I don’t experience that. But I have definitely heard the feeling of sitting on a golf ball or orange being described as a common symptom. My specialist asks me that every time I go see him about this problem. And he frowns (in confusion?) when I say no.

I did not realize that stress is what was causing my problem until the big 15 – person budget meeting for the planning of the fiscal year, at which I am pretty much the low person on the totem pole, yet I’m very much responsible for most of the grunt work, occurred.

By the grace of God, not only did my car decide to break down on the way to work that morning, and the Starbucks Wi-Fi not work, but also, I came down with the flu (vomiting, chills, and fever) about 15 minutes before the meeting! As a result, I could not attend the meeting. By the time I realized and communicated that I would not be able to participate in the meeting, my pelvic floor spasms, i.e., pain, were instantly gone!

During the ensuing six days in which I was very sick with the flu, I had very few and mostly mild/moderate pelvic floor spasms.

I am supposed to be on vacation this week, but I had surgery today for something unrelated. I am feeling totally fine now. I even feel like I could possibly go down to my previous level of muscle relaxer that was prescribed for the other condition without the pelvic floor spasms.

However, I have concluded that I really must learn to control my stress. I am starting by doing 10 minutes of meditation each day. That is all I am willing to commit to right now. I know that sounds terrible. I should be exercising every day, and I don’t. I have been sedentary for decades.

I did start learning to surf about nine months ago, but then got sidelined with an injury. I am going to have to get back into that when the weather warms up since I am recovered from that knee injury now. Even going just one day a week helped a lot. It really helped with my outlook.

I have an app called Headspace and another app called Wakeout, both pro versions, both of which I rarely use. They are supposed to be good for controlling stress. I need to start putting my actions where I’ve already put my money!

BTW, my CRS refuses to remove any hemorrhoids because he says it’ll cause intense pain. A while back I had thought I’d be willing to risk it but no way now. I can’t have my life be endlessly interrupted by pain.

@MartinB I am so sorry to hear of the horrible pain you’re experiencing. That is even worse than I have had it! You might try a standing desk or a convertible desk. I got mine during lockdown from Autonomous, but Amazon sells them now, too.

Here’s one that’s way fancier than the one I got for $200 less than I paid during remote work during lockdown, ha ha!

VIVO Electric Height Adjustable 63 x 55 inch Corner Stand Up Desk, Rustic Vintage Brown Table Top, Black Frame, L-Shaped Standing Workstation, DESK-E3CTN

https://a.co/d/c13ff1v

Now I am starting to wonder if your pain is also pelvic floor spasms. Maybe you could do with a second opinion?
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Re: Pain Returned 1.5 yrs after LIS

Postby MartinB » 07 Apr 2023, 23:51

Thanks for the suggestion of a standing desk, but I can't stand in one place for more than about 2 minutes due to a back issue (which is a story for another day!).

Nothing "spasms", but if searing pain qualifies as a spasm (I know that we've dicussed that before on this forum years ago), perhaps my pelvic floor could be an issue. Always new things to think about. My CT is coming up in a couple of weeks and I wonder if anything will be seen. I hate submitting myself to that level of radiation, but I'm so sick of being in pain.

Great to hear that things are improving for you.
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Re: Pain Returned 1.5 yrs after LIS

Postby MartinB » 08 Apr 2023, 00:03

I am going to add that I'm very active and can walk for miles and miles and miles (when I'm having my 2 pain-free days out of every 3), but my back pain kicks in as soon as I stand still. I would hate people to think that I'm so sick that I'm not active on my good days!

Also, just looked up pelvic spasms and physio, but it doesn't seem to fit with my symptoms at all. Oh well, on to another possibility soon, if I'm lucky.
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