Planning to get LIS - But I have questions

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Planning to get LIS - But I have questions

Postby LuMiNeeRS30 » 30 Apr 2022, 11:33

Hi all, been looking at posts on here for a month or so and figured I needed to post and see what other information I can gather. A little history on me, I'm 38/M and have been dealing with fissures for 8 years. I got my first one after a kidney stone and due to the pain meds I was extremely constipated and it led to the fissure. They've come and gone since then usually would bother me for a day or two every couple weeks. I'd have a hard stool, or large stool and it would act up. I'd put some nitroglycerin on it for a few days and it would subside. Then flare back up again.

The most recent flare up occurred in January of this year. Even with the nitro ointment it continued to bother me. Days turned into weeks so I went to the doctor to get it checked out. Confirmed it was "just" a fissure, scheduled a colonoscopy to make sure there was nothing else causing the blood. Also prescribed Diltiazem for 8 weeks.

Somewhere around the time I started to take the Diltiazem the pain began to get much more severe and linger longer through out the day. I have bowel movements in the morning and afterwards I needed to lay down to get the pain to subside or at least calm down some. Sitz baths seemed to stop working on relieving the pain so I cut them out. The colonoscopy didn't reveal anything so I was just dealing with the fissure. The doctor that performed the colonoscopy recommended LIS for the fissure that he could tell it had been there for a while and probably would not heal on it's own. I was not quite there yet. I had done a little research on the LIS surgery and was struggling to understand how the solution to a cut that doesn't heal is to make another cut in the same area.

So my wife (who is a pelvic floor physical therapist) and I tried to gather other information and other treatments to avoid the surgery. I scheduled a second opinion with CRS in Baltimore but had to make that appointment 2 months out (and still have 3 weeks to go before that appointment). I stopped using the Diltiazem because it seemed like my external sphincter was so relaxed from it that the rest of my muscles had to hold extra tight to make up for it. Thus causing the spasms and pain I was dealing with. She did internal and external releases on my pelvic floor muscles which seemed to help for a little while, although the internal ones were still pretty painful so we stopped those. I've been doing stretches, external releases, I started taking magnesium which has helped with softer stools, I've been taking stool softeners for YEARS to help avoid the hard stools and they never worked as well as the magnesium has. I eat like a bird to help have smaller stools and sometimes I'm in so much pain I just don't have an appetite.

So that's most of the history leading to this point. Yesterday I had diarrhea and needless to say that was absolutely miserable. Even before that kicked in it was a very painful morning. Over the last few weeks I had been having more "good" (or less painful) days than bad but still plenty of pain and bad days. I decided to go back to the original doctor that I had seen and have scheduled an appointment for this Friday (May 6th) to get more information on LIS and confirm if there has been any healing or changes in my situation. I think I will go ahead and schedule the LIS before the appointment just so I can get on the list and don't have to wait another week or two after Friday's appointment. I just can't live like this anymore. We have an 18 month old son that I can't really play with or help much with because it causes me pain to do almost anything. The only time I can be comfortable and/or pain free is when I'm laying down.

I just wanted to post on here to see if I could get some information from people who have had LIS or know more about it than I have. If there are other posts or threads that have this information I'll happily go to them. I have read through some of the recent success stories and journals and that's helped.

1 - I know this is an uncomfortable and painful recovery, but how does the pain relate after LIS to before? I'd consider my pain most days pretty severe, 5+ almost every morning. Driving, sitting, lifting, all are pretty painful. Sometimes walking too much can cause pain and spasms as well.

2 - How many people have had fissures recur after the LIS? Since any tear/wound will leave scar tissue that could lead to less mobility or a weak spot down the road I'm wondering if LIS is usually success long term or if fissures will still be a problem.

3 - I know everyone heals differently but an estimated time frame of when the pain was mostly gone and when you were able to get back to life as normal. Seems from what I've read those are two different timelines.

4 - If I have the surgery done in the next week or two it will be done by a general surgeon who has done a lot of these (I don't know the details, it's one of our questions for Friday). Has anyone else had LIS done by a general surgeon or is CRS pretty much a necessity (I'd have to wait until my 2nd opinion appt in 3 weeks and then however long it takes to get in for surgery to have CRS perform it).

5 - Anything else I should know, ask, or do before deciding? Or things to know about after surgery?

I appreciate any advice, opinions, and personal experiences. Finding this forum has been great and helped me to know that I'm not the only person dealing with this. It's not exactly something you want to talk about with many people.
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Re: Planning to get LIS - But I have questions

Postby Rich44 » 03 May 2022, 18:30

Hi, I would like to offer my advice. It will be direct, but here we go...

1 - I know this is an uncomfortable and painful recovery, but how does the pain relate after LIS to before? I'd consider my pain most days pretty severe, 5+ almost every morning. Driving, sitting, lifting, all are pretty painful. Sometimes walking too much can cause pain and spasms as well.

It was not an uncomfortable or painful recovery. I knew the pain could never be worse than what I had lived with. I was right.

2 - How many people have had fissures recur after the LIS? Since any tear/wound will leave scar tissue that could lead to less mobility or a weak spot down the road I'm wondering if LIS is usually success long term or if fissures will still be a problem.

It's a 95% successful surgical procedure. If you don't like those odds, I don't know what to tell you. You want to be certain you can handle it? Have an anal manometry test to see if your sphincter is strong enough. I was off the charts (I broke their machine). The CRS said I could crack a walnut in my ass. Every single surgery on the planet can have complications. The chances of them happening are rare. YES, you WILL have fissures again. They will be acute and you jump on them the day they happen and they will be gone by dinnertime. I think I have had maybe 6 fissure type episodes in 18 months since my LIS and all were immediately gone within hours.

3 - I know everyone heals differently but an estimated time frame of when the pain was mostly gone and when you were able to get back to life as normal. Seems from what I've read those are two different timelines.

I was back to normal in no more than 3 weeks if less. It's been over 18 months of NORMAL since. Some people take longer. We are all different. We all eat differently, have different fissures and go to the bathroom differently.

4 - If I have the surgery done in the next week or two it will be done by a general surgeon who has done a lot of these (I don't know the details, it's one of our questions for Friday). Has anyone else had LIS done by a general surgeon or is CRS pretty much a necessity (I'd have to wait until my 2nd opinion appt in 3 weeks and then however long it takes to get in for surgery to have CRS perform it).

I had a top CRS do mine. You of all people who seems scared to death of this surgery would actually let a general surgeon do it?! Even I who figured I was going to be ok went to the best. No way would I let a general surgeon do this if I am that concerned about complications. My CRS is the guy who teaches the general surgeons how to do it.

5 - Anything else I should know, ask, or do before deciding? Or things to know about after surgery?

Over analysis leads to paralysis. You have been dealing with this for 8 YEARS. Enough! There is no better treatment. Schedule it NOW with a top CRS and "get on with your life." That's exactly what my CRS said. And when I saw him after it was over I said, "I wish I had done that years ago." He said, "That's what everyone says." After surgery was nothing. 7-10 days of minor discomfort. I was SO excited and positive for my future that I think my body responded well. LIS was the best decision I ever made.

Let me know if you have any other questions. And lay off the stool softeners. They are making your sphincter tighten up because your stool is too loose. And you reduce blood flow to heal the fissure as a result. You want fiber and bulk up your stools. Good luck!
Fissure June 2014 - Oct 2020
Botox, skin tag removed - Feb 2015
Levator Ani Sep 2014 - Feb 2016 (left job, cured!)
LIS, skin tags removed - Oct 2020
Fissure 100% healed!
If you need me to reply to a post ASAP send me an email too
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Re: Planning to get LIS - But I have questions

Postby LuMiNeeRS30 » 03 May 2022, 21:07

Thank you for the information! That's all helpful.

I guess I should clarify that I am not scared of the surgery. After rereading my post I can see how some of the questions come off that way. Originally when they told me it would require surgery I was scared, and trying to understand how making a cut to heal a cut that won't heal was a bit of a struggle. But in doing research on it that's how I found this board and from what I read here and elsewhere it calmed my fears. The main reason I posted and asked these questions was to get feedback from those who have gone through this. I don't know anyone else who has had fissures, let alone had surgery on them so information is limited.

For the rest of your reply...

1- That was kind of what I had come to assume, that it can't be much worse than what I deal with now. I didn't get the impression from the diaries I've read on here that it was any worse than before the surgery but not everyone compares it that way.

2 - I do like those odds, but most of the diaries I have read on here don't go beyond a few months, or I haven't read that far into them yet. There may be some posts or other comments by people beyond that but they've been more difficult to find. I just was curious if this fixes and prevents, or if it's like you said, any recurrences are much less severe. I haven't seen where anyone has gotten the surgery twice so I assumed it wasn't as bad if there were recurrences.

3 - Yeah, I know everyone heals differently and all that. Like I said above, just trying to get an idea from people who have experienced this and if what I've read online is realistic.

4 - I'd definitely prefer to have a CRS do the surgery, but unfortunately I'm not in a location that has a lot of options. I'm 2+ hours from the nearest major city and as I said in my original post, I've been waiting 2 months for a second opinion with a CRS, and I still have almost 3 weeks until I get to that appointment. My concern is trying to deal with this for another 2 months or however long after that waiting for surgery. I've actually got appointments set up with 2 CRS and am on the cancellation list for both hoping I'd get in sooner but that's not been the case so far at least. So my question was more of - Is it worth potentially dealing with this for another couple months to wait for the CRS because it makes that big of a difference or is it something a general surgeon is capable of doing? I'm not going to have the general surgeon do it just to do it if I'm not comfortable with them or don't feel they have the experience with it no matter what the responses are on here though. Again, just looking for input from people who have had the surgery. Whether it's pretty much CRS across the board or if general surgeons are used too.

5 - Believe me, if I could get it done any sooner I would. I'm done living like this and look forward to being done with this.

For the stool softeners/fiber I guess my thinking has been that if the stool is softer, it won't irritate or reopen the fissure (assuming it's healing). But it sounds like the soft stool is creating more problems than it's preventing?

Again, thanks for the input!
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Re: Planning to get LIS - But I have questions

Postby Rich44 » 03 May 2022, 23:11

And thank you for your detailed replies and understanding I was replying based on what you wrote.

As to the softeners, they are intended for people with constipation, not necessarily for a fissure. Like I said, you truly want large, bulky stools and while they may sound scary in actuality they can help you heal faster because your sphincter won't tighten up (as with very loose BMs). Either way, you are coming to a new chapter - the LIS and post-fissure.

I am sure there may be some cases where the LIS didn't work but I haven't seen any on here (and I haven't exactly looked). I have heard of some people having issues after the surgery and possibly a chronic fissure returning after the surgery as well. Just because you have the surgery doesn't mean you won't get any fissures again. Also remember, once a fissure heals you could get a new fissure in a different spot. The only difference is you will know to treat it aggressively immediately (doing a few sitz baths is first line of defense - and for me all I have had to do if I had a little fissure over the last 18 months). Remember, you can easily deal with an acute fissure. It's letting it become chronic where you end up in trouble. You have to also ask yourself why did you get another fissure? And it's almost always food related because the BM tears your rectum (either hard stool or very loose).

If a general surgeon is your best bet solely based on location - go for it. Sounds like yours has done this many times. But it's your a** on the line (the puns are so easy) so even though you are 2+ hours away from a CRS, it's not like it's 12 hours away so you could consider one if you are on the fence. At the end of the day you will find plenty of people had a general surgeon do their LIS.

I'll be honest, I didn't ask most of the questions you are when I had the surgery. I didn't even know about this board. I knew I was not going to be incontinent based on how strong my sphincter was - and that was my main concern. I was not worried about the LIS itself. I wasn't worried about recovery. I wasn't worried about it failing. I wasn't worried about it coming back. I was very optimistic that it would fix the problem. And it did! You got this. Get it done and get on with your life.
Fissure June 2014 - Oct 2020
Botox, skin tag removed - Feb 2015
Levator Ani Sep 2014 - Feb 2016 (left job, cured!)
LIS, skin tags removed - Oct 2020
Fissure 100% healed!
If you need me to reply to a post ASAP send me an email too
Rich44
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