Post- LIS muscle problems

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Post- LIS muscle problems

Postby Still hoping » 19 Mar 2015, 11:06

I had LIS nine weeks ago. The fissure and the surgery healed up within four weeks. I developed an unfortunate side effect of anal pain after the surgery. The pain seems to be coming from a very tight external anal sphincter (not levator ani as my CRS said the pain was from). I had a history of pelvic floor muscle tightness.

Last week my pelvic floor therapist finally tried to assess my muscles rectally. She could only assess the external analysis sphincter because I was in too much pain. She thinks that muscle was stretched during the surgery and then it got cranky and decided to spasm. She's having me do a gentle sphincter massage with my finger once a day. So far I have seen no improvement.

I've been on a muscle relaxant, flexeril, for five weeks and it helps a lot with the pain. By I can't handle the side effects anymore so I am tapering off it or maybe just got to stop it entirely. I could put up with the exhaustion, spaciness, and dry mouth but this week I started getting lightheaded and when I walk everything around me seems to go up and down.

I don't want to scare anyone away from the surgery. I encourage people to have it and get on with their lives. But maybe there's something doctors can do for their patients who have fissures and pelvic floor issues so that they can have the surgery and not have this problem. Maybe get on a muscle relaxant right after surgery to help try to prevent this.
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Re: Post- LIS muscle problems

Postby msimon » 19 Mar 2015, 12:17

That is wonderful that you have healed ! I have the same thing going on. My problem is definitely the external sphincter but nobody wants to botox it. I am hoping when my incision finally heals it will settle down but I am starting to wonder if it's WHY I haven't healed yet.

I'm glad you have a therapist to work with. I hope they can help you sort this out. Have you ever heard of Baclofen? It is another muscle relaxant for spasticity (often used for MS). You may want to try that? I had some success with it and didn't find the side effects as bad as with flexeril. I got really lightheaded and dizzy/unsteady on flexeril.
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: Post- LIS muscle problems

Postby Still hoping » 27 Mar 2015, 19:52

Thanks msimon. I ended up reducing the dose a bit and the lightheadedness is gone. Im still really tired and a bit spacey. I was supposed to talk to my pelvic floor physical therapist today about reducing it more but she was out sick. I appreciate the info on baclofen.

I never knew an external sphincter could get tight until this happened. My colorectal doctor doesn't want to botox the external anal sphincter because that would cause incontinence.

I have been doing a daily external sphincter massage with my finger for two minutes and that actually has been helping. It's not as tight as it was a few weeks ago. I still have pain, which is a bummer, but I am using a lidocaine ointment and that has helped as well. Still, I am frustrated with how slow the progress is. At least I am able to poop ok.

Msimon, remind me, have they given you any treatment for the external sphincter? Massage? Might be hard to do when you are still healing from the fissure and the infection and deroofing and another fissure.

Sorry I post so infrequently these days. It's all I can do some days just to go to work and do my exercises.
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Re: Post- LIS muscle problems

Postby msimon » 28 Mar 2015, 16:52

You're welcome Still Hoping :) Glad to see you on here. I have been wondering how you are doing. My external sphinter is awfully tight and painful too. I hope I can get to the point that I can massage it soon as my incision site is right over it now so I cannot. I asked my CRS about botoxing it too and he refused for the same reason. I had it once before but that was before LIS and was a tiny amount. Probably wouldn't be a long term solution but would provide a break from the pain and tightness. Would be nice, but alas...

Glad to hear you have had some improvement.

I have not had any treatment other than botox into the external sphincter and that was years ago, before the fissure (I have had butt problems for a long time before my fissure). I will be doing physio when healed, I hope.
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: Post- LIS muscle problems

Postby suzyljank » 29 Mar 2015, 08:50

Hi, have you tried dilation? I had to do this after surgery and it helped a lot. It took a long time before I was able to do this comforatably but when you feel spasming it helps break the spasm. Start with a small dialtor and gradually increase it. The largest one I have is 19mm. I'm coming up on my 2 year anniversary of double flap surgery and I still dilate 3 or 4 times a week. Before surgery I would get these intense charlie horse type pains up the butt and it would bring me to my knees. Hope this helps, Suzy.
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Re: Post- LIS muscle problems

Postby Deleted User 4175 » 30 Mar 2015, 15:43

I have been having what has always felt like rectal tearing on right side of rectal wall since surgery for LIS last September. I have been told it is muscle spasm in levator ani too but always pain is in rectum/anus. I have wondered whether this is because of LIS. I see a PFP this week for release massage, see what she thinks.
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Re: Post- LIS muscle problems

Postby suzyljank » 30 Mar 2015, 15:52

I'm so sorry you're having that pain. What I can tell you is that everyone heals at their own rate.
When I had flap surgery done two years ago in April I was told I needed to give it 2 years for everything to calm down. I wouldn't have believed it but I really needed the two years. There are so many nerves and muscles in that particular area that affect surrounding muscles. It really does take time. The first time around with LIS I didn't do dilation. Maybe it would have helped but I don't know. When I had the flaps done there was no negotiating this, I had to do it. I remember right after surgery sometimes I'd tighten up a bit, not a full blown spasm but it hurt. I'd dilate for just a minute and the spasm would stop. I think just that tiny bit of stretching interrupts the spasm.
I can give you a tip for the pain, sit on a warm heating pad. It did wonders for me. My pain was on the right side too and the charlie horse up the butt feeling was their too. Hope this helps Suzy.
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Re: Post- LIS muscle problems

Postby Deleted User 4175 » 30 Mar 2015, 16:39

yes thank you Suzy, it has. Thank you for taking the time to reply. Dilation is new to me. I will ask my PF physio this week but I will also try the heat pad. I do have a gel pack which is very useful for my coccyx pain. :)
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Re: Post- LIS muscle problems

Postby Savaici » 31 Mar 2015, 21:44

I am just so glad that I started with dilation when I did. It took time and perseverance but the pain relief in the end has been like night and day. I still have problems, but in comparison to those early days I can cope with these.
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Re: Post- LIS muscle problems

Postby Still hoping » 03 Apr 2015, 20:14

I'm glad that some of you have had success with dilation. I will have to ask my physical therapist about that. It's good that the heating pad is helping you Copycat. I hope the release with your therapist helps too.

The gentle anal massage I was doing was starting to have some positive effects. The external anal sphincter was becoming less tight. And then I had rectal bleeding five days ago! I had s but of diarrhea and there was the bleeding. No bleeding since then but the outside of the rectal area is sore. I got in to see my CRS right away. He said it isn't a fissure but it is a break in the skin. He gave me hydrocortisone ointment to use twice a day in addition to my lidocaine ointment. He said that the anal massage increases the risk of a skin break or fissure. I took a break from the massage for a couple of days but I started it again, very gently. It's now hard for me to tell what pain is from the skin break and what pain is from the muscles spasming.

My physical therapist hooked me up to the TENS machine today and that seemed to help. But tonight I am feeling some small stabbing pains in the anal area.

I really hate to use hydrocortisone. I know it helps with inflammation but I learned in school that it can thin the skin and delay wound healing. My doctors all tell me that's not true. But I got my third fissure while I was using hydrocortisone on my vulva (and it got everywhere!).

I hope the skin break heals quickly. Any ideas for how to help it along?
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