Need Advice

LIS Scheduled But Having Second Thoughts

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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Need Advice

Postby buttproblemz » 27 Jun 2015, 02:30

Hi all. I’m in need of some advice, probably more so from people who have had LIS & fissurectomy. Here’s my story... I’m a 33 year old male and I’ve been suffering now for 6 months with an anal fissure. It started out as just a mild pain after each BM a few days in a row. I assumed it was hemorrhoids because I have dealt with mild cases over the course of my life (once every couple of years) and they have always gone away within a couple days/weeks. So I thought nothing different of this. However, over the course of about a week or 2 it was growing increasingly more intense after every bowel movement. Still I didn’t really know what the deal was at this point, but by the 3rd week I was in so much pain and freaking out mentally that I made an appointment to see a GP. He did a digital exam (which actually made me scream out loud) and explained to me that it was an anal fissure. He prescribed 2% lidocaine and nitro and scheduled a follow-up in 2 weeks. 2 weeks later I wasn’t any better so he referred me to a CRS. 1 week later I met with the CRS. By this point, I was in so much pain that I was unable to remain seated at work (9-5 job where I work on a computer all day from a desk chair.) For a solid 2 weeks, I was experiencing spasm of the sphincter 24/7. The best way I can describe that feeling is if my anus were a black hole sucking in knives. The CRS instructed me to get way more aggressive with application of the prescription creams from the GP and to begin a very strict high fiber diet with stool softener. He also brought up the possibility of Botox or LIS if these didn’t work. At the time, I thought no way to either procedure and I was determined to heal naturally. From that point forward I slowly got better in phases and had monthly follow-up appointments. By the 1st follow up, the spasm was limited to only 6-8 hours post BM. His indicated by his exam that he can still see muscle fibers and that there was some granulated skin growing over it. By the second follow up, I felt as if I was only experiencing the spasm for 3-4 hours post BM and it was much more mild. He noted that the fissure was mostly covered by granulated skin and that it was about 10mm by 3mm in size. By the 3rd follow up, I felt as though I was no longer experiencing spasms at all and what I was feeling was no longer pain – just occasional discomfort and general soreness throughout the day, especially post BM. This follow-up, I came away feeling very encouraged. My CRS said the size of the fissure was now a dot, 3mm x 3mm. He also noted that at this point he wouldn’t recommend surgery and that he would like to schedule a 6 month follow up. He said that if it gets worse again, I can always call to see him sooner. So at this point, I had been dealing with this thing for 5 months and felt as though it would very soon be gone. What’s been happening over the last month is that the progress seems to have really reached a plateau. While I’ve ceased my use of all my creams, I’m still taking miralax 2x/day and getting plenty of fiber and water. I will enjoy a few days at a time of being very close to pain free and all of a sudden I will have a few days where the discomfort and soreness elevate again slightly. Then again I will experience a few days with diminished symptoms and this cycle has been going on ever since my last follow up a few weeks ago. It’s very discouraging to feel one minute like you have this thing finally beat to all of a sudden realizing that it’s not. It’s definitely draining me mentally. Last week, while sitting through a 3 hour meeting at work in an elevated degree of discomfort, I finally said to myself “enough already – I want this thing gone.” I made an appointment with my CRS to have the surgery. I have a date set now (2 weeks from today) but he wants to give me one more exam 3 days from now just to make sure. One thing I don’t want to be is in denial, but I can’t help but feel that since I made that call that things are actually still improving. This week especially, I had to go on a business trip where I was terrified of the prospect on spending 3 hours on a flight both ways. The trip ended up being perfectly fine and I experienced minimal discomfort throughout the whole time, including time spent on the plane. So here is my dilemma and where I am in definite need of advice, especially from those who may have opted for the LIS and fissurectomy eventhough they felt they were close to healed: am I being brash in my decision here? I am far removed from the agony I experienced in the beginning and the problem has been reduced to merely an annoyance. I really feel like I’m a million miles from where I was in the early days of this thing, but I still can’t believe that it’s not gone yet! Is this something that will never completely go away or have I not given it enough time? I know that people say it can take a year or 2 for it to completely heal naturally but then I also read stories on this board of people suffering with these things for 5-10 years before they finally opt for surgery. I definitely don’t want to be the latter and one thing I know for sure is that as long as I know it’s still there, it has just as much capacity to get worse again as it does to improve. I guess ultimately it will come down to what my CRS advises me after I meet with him in a couple days, but I’m really interested to hear the experience of others who have been in a similar situation. Thank you all!
Last edited by buttproblemz on 28 Jun 2015, 16:13, edited 1 time in total.
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Re: Need Advice

Postby Mommaof1 » 27 Jun 2015, 13:40

Hi! Im a 33 yr old female (hence the name). I suffered for a YEAR AND A HALF before my LIS. When I originally saw a CRS and booked my surgery....I cancelled it because things were healing. This happened after I discovered Clearlax. So..I cancelled it. Stupid. It came back again. So I went back to my Dr and booked it again. It was the BEST decision of my life. LOL. Dramatic, I know. I still have flare ups once in a while after hard stools but NOTHING like I used too. I used to cry when I had BM's, and like a lot of people, was always scared to have them. I feel like my life has changed. My days don't revolve around whether or not I will poop and be in pain all day. I wish I could go back in time and have the LIS earlier. It annoys me that Dr's don't take fissures as seriously we do. Originally I was referred to a surgeon and waited 6 months before giving up and begging to be referred to someone else. It also slightly annoys me to read that your CRS wants to keep "checking to be sure". These things are horrific. I say go for it. Good luck :)
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Re: Need Advice

Postby buttproblemz » 27 Jun 2015, 14:18

I can't really fault my CRS for the follow up visits. He's presented the surgery as being an option since day one and it's more or less been my choice to attempt to heal naturally up until this point through his guidance. If anything, I'm appreciative of having the check ups because my fissure is internal and there's no possible way for me to determine whether or not it's healed on my own, regardless of whether or not I feel symptom free. In his own words during our first visit, "I've had patients who have battled these things for years until they finally throw in the towel and say they've had enough."

I'm glad to hear that you're happy with your LIS outcome. The only thing that makes me feel uneasy about what you said is that you still have flare ups. Can you elaborate alittle? How long has it been since your LIS? Are these flare ups retears which require a couple days to heal up again?
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Re: Need Advice

Postby hurtinend » 27 Jun 2015, 18:02

I've been battling on and semi off for many years

I'm on the verge of surgery as I have exhausted every possible cure. Trust me I've tried everything including the manufacture of my own suppositories, Ayurveda, Chinese Medicine, Naturopath, and the standard ointments from CRS

All I can say is follow suggestions on this board and don't rush into surgery. Many can heal without surgery.
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Re: Need Advice

Postby buttproblemz » 27 Jun 2015, 18:34

thank you hurtinend. I appreciate the advice and I will have to put a check in the hold-off on surgery column of the survey... I'm OK with the notion of this going away and possibly returning in the future. At least in that event I will be able to remedy the problem earlier and the correct way. I'm not OK with the "semi" part however. I want this gone to the point where I don't have to focus any attention on preserving or maintaining. As long as I still semi have this thing, I'll have to always be on stool softener and constantly worry about whether or not the food I am eating can cause my problem to worsen. IMO that is no way to live life.
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Re: Need Advice

Postby shams1000 » 30 Jun 2015, 22:53

I am in the same boat as buttproblemz. I first had my fissure in Nov. 2014 after a hard BM and I felt like I was healed only to bleed, get the burning sensation, pain, etc. I am throwing in the towel. I will have surgery in a few weeks. I have read though that LIS is delicate and the amount of cut in the sphincter can make a difference to the success of the surgery. I have also read that if you have a sentinel pile (I have a large one) the chance of healing is diminished.

For those with successful LIS, (Mommaof1?) any special recommendations ?

--------------------
Fissure Nov. 2014
Tried Dilt - not helpful at all
Nitro - very helpful but only helps with symptoms. No cure for me!
Right now: high fiber diet, stool softener, Nitro but still experience burning, some pain, and bleeding with BM.
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Re: Need Advice

Postby msimon » 01 Jul 2015, 13:43

Best piece of advise I can give with this surgery is to make sure you have a very experienced CRS who has done a lot of LIS surgeries that have been successful (high healing rate AND low incontinence rate). That, and keep our BMs soft afterwards for a long time to facilitate healing.
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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