My LIS experience

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My LIS experience

Postby BillyBob » 17 Jan 2016, 03:21

Hi everyone,

I've been using these forums as a source of help and comfort over the past 2 months and wanted to relay my own experience to help others.

At the end of November 2015 I suffered a very sudden onset of piles (which I'd had on and off during my life). The pain usually settles down very quickly for me and it did this time, except that the haemorrhoid pain was quickly replaced with that of a fissure within a day or so. After reading around it seems that fissures are quite common occurrences when you have an onset of piles simply because the piles occupy too much space within the back passage, meaning that when you pass even a regular stool the anus takes the strain and can split.

I went to see my GP and they prescribed me Scheriproct ointment and suppositories and told me to go on a high fibre diet and to stay hydrated. Because the pain was so bad when going to the toilet, I adopted the 'high fibre' advice to an extreme level, and just wound up giving myself copious gas, bloating and cramps. in any case, the cream and supps did not work so I asked for a referral to a CRS. He examined me and said the fissure was small and acute and would heal within a week. I'll tell you, hearing that my injury was 'small' was not what I wanted to hear as the pain was ... well, you know!

I'll fast forward 6 weeks which included the Christmas period. Here are the highlights:

- I managed to nail the high fibre diet:

1. 2 x Weetabix for breakfast with 15 ml lactulose.
2. 2 x pieces fruit at 10:30 for snack
3. Baked potato with either fish or chicken and either beans or green vegetables and one slice of wholemeal bread with butter. 15 ml lactulose.
4. Large bowl of Bran Flakes with 7 ml lactulose.

My stools were text book J - "Mr Whippy" but not too loose.

- Around 5 pints of water per day. Basically, without going overboard I made sure my urine was largely running clear at all times (but don't go crazy so you lose your salts). I occasionally (every 3 days) added a Diarolyte sachet to one drink to replace lost salts.

- Exercise once per day. I walked for around 1 mile, typically after my main meal and this was a fantastic aid to maintaining regular BMs.

- I applied topical "cream of the week" (see below) after each BM. Typically this was GTN ointment. I was lucky to only suffer mild headaches.

- I took baths after each BM.

My BMs were like clockwork - 08:00 and 18:00 typically, which gave some comfort in that they were predictable so you could plan to be at home with all therequired paraphanalia around you that you need to support yourself.

*** None of the above fixed the fissure ***

Christmas was a torrid time, not least of which from watching everyone overload on nice food while I stuck to my baked potato and lactulose diet! Also, the doctors had tried me on something like 5 topical creams, prescribing me Anoheal (Diltiazem hydrochloride 2% Cream). I applied this 3 times, starting on Christmas Eve: 1st time gave me itching. 2nd and 3rd time (Xmas day: bad itching + a little burning). 4th time (Boxing day) intense burning like napalm in the back passage that lasted 3.5 hours! It was horrible and I wondered if I was going to have to call an ambulance. I realised I was either allergic to it or had developed contact dermatitis through all of the different medicines prescribed to me.

I went back to my CRS in desperation. He examined me and said he could hardly see a fissure (!!). I told him it was there, that I'd been robbed of my life and I wanted the lateral internal sphincterotomy no matter what. He offered Botox. I said "LIS!". He booked me in for the following week.

I had the LIS under general anaesthetic. Guys I am here to tell you, it was the best decision of my life.

The op itself is a 5-10 minute procedure but I didn't want to be conscious for it. However the GA itself does complicate things in that it all but paralyses the digestive tract for 48-72 hours after the op. Also, because you have to starve for nearly 24 hours beforehand, it means your first BM after the op is going to be at least 2 days out. For fissure sufferers that obsess over good BM maintenance and regularity this is in my opinion the most difficult aspect of having an LIS. I had considerable apprehension around having my first BM post-op. Would it be painful? Would I bleed? Would I get an infection? Well, after a fraught 48 hours and 4 attempted and aborted trips to the toilet, I'm here to tell you - when I finally went it was *** PAIN FREE!! *** I cannot remember feeling more relieved (in all regards) in my life!!

I did have one complication post-op: I immediately developed piles again. I searched around and found others that reported the same after an LIS. For me, there was a lot of absolutely unavoidable straining for that first BM because my colon was dead from the GA and using a step etc didn't do it on its own. It absolutely would not come without some pushing, and the unfortunate cost was piles. However, these are easy to treat so I thought "I'll take it". Getting tht first BM done was the first day of the rest of my life as the conveyor belt then kicked in.

I am +1 week after the LIS. BMs are easy (there is more slack to play with). I actually think I was too tight back there previously which may be why I had suffered with fissures during my life (but just a theory). I have slight incontinence to wind (again, I'll take it) and that may improve. Piles are settling. Baths after each BM are highly recommended (but please, keep the water WARM not HOT - I read people on here having hot baths for piles, don't do it as it encourages blood flow to the inflamed area!).

One thing that was never mentioned to me by my CRS: for the first 4 days post-surgery I got occasional cramp/spasms in my back passage. They were really quite painful – sudden grips that happened usually as a precursor to passing wind. They would wake me up say 3 or 4 times in the night. I haven’t had the them after day 4.
I just wanted to share this because I went through 2 months of hell and if this helps a single person I will be delighted. My fissure was apparently small, but felt like the Grand Canyon during a BM. That said I read accounts on this site of people with fissures ten times worse than my own and they have my utmost sympathy. I was used to doing sport 5 days per week and that stopped dead suring this episode and depressed me considerably. I read on here of some people suffering for 6 months to many years without having had an LIS. Hopefully this will offer some encouragement. After micro-managing the conservative treatments for 6 weeks my fissure was as fresh as the it was on day 1. After an LIS I felt zero pain from it on day 2.

Stay strong people and best wishes for a speedy recovery!
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Re: My LIS experience

Postby Manitourose » 17 Jan 2016, 08:27

Glad to hear your results with LIS overall went smoothly and you are on the road back to a healthy bum! Thanks for sharing.
Great reminder about the baths too, WARM not hot. HOT is not encouraged as it can be damaging to the sensitive skin. However, for fissures a warm bath is good as it is helpful to promote blood flow to the area to encourage healing.

You may find your incontinence of wind reducing over time. Some experience it for the first year after and as everything fully heals up down to the tiny cells inside our muscles it can reduce as the muscles get back to how they should be.

Thanks again for sharing your story. Welcome!!
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LIS Surgery ( great results, takes time)

Postby oliver123 » 17 Jan 2016, 15:47

Hi all,

I am a young fit 25 year old male, got a severe fissure 7 months ago. Tried everything possible out there. I had good days (0 pain for 1 week) and bad days ( severe pain for many weeks ).

To cut it short, I did the LIS surgery 7 days ago, spinal anesthesia outpatient.

If you need to know one thing and one thing only is that: go the best of the best surgeons out there. I had two options 0 cost insurance covered hospital or 5,000 dollars operation not covered by insurance. Well you guessed it, I payed 5k and didn't flinch.

The pain decreases as time passes by, I am on day 7 and have zero pain. Guess what, I can control my gas and stool as well.

I would love to help anyone out there because I am well aware how this tiny tear could ruin a person's quality of life.

Try all measures and if nothing works in 3 months time, go do the operation. At least you'll be able to enjoy the simple things in life. Stop feeling sorry for yourself and making your life and your loved ones miserable.
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Re: My LIS experience

Postby Luka » 18 Jan 2016, 11:04

Thank you for sharing your LIS story, BillyBob. I'm so happy it worked out for you and that now you're healing and pain-free. : ) That's wonderful!

I will most likely be getting LIS myself eventually, since this stubborn fissure refuses to heal up decently. My problem is finding the right CRS to do it and finding the money to do it (I currently only have Medi-Cal insurance and there are no CRS's in the system in my area, only general surgeons). The first CRS I saw said they will do exam under anesthesia and then decide on the best method (LIS) to heal it, but it will cost thousands without insurance (their words... they probably have no clue how much it costs). The second said they'd do the LIS and cauterization in their office without any kind of anesthesia (just a Valium), which I refuse to do since I do not want to be awake for something like that. The third CRS said I had mental issues and refused to deal with me, just giving me diet suggestions and telling me to "live with the pain" until I get my stress issues resolved and see a therapist. : ( So it appears I will be sticking with the first CRS and getting LIS with him eventually.

BillyBob - Did you need to get an enema before your surgery? I heard that's the worst part of it from a lot of people, but some people get it and some people don't. Did you take any strong pain meds afterward or did you not need them? Also, did you get the fissure cauterized or cut out in any way (fissurectomy)?

oliver123 - Were you quoted exactly 5k for your surgery without insurance? I ask because I will be doing the same (paying without insurance because my insurance does not have any CRS's in the system; just general surgeons). Was it done at a surgery center (not hospital)?

Thank you both for sharing your success stories with LIS. It really helps out others to decide what's best for them and gives us hope. : )
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: My LIS experience

Postby oliver123 » 18 Jan 2016, 11:26

Hi Luka,

Yes I have paid 5000 dollars with zero coverage from insurance since it's was a clinic.

My advice, do either general or spinal since it relaxes your body which enables the surgeon to properly do his job.

I urge you to do it with a surgeon who has vast expierence in it, that determines the success of the operation and being able to control gas and stool.

Best of luck.
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Re: My LIS experience

Postby BillyBob » 18 Jan 2016, 11:32

Hi Luka,

I am staggered at the advice you have received so far. I spoke to my CRS and asked whether LIS is performed under GA or local anaesthetic and he said 'usually general, and I would advise that'. I was really anxious about the possibility of a local for such a procedure so I bit his hand off. I live in the UK and am lucky to have private health insurance (they cover everything). However, I looked up the procedure codes on the health provider's Website: I had a sigmoidoscopy which was listed as £99 cost and an LIS which was also £99. The GA would have been expensive - I estimate something like £500 and I haven't received a copy of the final bill yet but it will not be anything approaching the US costs you mention. I feel for you!

I did not have the fissurectomy. My CRS asked me before the op "what do you want me to do if I don't find a fissure, which does happen from time to time". Well, knowing I had one I said 'do the LIS anyway".

I did not have an enema before the surgery and they never even mentioned one. It's something I wondered about in advance to as you have. I can imagine that being painful and potentially causing more damage if you already had a fissure. I was in a good BM routine so managed to have a BM the morning of the op so I was good to go :).

Immediately after the op they offered me painkillers and I said no thanks. Then 30 mins later I felt pain and had some morphine orally and 500 mg paracetamol. That's all I needed on the actual day of the op. I went home in the evening and they prescribed me Ibuprofen, paracetamol and Tramadol to take home. I didn't need any of them, not even Ibuprofen. And I had been on 2 x Ibuprofen and 2 paracetamol every day for 2 months before the op! I just had a nice warm bath, some dinner and wet to bed and slept! Next day: no pain. No pain with BM. Just magical. I felt it was my overdue Xmas present.

I have read a lot of accounts from people in the US saying the choice of CRS is key and not to just go with a general surgeon that can turn their hand to this procedure. I'm really amazed it's so hard to find a good CRS out there. I would say keep hunting - know what you want and insist on the LIS with GA from someone who does this op routinely. I wish you the best of luck.
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Re: My LIS experience

Postby Luka » 18 Jan 2016, 11:36

Thanks for the quick reply, oliver123. Yes, I agree about doing the surgery under GA or spinal anesthesia. I would never do it with just local. First of all, I'm a very anxious person, so I could never stay still. Honestly, though, I don't think any normal person could stay very still during that if they were awake. I would want to be completely relaxed and put out.

The CRS I originally saw is younger, but has 16 years of experience at a local practice that specializes in colon and rectal problems and is very well respected in the area. The other CRS I saw recently has 38+ years of experience at the same practice, but unfortunately he barely gave me the time of day and didn't want to deal with my anxiety disorder issues. His bedside manner was terrible compared to the previous CRS and bedside manner matters to me just as much as experience.

Thank you for the advice and I wish you all the best!
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: My LIS experience

Postby Luka » 18 Jan 2016, 11:48

Billybob - Thanks so much for the quick reply. I really appreciate it. : ) Yes, the CRS I saw in San Francisco a few weeks ago said she only does LIS and cauterization in the office under local anesthesia. The most she offered me was a Valium to "relax" me. Wow. Needless to say, I didn't go back. She offered an affordable price for it ($1500), but I just could not go through with it without general anesthesia. She seemed taken aback when I asked to have some kind of deep sedation for it. I thought the whole experience was very strange and I wouldn't trust my butt with her.

Yes, our healthcare system in the US is horrible. The insurance I have is the bottom of the barrel in insurance because it's all I can get with my income. Even if I wanted better insurance, I couldn't get it because people below a certain income level automatically get put in the worst insurance program. There are only general surgeons (and not very good ones, I might add) in the Medi-Cal program in my area, so I'm stuck paying out-of-pocket to get someone who is specialized and with years of experience. Everyone has a right to good healthcare, but it doesn't work that way in the US and so many people end up getting screwed with huge bills and horrible doctors.

That's good to hear about not needing an enema for the surgery. I know some people do and some people don't. I know if it were me, I would use the bathroom anyway before surgery becasue I'd be so freaked out about it and am very regular, anyway.

It sounds like you had a very successful experience getting the LIS and didn't get much pain at all. That's awesome! : ) I'm so happy to hear you're better and I wish you the best of luck in the future. Thanks so much for posting your story here.
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: My LIS experience

Postby skoonix » 08 Mar 2016, 20:36

It helps to read some success stories with the LIS surgery. I guess I'm a big chicken. Obviously Ive had a colonoscopy and that was fine & it was great to get a clean bill of health but I was surprised how nervous I got before THAT, but my fissure (which started this past summer) has "healed" three times now - in which I would follow a routine, it would be working, weekly steady soft BMs, no pain, would even forget I had one, but THREE times now it has come back - like today, nice soft BMs but today - out of the blue - a hard tipped one and it hurt. A bit of blood on the wipes. But then it seemed ok pain-wise. Until two hours later & now the throbbing is constant and painful. My doctor has suggested three procedures for when I would come in for the surgery: Fissurectomy, remove the skin tag and a partial LIS. (I don't know why a partial, but these are the three things he wrote down for me). I guess I should bite the bullet (I have insurance) but I'm just terrified of complications or of being that tiny tiny percentage that end up permanently incontinent!
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