Scheduled for LIS on 10/10/19

Ongoing Sphincter Spasm

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Scheduled for LIS on 10/10/19

Postby tight80 » 02 Oct 2019, 23:18

Had a follow up with my CRS yesterday and scheduled my LIS surgery.
History:
*Constipation as a kid
*First of many hemorrhoids at age 15
*First fissure at 32 (successfully treated with one month of nifedipine)
*Had a round of internal hemorrhoids banded also at 32
*Bowels shifted to chronic diarrhea in my mid 30s.
*IBS symptoms became difficult to manage about a year ago - I'm 39 now. Started having urgency, upset stomach after most meals, nothing but 6s and 7s on the Bristol Chart - I mentioned this to my GP and he did a C Reactive Protein test to check for Crohn's indicator and it came back negative - so he thinks I most likely have IBS-D Prominent.

So 3 months ago I felt a stretch during a BM with a burning sensation that lasted for hours after. Felt like fissure so I made an appointment with my CRS. He tried to do a rectal exam but couldn't due to sphincter spasm. He suspected fissure and sent me home with nifedipine. Used it for a month. Had ups and downs but felt pretty good at the 1 month follow up. CRS tried to do the rectal exam again and couldn't due to pain and spasm. He still suspects fissure and starts to talk about surgery options. He says I have an incredibly tight sphincter muscle which may be adding to my BM problems. He also mentions I may have Pelvic Floor Dys and that there is a possibility of anal stenosis occurring if my sphincter stays in the current state that it is in. It was a lot of information to take in, but I decided to stick with nifedipine for another 1.5 months to see if I can fix the problem because surgery sounds excruciating.

So for the next 45 days I live in my bathtub and start working with a nutritionist on the LOW FODMAP diet to try and get my IBS under control. I do everything in my power to get better. Nifedipine 4x per day...I give up alcohol, sugar, gluten and dairy... my whole life shifts to try to get a handle on this. I go in for another follow up (now after 12 weeks of conservative treatment) and he still can't do the rectal exam because of spasm and pain. I'm fed up. He says he was impressed that I gave it such great effort (more than most of his patients do) and he thinks that LIS would really help me, so I sign up for surgery next week... and of course now my mind is racing and I'm having second thoughts.

I mean my symptoms aren't that bad now... and I'm operating around 70% most of the time. I do feel a sore spot on the right side but the pain there only comes sometimes after BMs and sometimes at night if I've eaten something that bloats me. My hemms swell all over back there at times, but it comes and goes. And there's some burning but I'm used to that living with IBS-D. Some days I'm freaking out that I may have an abscess because the swelling bothers me so much... but then it all calms down and I calm down. I was having pain with driving about a month ago and lost a few nights of sleep, but that has subsided. And since the doc hasn't been able to SEE the fissure due to spasm... could this be something else like Levator Syndrome or Proctal Fugax? Have any of you had similar problems with tight sphincter pain / spasm and the digital exam not being possible? Has the spasm always turned out to be because of fissure? Is LIS also used for sphincter tone issues without fissure? My CRS has performed thousands of successful LIS surgeries which has me feeling great, but when I asked if he will perform the surgery without seeing the fissure, he said yes because fissure heals over and recurs. Would you move ahead with surgery if you were me? Thanks in advance for taking the time to read this.
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Re: Scheduled for LIS on 10/10/19

Postby patience_and_healing » 02 Oct 2019, 23:29

Welcome to the forum and sorry to hear you are dealing with this awful problem. I think the surgery question is a very hard one to answer. I personally turned it down. At some point a person can get used to living with regular pain but it's not the best way to live if there's a procedure that can fix the problem. If your doctor suspected pelvic floor dysfunction then maybe you can go see a pelvic floor PT and get a diagnosis before going in for surgery. Also if you're getting this done under general anesthesia your doctor will most likely do an anal exam to check that there's nothing else contributing to the pain.
8/16-12/16: Fissure due to antibiotics
5/17: Botox to sphincter
Currently in pelvic physical therapy
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Re: Scheduled for LIS on 10/10/19

Postby Tatie » 04 Oct 2019, 12:46

Tight80,

I as well was diagnosed with a very tight anal sphincter that was causing stenosis. I had an anal fissure for 2 years and after exhausting all conservative methods I opted for a LIS with tag removal July 25th,2019. It's a personal decision that only you can make but I decided to go forward with surgery because I wanted my life back. Recovery was smooth and I would do it again in a heartbeat.

I am also followed by a physiotherapist that specializes in the pelvic floor. I found her before my surgery and then continued to be followed by her after the surgery. I have found it to be very helpful but ultimately the surgery released the muscle spasm curing the anal stenosis and allowing the fissure to heal.My life has been 100% better since the surgery. I was on the fence, like you, for months before finally accepting the surgery.

The first week after the surgery I took many sitz baths and only tylenol for pain relief. I do not have incontinence to stool or gas. Everyone's recovery is different but although unpleasant for me it was definitely worth it !

Hope this helps and keep us posted !
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Re: Scheduled for LIS on 10/10/19

Postby tight80 » 04 Oct 2019, 13:21

Thank you for your reply, Tatie!

Very glad to hear that LIS was the right choice for you. You give me hope! Were you experiencing spasm during a rectal exam when you were dealing with your fissure? I've been wondering if spasm can occur in Pelvic Floor Dysfunction without fissure? But when I asked my surgeon he told me that fighting a fissure is probably what caused my Pelvic Floor Dysfunction. I'm going to start PFT when I am feeling better - I'm so glad it is working for you!

Did you have any change in your bowel habits after the surgery? Right now I only get a few minutes of warning to get to the restroom and I suffer from loose, thin stools. I haven't seen many posts from IBS chronic diarrhea sufferers who underwent the LIS surgery so I'm wondering if the surgery could make the urgency worse or if that's all mostly controlled by external sphincter?

What type of symptoms did you have with Stenosis when you had it?

Thanks in advance, Chris
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Re: Scheduled for LIS on 10/10/19

Postby tight80 » 04 Oct 2019, 13:33

Thank you for your reply, Patience and Healing. CRS said he will do a visual exam first since pain and spasm has kept that from being possible in my follow ups. I agree that we can learn to live with pain. This has been my argument for not having the surgery because after nifedipine I'm only having bad days here and there and I'm operating at 80% most of the time. It's so hard to pull the trigger on surgery when you're feeling good. But the little sharp spot that I feel on my right side keeps reminding me that I'm still not healed. What a vicious circle.
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Re: Scheduled for LIS on 10/10/19

Postby Tatie » 04 Oct 2019, 16:16

Tight80,

My CRS did not do a rectal exam until I was under general anesthesia. He said he would do an anoscope and a proper exam once I was asleep in the OR because it can further tear a fissure and cause a lot of pain ( I have the nicest surgeon ! ). He could visualize the small fissure. When I woke up after surgery he told me that my muscle was VERY tight even under general anesthesia and it was then that he gave me the diagnosis of stenosis.

Did the fissure cause the stenosis or the tight pelvic floor cause my fissure ? We do not know, but I should mention my pelvic floor issues began after a traumatic birth injury leading to a third degree tear in the 12 o'clock area of the anus and that is where I tore 15 years later. He did mention that 2% of people that require LIS will require a second LIS on the opposite side because over time ( he said a few years ) the muscle MAY tighten again. He has been doing this procedure for 17 yrs and he has had to do a second LIS about 10 times.

The main change in bowels habits is that it is effortless now ! No stress or straining on the toilet ...just sit and relax a few seconds and my body evacuates the way nature intended. Pre-lis since I had stenosis I would have to mildly strain and my bowel movements had to be soft or the stretch would tear open the healing fissure over and over causing pain and some minor spasming ( which both were relieved from nifedipine however I was unable to wean off of it). I do not suffer from diarrhea nor constipation regularly. I do not require laxatives, however I do eat really healthy and mainly plant based.

The initial month my anus was weakish ( normal !) so I could easily evacuate air like I had never before...but that resolved with time and healing. I feel much more relaxed down there but not in a bad way. The sense of urgency has not changed since surgery...it feels the same for me. I am mentioning this since you have IBS-D you may be more at risk for leakage INITIALLY because your stool is always liquid? I purchased adult diapers to wear for the first few days incase I would have soiling issues, and in the end I did not need them.

Are you able to take a few weeks off of work for the surgery?
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Re: Scheduled for LIS on 10/10/19

Postby tight80 » 10 Oct 2019, 14:37

Thank you for the reply, Tatie. Glad to hear that you haven't had any long-term issues from the surgery. I'm on my way to the surgery center in about an hour and am keeping fingers and toes crossed for the best. I'm planning on taking one to two weeks off, depending on how I'm feeling. How long after the surgery was it until you were feeling 80-90%? Best, Chris
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Re: Scheduled for LIS on 10/10/19

Postby Tatie » 10 Oct 2019, 20:00

Tight80,

Good luck and keep us posted ! I felt 80% ish by two weeks - 90% ish by three weeks and 100% by 8 weeks. The first few days take MANY sitz baths and take it easy! It goes by quickly.
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Re: Scheduled for LIS on 10/10/19

Postby tight80 » 10 Oct 2019, 20:55

Thanks Tatie. I’m supposed to go to Hawaii on the 31st. I hope I feel good enough for travel and time in the ocean by then. Doc did three things. LIS, fissurectomy and he cauterized 3 internal hemms. I hope this doesn’t lengthen my recovery time. I was in level 2 pain when I woke up from the anesthesia. It jumped up to a 4/5 pretty quickly so I took a norco right away. Fingers crossed that the first few days are the worst.
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Re: Scheduled for LIS on 10/10/19

Postby Tatie » 11 Oct 2019, 18:11

Tight80,

I have read that a fissurectomy can be painful...I hope you are doing well so far ! Give us an update when you are up to it.
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