I have had a painful fissure for 6 months. 2 weeks ago i had the LIS/Sphincteromy w/ tag removal. I was hesitant to have the surgery as I was pain free for a month and the fissure was healing. My Dr. said it would be a good idea to go through with it. I healed fine the first week and I must have had a large BM as about five days ago I had extreme pain and the fissure looked like it doubled in size. I called my Dr. who was out and told the story to a PA...she was very unhelpful as she told me to do my "homework" on how to heal it which really pissed me off as my diet is impeccable as I eat tons of fruits and vegetables and take metamucil twice a day (which probably isn't necessary with my diet). I told her my concern was that the incision has already healed which won't allow the muscle to relax and my fissure to close. She said I was probably right...that incisions take a week or two to heal. I'm worried I'm back to square one, in even worse shape then before. I've noticed my anal muscle was weak the first 4-5 days but I have alot more control now. Am I screwed?

No, I don't think you're screwed. The LIS gives the fissure the best chance of healing, and stops the spasms but it does take a loooong time for it to actually heal. You can't count progress in days, or sometimes even weeks, it will be an up and down recovery. For some reason, it doesn't follow the same healing pattern as any other surgery.
Hang in there, you've done the right thing by having the surgery, I'm sure!

You mention it takes a long time to heal but the PA said the incision can completely heal in as short as a week. Is she wrong? I hope so. I have alot more control then a week ago which makes me think it has healed.

The internal muscle (sphincter) will remain loose and allow the fissure to heal even if the external cut on the outside closes in a few days...
It takes 6-8 weeks to heal a fissure under the best circumstances. Many people have set backs here and there with the fissure while recovering. Too much fiber with the supplements and food could cause larger bm's which could have re-injured your fissure. Many of us take a stool softener. Don't get discouraged. This doesn't mean you aren't going to heal! The sphincter is relaxed now from your LIS and will allow the fissure to heal.

Are you still having spasms?

Here's a link that may help you on -Open or Closed LIS.
http://anal-fissure.org/t2215-open-or-closed-lis#48586

I don't know why they give "best case" scenarios, it gives a distorted view on normal people's healing time, and makes us worry that we aren't healing in the required time.
You will heal when you heal, there will almost certainly be ups and downs. Hopefully you will be one of the lucky ones who heal totally and quickly.

I agree with Val and Dawn 100%. The healing of the surgical incision has nothing to do with the healing of the fissure itself. The incision will heal well before the fissure will. The LIS just stops the spasms and loosens the sphincter muscle. The reason chronic fissures don't heal is because the spasms and tight sphincter prevent proper blood flow in the anus. When the tightness and spasms are gone, the blood flows better in the butt and the fissure can heal. But it will still take 6 to 8 weeks, and sometimes longer, for the fissure itself to heal. So, you are not in bad shape at all!
Metamucil will bulk up the stool, so you may want to consider tapering off that and maybe using a gentle stool softener, like Miralax, instead. Many folks retear after an LIS - that's not uncommon. The good news is that because the sphincter is looser and not spasming, the retears generally heal up pretty fast. Don't forget to take nice warm baths - the warm water also helps the stimulate blood flow and they are very soothing too.
You are definitely not screwed! :D And don't worry that the incision is healed - that's normal.

Dawn wrote: The internal muscle (sphincter) will remain loose and allow the fissure to heal even if the external cut on the outside closes in a few days...
It takes 6-8 weeks to heal a fissure under the best circumstances. Many people have set backs here and there with the fissure while recovering. Too much fiber with the supplements and food could cause larger bm's which could have re-injured your fissure. Many of us take a stool softener. Don't get discouraged. This doesn't mean you aren't going to heal! The sphincter is relaxed now from your LIS and will allow the fissure to heal.

Thanks...It sounds like the PA is the one that needs to do her homework. I always questioned whether my problem was too much fiber. I have had a small fissure for years that was probably due to poor diet...I used to have 4-5 BM's a day that were mostly diahrea. I drastically changed my diet to fruits and vegetables and lost 60 pounds. I went to having 1-2 BM's that were much better formed. About 1-2 months into the diet I must have torn the fissure more then usual and had pain that I never had with the fissure that was there for 6-8 years. I always questioned that the excess fiber caused the major tear but my Dr. said that there is no such thing as having too much fiber...he said fiber will remain soft and never cause problems. Have I been getting misinformation? should I cut down on my fiber intake?

The worse tear of my life was when I had too much fiber. I was taking metamucil with my fissure and eating loads of fiber...
I eat 25 grams of fiber a day now and I don't take any fiber supplements, just miralax. We had another boardie who stopped the metamucil after her lis because the poops were too big. I'd suggest just getting the RDA for you and go with that. Some folks have said they spread out their fiber intake throughout the day and try not to get too much at one meal. That may be something to think about. But I personally believe you could get too much(when healing from butt surgery) and we all know it can cause bigger bm's. It may be that you can tolerate it later but right now, you're trying to heal and probably would fair better without huge bm's.
I'm sure you know this but be sure and drink plenty of water too.