Hi everyone,
I went to see my new CRS on Monday because I had been seeing my first one for a year and he kept telling me sitz baths, fiber and water and it will heal. It wasn't healing. So I expected to see this new CRS (a woman) Monday and then go to see him Tuesday and see which one understood more. But after seeing this new one I guess I have decided to trust in her and have LIS. It has not been scheduled yet, doing that this week when her scheduler calls.
The new CRS talked to me and asked what issue was, then asked me if I was doing all the fiber, sitz baths, water, etc. Also asked me if I tried any creams and I told her Diltiazem worked at first but then became ineffective.
Then she took a look and it wasn't a long look, lasted like 30 seconds (no analscope needed). Then she asked "Did Dr Brown (my other CRS) ever talk to you about surgery?" That's when I told her no he never did. The last time I saw him about six weeks ago he said my fissures were "superficial" and can be healed with water, fiber and sitz baths. This despite the fact that I have been battling these things for well over a year.
I got dressed and she came back in and told me and my wife (she was with me) that she felt I was a good candidate for surgery.
She said the fissure was surely chronic by now and probably has been for six months or more (Based on what I have read probably longer than that). She said she only does surgery on good candidates meaning those who have tried many other things to heal but it hasn't worked. She said my initial good response to Diltiazem was a good sign because the Diltiazem tries to do what surgery actually does, relax the inner sphincter muscle so the wound can heal.
She said every time someone with a chronic fissure has a BM, the wound either opens again or is traumatized forcing the inner sphincter muscle to tighten and clench and not allowing blood flow to the area to heal. Those are spasms and can come in two forms -- throbbing, long spasms or a constant pain like you've been sliced with a knife (I have the second kind but have had the first kind before). I told her BMs don't hurt, but wiping or anything else done to the area does. She said the smaller fissures I have are likely caused by the skin being weakened by constant moisture down there.
She said LIS was what I needed. I asked her many questions including does she need to cauterize the big fissure and she said "no, that will just be more pain, let the body heal itself after the pressure is taken off".
She said she has read about incontinence with LIS before but she has never had a patient experience it in 14 years of doing a "gabillion of these" and she has never known another doctor either in her practice or any other makings someone permanently incontinent. She said this is a very common surgery and one she has done to so many people.
I asked her about infection and she said the national average is about 12% of the time but she thinks it's a little higher than that. She says there have been times where she has gone six months where no LIS patients got an infection and other times where she had a couple in the same month. She said it happens, it's an incision that is constantly being passed over and filled with feces so it's hit or miss if it happens. They give you antibiotics to take, they ask you to obviously keep things soft, take sitz baths and such after surgery while recovering, but it's always a chance. If it does become infected and discharges pus and becomes bothersome, she said another procedure is needed to "pop it open" and that is another surgery under anesthesia. This kind of upset me a bit, I really, really don't want to have a second surgery for an infection.
She said only one person she's ever done this surgery on has ever had to have LIS done again. She says it takes 1-2 weeks to recover, to take it light for the first 7-10 days.
I forgot to ask many questions like how long before the fissure heals, will there be scar tissue or a skin tag from the ones that heal after the surgery that needs to be dealt with, etc and am writing them down now. I might go see her for a consultation prior to the actual surgery just to ask my additional questions.
Surgery freaks me out and scares me quite a bit. I haven't had surgery on anything since I was 11 years old and had tubes put in my nose. I am 41 now and it has been a nice 30 year run. The thought of going into the outpatient surgical area, getting an IV, meeting with the anesthesiologist, the surgeon, being wheeled off and put to sleep and then waking up and dealing with recovery all has me super anxious. And I would be so upset if I got an infection and had to have surgery all over again, jheesh I think that's my biggest fear.
So there you have it.
Can anyone think of any questions I didn't ask and should still ask or any concerns you would have? I'm sure I missed a bunch of things to ask. I cancelled my appointment with my old CRS today so I'm moving forward with this new one.
Putting this on the surgery board as well. Help?

I had the surgery 5 days ago and can tell you as of now I am very glad i did! I had a fissure about 4 years ago that healed on its own and this one that was going on a month. The CRS said because i had it before and this one seems to be stubborn (nothing helped). I tried creams for a couple of weeks then I scheduled the surgery. The first couple of days is rough no kidding there. I still have pain with the bm and have to get psyched up to go its only been 5 days. However pain post bm now seems to be gone.. I can feel myself healing, everyday it is getting better. Trying to keep stools soft is a must but hit and miss (no two are the same). I didn't even get antibiotics he felt there was no need but i cant worry about infection and i will take those percentages. If you went to vegas and they said you have an 88% chance of winning you take it. Ask about your pain meds and what she perscribes for pain. I took vicodin for a day and that was it. Advil after that. If you have any more questions no problem i will try to help you. I am actually going to a concert tonight and i feel great. Good luck

Personally I wouldn't be too concerned about the procedure, I know that's easy for me to say but trust me it's a breeze, it's actually a short op and it'll be over before you know it, you wouldn't be normal if you didn't have a bit of nerves but I'm sure you'll be fine, try not to obsess about it too much, lots of us have been through it and come through the other side just fine, just think of the outcome and no more agonizing pain during/after BM, sure it'll hurt a bit post-op but that's to be expected, but please don't worry, we'll be here waiting with any advice you need.

Thanks to both of your for your responses, hearing from people who have already been through, especially men, is important. I think women are much tougher when it comes to surgery, I really do. My wife has had three biopsies, finger surgery and then had an endoscopy, colonoscopy and then had her gall bladder removed and she was a rock. Me, I'm a mess.

If you read my stories on here, I was very nervous as I have never had surgery. I am almost 2 weeks out, back to work. Tapering off the Miralax. I too only took ibuprofen, never needed the stronger stuff. Wish inhad just did this in 2005. Drove 5 days after surgery. Talking with others on here, I think most people have tge surgery, pain free in a week or so and never think twice about getting back on here. I too find it hard to log in because I don't want to keep reading about the pain. Having had the surgery though I am trying to hang out to be a voice telling you it will be ok. Even if it's rough, it will get better. But my experience has been 200% different than I expected.