Hi All,
Just joined this forum now but have been suffering with this damn thing for 7 months already. I delayed going to get medical help because I had had the fissure issues twice before years ago and was able to resolve them myself. Also, the one I currently have kept teasing me by getting a little better which would delay my visit to the doctor only to retear and start all over again. Finally, the pain got to the point where I had to miss work or miss sleep or both sometimes because I was having 10+ hr pain sessions which prevented sleep or work or really anything after a BM.
I have Kaiser so I started with my GP as you do. Not really realizing the acute pain I was, in she went strait for the Anoscope which she got about a cm in before it was clear that visualizing me this way was not happening. Tried a finger as well which also was a no go. She prescribed Nitro cream and Lidocaine and set up an appointment for me in the General Surgery clinic a week later.
Over that week things did get a little better, it was more like 2 or 3 hours of pain instead of 10+. So when I went the the Surgery Clinic (where I really only met with a PA) she basically said I should give the cream and the fiber a chance and laid out the Nitro-Botox-LIS road map. Since my pain was reduced, I agreed to give it a go. A week later I emailed her because I was having another 10+ hr incapacitating pain session which kept me up all night on a Sunday before work. She agreed to see me again quickly. I went in this time and she convinced me that the Botox would instantly end the pain. So I agreed to have the injections. Which were given on the spot. They said it would hurt a little but in reality the pain of the injections was like childs play compared to the fissure pain.
However, all the botox really seemed to accomplish was to give me gas incontinence. The pain remained as before. I also started Colace along with my extremely high fiber diet I had been on right around this time. At that point I had the runs for a day and then became constipated for 4 days which has not happened for quite a while. I was terrified have missing a BM because that meant a large hard one in the past. So at the end of the first day I took a fleet enema to force it. This resulted in a smallish BM and a lot of pain and another sleepless night. Fed up at this point I sent an email to the PA again saying pretty much that nothing was working to ease my incredibly long pain sessions and I can no longer just keep hoping that it would get better. It had been a week since the botox at that point and I had nothing to show for it other than incontinence.
So she made an appointment for me to see the 1 surgeon that they have that does the LIS. That appt was today.
Since it was the first time he was seeing me and since I mentioned that I had some constipation recently he basically started going down the road of lets see if we can soften my stool. After 7 months of trying, and succeeding for large periods of time, I pretty much didn't want to hear another scheme to eat this magic thing or that magic thing and it will heal itself. He started talking about how he doesn't like Colace and would rather I use Prune Juice instead. At this point I was thinking, "I have had 7 months of terrible long lasting pain which is preventing me from working and sleeping and this guy is talking about prune juice!!!" As if I had not tried prune juice already.
He was basically saying also that the surgery is nowhere near 95% success rate and basically I thought he was trying to talk me out of the surgery. So finally he wants to take a look, I tell him that anything more than spreading me apart a little is pretty much not happening without putting me to sleep first. He was very gentle actually, and confirmed the fissure and that he could see the muscle below the fissure.
After that he suddenly says, "Well do you want to do it?" As in right then and there. I was taken aback, so he said maybe will talk about it a little more. I got off the table and he pretty much says that he can do the surgery (LIS) right then and there with a local anesthetic. He then went on to say the numbing process is quite painful but the whole thing takes ten minutes and I am done. I mention that I don't want to do it then and there because I was there alone with no one to drive me home and I have not made any preparations to miss work for a period of time. He says, "No problem, you can drive right back to work after we are done." I was kind of astounded because I had always read everyones experience of general anesthetic and 2 weeks or so recovery. He then kept asking me if I wanted to do it after describing what sounded really hellish to me (doing it while awake). I actually thought he was just seeing if I would agree to that to assess my real level of pain.
Anyway, after convincing me that he was serious and telling me that he can also do it under general but it would have be scheduled, I finally just basically agreed to schedule it for 3 weeks out under general but really I just wanted time since I felt very uncomfortable with the situation. I said I would try the prune juice. lol
Sorry for the absurdly long first post.
Is it normal to have an LIS under local and basically go right back to work the same day? Was this guy just trying to scare me into not getting the surgery? It really seemed like he was just basically giving me what sounded like a really bad option so that I would not want to do the surgery. However I confirmed with the nurse afterward that indeed he has done a ton of them with local and it takes ten minutes and you are out the door.
Again sorry for the long post, any comments are appreciated.

Dear kuhio, in my opinion you should "run for the hills", and get yourself another doctor, preferrably a colon rectal specialist if that is a possibility near your area! It is definitely not the norm to have this surgery under a local unless there are other underlying medical issues that would prevent you from having general anesthesia. Pre-op preparations also require you to have someone with you to
transport you from the facility to your place of residence as
you MAY NOT DRIVE YOURSELF, you will be on pain meds
if the proper medical care is followed...I'm sorry to say I
don't believe that proper procedure will be carried out by
this physician! Something seems terribly wrong with the
whole scenario you were given, please seek out another
Doctor and in the meantime just search the web or this forum for information as to what the standard procedures are for this
surgery...you will find it is not at all what you were told.
Best wishes to you, angel.

I totally agree with the above post: if I were you, I would RUN, RUN, RUN! I also agree that you need to make an appointment with a colorectal surgeon (CRS), not a general surgeon. You want someone that deals with anal issues such as fissures every day, all day. At the VERY LEAST, please (please!) get a second opinion from a CRS. Something just doesn't seem right here, in my opinion.
Keep posting your questions on this forum. There are lots of people here who have been through the same thing you are going through and they can help you. I am just beginning my fissure journey (unfortunately), but the help and advice I have received on this forum has been VERY helpful!

Yikes! that's one strange doc; I wouldn't let him anywhere near my rear end with a scalpel.

Kuhio, I am now just shy of three weeks post LIS. Because of meds that I'm taking, and an as of yet undiagnosed neurological issue, the anasthesiologist recommended an epidural over general anesthesia. I had never experienced same before. It was somewhat painful as they put the needle in and moved it around, but within a few minutes, I was feeling nothing from the waist down. The surgery itself went very quickly, but it took five or six hours before I could stand and walk. I don't think that I would want to go straight to work. That said, I am in a day hospital program and was able to attend the following day. I experienced some discomfort, but nothing that a couple Ibuprofen wouldn't deal with.
All this said, my surgery was performed by a very experienced Colorectal surgeon. I would be quite worried having a general surgeon performing this. BTW, according to my CRS, that 5% figure is pretty accurate, and nearly three weeks post-op, I am doing so much better!
Good luck.
Rob