Let me begin with my story( I apologize for this long post )
It was a year ago, on a Thursday, when I ripped my bum-hole. I was constipated rather badly, and had to put on a glove to try and yank the monster turd out. My attempts were to no avail. Then I resorted to pushing and straining with all my might, and that kind of did the trick, but i had to pay a painful price... You can pretty much see where I'm going now. Yeap, that's how my problem started.
I went to my GP's( yes, I have 2 working in the same clinic ) and one suspected a fissure( so right she was ) while the other suspected piles. To be honest, both were right. I had piles AND a fissure. Nastly little combination right there. So then they prescribed lactulose and daflon, which healed me up in a week or two, but then tragedy struck once again... My dear old chap, constipation, decided to pay me a visit.
How I dreaded making trips to the bathroom, going to school, and lots of other things normal people would feel fine doing. At home, I was a deranged primate, squatting every now and then to somehow alleviate the pressure on my bum. Oh the agony:'(
So this cycle goes on and on and on, until today... Today I snapped, I literally lost it. As the monsters poked their head out of my bum-hole, I cried buckets. Wailing and sobbing in sheer agony and defeat. I kept telling myself death will be better over this, and that everybody was against me. I may sound like I was wallowing in self-pity, but I couldn't help it... A year of suffering is enough for even a strong man to fall scrambling at God's feet, begging for mercy. Ive spoken with my parents and I told them I want LIS done, right after my prelim exams. No more. I've had enough.
I'm feeling terribly lost and defeated, because I haven't got a clue as to how this procedure works and feels( post and pre op ). I've read many posts on LIS, but I just can't seem to work my head around it. If someone were to be kind enough, please do explain it to me in simpler terms. I'm just a kid:(
1) how is pre-op for LIS+General Anesthesia like?
2) what do they actually do?
3) what do I expect right after surgery?
4) how expensive is it? ( I live in Singapore by the way )
5) does lactulose stop working after a while?
6) are there any possible diseases that cause constipation?
Thanks guys, really really appreciated it:)

Palash,
I haven't had LIS, but I have had three surgeries for other health problems. I can address your questions to the best of my ability with the hope that some others who have had LIS surgery will jump in.
1) pre-op and anesthesia... The type of general anesthesia used for LIS is very light, which means you will be asleep for the procedure but you won't be as deeply under anesthesia as you would be for more complex surgery. Basically, you will just grw sleepy and drift off to sleep. It's really easy. When you wake up you will be a bit groggy and confused, and there will be a nurse with you to help you wake up and get your bearings. Prior to your surgery, your surgeon may have you administer an enema at home to make sure your lower bowel is empty.
2) what they actually do is make a cut into the internal anal sphincter muscle in order to release it from the increased tension it is constantly under when you have a fissure. You have two different anal sphincter muscles that control bowel movement control. The internal anal sphincter is the one that you do not have conscious control over. The external anal sphincter muscle is the one you feel contract when you hold back a bowel movement.
3) After surgery you will have some degree of soreness. Different people report different levels of pain while they recuperate. You may have some bleeding and some discharge as you heal. Your doctor may or may not pack the area with some gauze. You will be instructed to take sitz baths and maintain soft stools because it is essential that you avoid straining. You will be given all the instructions you need for your healing period by your doctor, including managing the pain.
4) I can't comment on the cost of your surgery in Singapore.
5) lactulose shouldn't stop working over time, but with some laxative products you may find you need an increased dosage to be effective. Part of the problem created with having a fissure is that bowel movments are more difficult to complete because of the increased muscle tension in the sphincter muscle.
6) yes, there are conditions that can cause chronic problems with constipation. Some people are also just more predisposed to suffer constipation than others. Most of the time it is just a predisposition and is not being caused by an underlying disease. If it is an ongoing, chronic problem with you, it is best to be evaluated by a physician to rule out any underlying causes that could be corrected.
We all understand the pain and desperation you are feeling. At times, this affliction can be so painful you wonder if life will ever be better again. But it will get better. There are lots of really inspirational stories on this site of people just like you who were at the end of their rope with no hope left who are happily back living their lives to the fullest again. Keep reminding yourself of this over and over.
You need to get an evaluation by a colorectal surgeon who can answer all of your questions and concerns, and who can get you on track for a treatment plan to get you healed and back living life again. You may not even need surgery. Have you tried any topicals like nitroglycerin or nifedipine? It sounds like you could also benefit from a visit to a gastroenterologist who specializes in dysfunctions of the bowel to get you on a better, more consistent regimen to avoid constipation. Regardless of whether you have surgery or not, it is imperative to find a regimen that works for you on a consistent basis. This may require a combination of diet changes and stool softeners and/or laxatives.
Keep us posted on how you're doing, and browse around the forums and ask questions. There are a lot of kind, supportive, informative people here who really do care, and who have been where you are now.
All the best to you.

Wow... Just wow... I can't express my gratitude to you, jr2. Thank you do much for clearing my doubts. I have visited my CRS, and have also cleared my doubts with him, but every once in a while a thought creeps into my head and stays there until I clarify with someone. And of course, it would be inconvenient to ring up my CRS/GP's whenever I have to ask something minor. So I hope you wouldn't mind me asking you a bit more? Thanks lots:)
When you say enema, you mean that little rubber blower thingy? With a tube and a rubber ball sack attached (excuse my description:P)? I've heard they aid in bowel movements, but I'm absolutely terrified of them. When the GP prescribed proctosedyl suppositories for piles, it was uncomfortable as hell! I just couldn't shove one up myself and often had to get someone to help me( I was so squeamish to the point that I had to have a towel stuffed in my mouth, to prevent me bawling my guys out ). So yeah, that's why I'm super scared to have something shoved up my hole, especially when I have a fissure. Is there an alternative? Like a strong laxative that will do the job?
Now, the "packing" that I've heard about. What exactly is it ( is it a kind of ball or pad or what )and what is it for? Many people claim it is uncomfortable and find relief when they remove theirs. How to they apply a "packing" and how do you remove it?
Lastly, could you compare the "soreness" to the pain of the fissure? Like on a scale of 1-10. 1 being a slight pain after BM's and 10 being the actual fissure pain.
Sorry, 4got to add in this. How will my first BM be like after the surgery?
Thanks so much and sorry for the trouble:)

oh, it's no trouble at all. I'm happy to help in whatever way I can.
I'm not sure what kinds of enemas you have available in Singapore, but yes, an enema does involve the insertion of a tip into the anal canal and the administration of a liquid to cause the lower bowel to empty. If you are very squeamish about it and feel you really cannot do it, be sure to discuss your concerns with your surgeon when you go for your pre-operative appointment. He may be fine with prescribing you a strong oral laxative, or he may not require a prep at all. Surgeons are all a bit different in the way they do things. Just express your concerns openly so he can come up with something you feel you can manage.
The packing is essentially a piece of gauze placed against the incision site to help with blood and drainage following surgery. Some surgeons apply this gauze and some don't. The gauze falls off on its own either during the first bowel movement or sitz bath. It can cause some discomfort, but it's not something to be worried about.
As far as the soreness in comparison to the fissure, that's totally individual and varies so much it's hard to really say. Some people actually feel so much relief from the surgery as it releases them from the fissure pain that they barely even notice any pain from the incision. Other people report it as a soreness and a stinging that they mostly feel after a bowel movement but is relieved by a sitz bath afterward.
The first bowel movement following surgery is something everyone who has surgery is naturally anxious about. But across the board I've heard that most people report it isn't nearly as bad as they thought it was going to be.
I know what you mean about being able to call up doctors when you have concerns and questions. Forums like these are great for sharing information, experience and support. Make sure to make a list of all of your questions for your doctors though, as it is important for you to feel comfortable with any devisions you make regarding your medical care. It is your body, and you are naturally concerned about what is going to happen and what to expect.

Oh wow, thanks:) that really eased things up for me. Sigh, my parents spoke with different hospitals and they all r costing 5 to 8.5k dollars!!! Although I'm still young, I can feel how much this pinches>< Last question for the day, now that my sphincter muscle is loosened, what are the chances of me getting a fissure again( after the one I have now is completely healed )? Higher than before or lower?

Hi there,
Well, the idea is that because the pressure in the sphincter has been released and the muscle is made permanently looser you will have a lower risk of ever developing a fissure again. Unfortunately, there are no guarantees though, which is why it is important to get a handle on these constipation issues to give you the best possible shot at avoiding anal problems in the future. Since you are young you also have a higher likelihood of success as healing will be swifter and more efficient in someone who is younger than someone who is older.

Phew okay. That pretty much cleared all the congestion in my head. Thanks a lot, you really helped big time. I'm grateful that there are helpful and kind people like you and those who created this forum. It is indeed a genius way for sufferers to interlock hands in their suffering, and for wise elders like yourself to be by their side, offering advice and giving comfort. :) I'll keep you posted on things:)

glad to help. Do keep us posted on how you're doing. It really does help to be able to share information with others.
Good luck with whatever you decide!