I'm planning on getting LIS again. I had it about 2 years ago, and I'm wondering if it's safe to have it again? Specifically, I'm worried about incontinence. I have a CRS that said, because I had LIS before, and that my sphincter isn't too tight, that it will make me permanently incontinent.

I had LIS four years ago, and my AF healed up quite well afterward, but I am here on this forum now because I re-tore a few weeks ago. To answer your question, my GP says a second LIS is no big deal. Incontinence is always an issue with any LIS and the skill of the surgeon is more of a deciding factor than the number of LIS's that you've had (although jt seems there must be SOME limit!). I might be facing LIS #2, but I have not spoken with my CRS this time around, yet...because I am trying to employ a bunch of the advice I've learned from this forum to heal on my own. Diet adjustment to emphasize soluble fiber - check. Lots of water - check. Diltiazem, twice a day, distributed thoroughly and massaged directly on fissure - check. Coconut oil "suppositories" (just hunks of solidified oil) - check. I believe I am making progress!

If your CRS said it will make you incontinent I think you should consider other methods. Also I don't think at least that CRS would be willing to do another LIS on you if he feels it will make you incontinent.

WILL make you incontinent seems like strong words. Is that really exactly what CRS said? And if so, maybe CRS knows something about the ahem "internal architecture" that is driving this opinion.

Hi, so sorry but I completely understand how you feel. I had LIS 5 years ago and it didn't help me much, I was managing these past 5 years until last year really. Things got so bad I went back to my CRS and asked about a 2nd LIS and he told me he wouldn't do it. I consented to an exam under anesthesia to see just what I was dealing with and we discuss the advancement flap surgery. I had severe anal stenosis from previous surgery and an anal fissure. I had a bilateral sliding flap anoplasty, (a double flap with the donor sites let open so when it healed there would be less scarring and tendency to pull. I stayed in the hospital a few days to manage pain and left on day 3. I was able to manage most of my pain with ibuprofen. I was also given norco but I only used it at night and only for a short time. I'm almost 6 months out now and I'm glad I did the surgery. If your anal resting pressure is low than another LIS probably isn't a good choice. Advancement flap surgery is usally the choice when LIS isn't recommended and it's really not that bad. I still get some residual pain once in a while but nothing like before. I was told it would take 2 years for things to heal completely. I've continued with miralax nightly but at a much lower dose than I used to take. I personally think that while diet has some impact on anal problems keeping your stools consistenly easy to pass isn't that easy to accomplish without a little help. Miralax is safe to use because none of it gets absorbed into your body and it isn't a stimulant. I also dilate every morning. It takes less then a minute and it helps keep the muscle stretched. Anal pain is horrible, I think it's the worst and it's not a subject you can talk about easily. For me it kept me isolated. Finding a good CRS and trusting him is really an important first step. I know I side stepped surgery for years, my CRS recommend a single flap 5 years ago and I panicked and didn't go back until this year. Looking back I wish I would have done the surgery years ago. I would have saved myself so much pain. Whatever you decide to do I wish you good thoughts and a speedy recovery. Suzy

I am currently doing research on LIS and considering it myself. My GP seemed very hesitant about it but I am yet to ask at the hospital and am awaiting a follow up. I know someone who had LIS and it didn't work for her at all. She returned to the CRS and he wouldn't do another due to incontinence, said she may end up with a colostomy bag. If the CRS is saying this I would maybe listen to them, ask he/she why they wouldn't. There must be a reason, keep asking the questions :)