I'm a 34 year old female looking for recommended Colorectal consultants specialising in LIS, in London. I have met with Mr. Windsor and am looking for a second opinion, since he didnt seem to be too keen to consider LIS, and recommended botox which i dont particularly care for. Would truly appreciate any advice.

Some context - i have had a fissure since the past 2 years. It seems to be tearing much more frequently since i had my (first) baby last year, even though i got a c-section done just to avoid stressing the area from natural childbirth. Prior to having my baby, the fissure probably tore every once in 4-5 months, pained for 2-3 weeks before it healed, so i learned to live with it. The pattern of flare ups has changed since i got pregnant. It is now tearing nearly every month i think, although with aggressive sitz baths and stool softeners, the pain subsides in 2-3 days. I take a dulcolax every day, as well as a sachet of movicol. Drink lots of water, and take sitz baths and use gtn ointment - though only when the fissure is hurting. I suppose i havent been very regular in continuing with movicol, gtn and sitz baths once the pain subsides, so it could be the fissure isnt getting time to fully heal. I do have a tendency towards hard stools - although generally the combination of movicol and dulcolax seems to fix it. I havent tried magnesium supplements yet.

After reading positive reviews on this site, I consulted Mr. Windsor with a view to discussing LIS. He didnt seem keen to begin with - said he preferred not to perform the procedure on female patients, and recommended botox instead. He also mentioned i have a slight rectal prolapse perhaps from my pregnancy. He didnt prescribe any pressure etc test. Im not keen on botox at all, since havent read many positive outcomes. When i questioned him further, he said he would do LIS if i felt it would help, but pointed out the risk of incontinence. Mr. W also recommended skin tag removal - I'm scared to get this done since have heard it is very painful. Is it absolutely essential - does the presence of skin tags slow the fissure's healing? I believe he is a very experienced CRS in this field, but am keen to get a second opinion, and to hear how women my age have fared with LIS, esp re the incontinence bit which is scary.

Fear of retearing the fissure is dominating my life, and i just want to get on with it -a sentiment i know all of you can identify with. Historically i have been lax with my diet, though have made some changes now. Im not even sure how long i can safely use gtn ointment and dulcolax - im sure there are side effects from long term use, and i fear i am getting over-dependent on them.

I have heard of Mr. Emin Carapeti and Mr. Amir Darakhshan. Has anyone had any experience of either of these consultants?

Thanks so much for your support,
Pyra.

Hello Pyra
I recently sought a second opinion about my AF problems from Mr Roger Leicester OBE, a CRS who came highly recommended to me. I have a woman friend who has had similar advice to you from Mr Windsor. I asked Mr Leicester waht he thought about LIS for women as opposed to men. He replied that he saw "No problem as long as the surgeon knows what he/she is doing and doen't damage the sphincter. There's a lot of cowboys out there!". I also asked his opinion of Botox. He answered "Useless. It was fashionable for a while but a waste of time"
If you have gathered from this that his manner was bluff and to the point you would be right!
Mr Leicester's private practice is at Wimbledon and Cheam. NHS at St George's, Tooting. If you are interested I can let you have contact details or you can simply Google him.
Incidentally my skin tags/sentinel piles have always disappeared as the fissure heals.
I hope this helps and sent you my very best wishes for healing.
Allan

Pyra wrote:I'm a 34 year old female looking for recommended Colorectal consultants specialising in LIS, in London. I have met with Mr. Windsor and am looking for a second opinion, since he didnt seem to be too keen to consider LIS, and recommended botox which i dont particularly care for. Would truly appreciate any advice.

Some context - i have had a fissure since the past 2 years. It seems to be tearing much more frequently since i had my (first) baby last year, even though i got a c-section done just to avoid stressing the area from natural childbirth. Prior to having my baby, the fissure probably tore every once in 4-5 months, pained for 2-3 weeks before it healed, so i learned to live with it. The pattern of flare ups has changed since i got pregnant. It is now tearing nearly every month i think, although with aggressive sitz baths and stool softeners, the pain subsides in 2-3 days. I take a dulcolax every day, as well as a sachet of movicol. Drink lots of water, and take sitz baths and use gtn ointment - though only when the fissure is hurting. I suppose i havent been very regular in continuing with movicol, gtn and sitz baths once the pain subsides, so it could be the fissure isnt getting time to fully heal. I do have a tendency towards hard stools - although generally the combination of movicol and dulcolax seems to fix it. I havent tried magnesium supplements yet.

After reading positive reviews on this site, I consulted Mr. Windsor with a view to discussing LIS. He didnt seem keen to begin with - said he preferred not to perform the procedure on female patients, and recommended botox instead. He also mentioned i have a slight rectal prolapse perhaps from my pregnancy. He didnt prescribe any pressure etc test. Im not keen on botox at all, since havent read many positive outcomes. When i questioned him further, he said he would do LIS if i felt it would help, but pointed out the risk of incontinence. Mr. W also recommended skin tag removal - I'm scared to get this done since have heard it is very painful. Is it absolutely essential - does the presence of skin tags slow the fissure's healing? I believe he is a very experienced CRS in this field, but am keen to get a second opinion, and to hear how women my age have fared with LIS, esp re the incontinence bit which is scary.

Fear of retearing the fissure is dominating my life, and i just want to get on with it -a sentiment i know all of you can identify with. Historically i have been lax with my diet, though have made some changes now. Im not even sure how long i can safely use gtn ointment and dulcolax - im sure there are side effects from long term use, and i fear i am getting over-dependent on them.

I have heard of Mr. Emin Carapeti and Mr. Amir Darakhshan. Has anyone had any experience of either of these consultants?

Thanks so much for your support,
Pyra.

Mr Windsor is a top man and i would go with whatever he choses as for anyone else they would be less qualified and if in any doubt you should go to st marks hospital the world leader in this field


Prof. Robin Phillips MB BS MS FRCS Director, Consultant Colorectal Surgeon
is also one of the worlds best

http://www.stmarkshospital.org.uk/consultant-staff/page/2

Hi,

Just to mirror what nick7 said...

I had my LIS with Mr Windsor and when it comes to Colorectal surgery there are not many better surgeons out there. If he recommended against LIS then i would be very wary of looking for someone else who would consider giving you the surgery. He trains the majority of CRS's in London and has a huge reputation and if he thought LIS was the way forward for you I am sure he would have recommended it.

I do remember him saying to me that he refrains from offering LIS to patients of child bearing age as the risk of incontinence is much greater. I know Botox is not the favoured option for most people but it can work and certainly has better results that the prescription creams out there plus it has zero risk of permanent incontinence.

So yes by all means get a second opinion but don't rule out the alternatives

Davo

The issue with LIS as a woman who has had children is that childbirth can damage your sphincter and therefore you have a higher lifetime risk of incontinence.

Women have an anatomically shorter and less strong sphincter muscle, so if you carry out a LIS then there is a higher probability of incontinence. A woman in her 70s has a 50% risk of being incontinent without having had a LIS.

This is what Mr. Windsor is concerned about no doubt; Ultimately its a decision for you. I didn't want Botox either, and am forcing the issue with LIS but I am fortunate in that I'm a guy.

Only you can decide whether you want to assume the risks that go with the LIS procedure.

Hi Pyra

I was wondering if you managed to get the LIS surgery by Mr Wilson? I am currently researching colorectal surgeons in London for a second opinion and also came acros Mr Alistair Wilson.

Thanks

Hi,

I had Botox, then advancement flap surgery with mr Windsor. He is a highly rated surgeon, and very personable.
I wouldn’t hesitate to recommend him.

Thank you I will definitely look into meeting him. Did you go private if you don't mind me asking? Also did you have any issues after the advance flap surgery?

I initially went private, for the consultation, but he then put me on his nhs list. I received all my treatment at UCH London.

It took me a long time to heal from my flap, I cannot lie.... and I had no issues until last week when I had my first set back in a couple of years.

I have a diary covering most of it if you fancy a loooonnngggg read lol!

Oh no hope you are ok and not had too many issues with your set back. I saw a colorectal surgeon in Birmingham under NHS and she advise don't me that the advancement flap is only 40% success rate. She doesn't seem to think that a LIS is a good idea for me as my resting pressure is not that high, however I will challenge her on this on my next appointment as my resting pressure was showing high in the normal range.

I have found that some countries do laser LIS and this is proving a success as it does not leave a large wound (size of a tip of a pen as I have been advised by some surgeons when speaking to them on the phone) but the surgery itself is in affect the same outcome, i.e. Cutting part of the internal sphincter muscle, therefore the risk of incontinence is still there.

I have also read that a lot of the flare ups are linked to emotional stress as I have found a pattern with myself. The emotional stress that you have impacts the muscle tensitivity and causes fissure to reoccur.....

If you don't mind can you share your diary thank you