should i go for surgery or not?

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should i go for surgery or not?

Postby fokojan » 19 Aug 2014, 06:30

Hi All. I would like to share my story with you and have your suggestions and ideas for the next steps.

I’m a 30 year old male. I live in Europe. Since October/November 2012, I have had recurring fissures. Before that, I used to have occasional bleeding but without pain. I always dismissed them as "internal hemorrhoids" (stupid me..). November 2012 was the first time that the pain kicked in after a bout of bad constipation. Those days I was really stressed at work and I had a lousy diet that included a lot of protein bars. These certainly contributed to large and difficult to pass stools.
I immediately started a course of isosorbide dinitrate. I’ll fast forward the story from there on, I healed, I re-tore, I healed, I re-tore. Finally this year around March – May I had a couple of bad re-tears and the longest I went without a tear was maybe 2 weeks. I finally found a surgeon who recommended surgery because my bottom is very spasmic and I keep having recurrences. He said a little cut to normalize the blood circulation there would be good.
My level of pain nowadays is actually painful during BMs but I don’t seem to have much cramps afterwards. Pain during bowel movements ranges from 5 to 8 out of 10. I seem to always heal somehow, but with the slightest constipation I’m back to square one.
I try to eat healthy, I am very active physically, playing football and also working out. I find that what triggers my fissures are almost always stress/anger at work and poor diet habits (too much red meat, fries, lack of fiber, etc.) I work a 9 to 5 job that involves occasional travelling but mostly sitting by the desk (which doesn't seem to help much either).
I use Movicol on a weekly basis and alternate between days. I feel that it's usually too late to help when i'm already impacted.
I am stuck between going for the surgery or not. The surgeon is just a phone call away and he’s expecting my decision. I fi go for it, I’ll get it in a large hospital here.
I have never had surgery in my life therefore I’m a bit worried.
Any recommendations for me? Should i gof or the surgery ? or should i pursue other routes, like a psychologist to help with stress (possible cause of my issues)...i'm really confused.

Thanks
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Re: should i go for surgery or not?

Postby Roidsfizzman » 19 Aug 2014, 09:57

Hi Fokojan,

Your surgeon should be a Colon & Rectal Specialist (CRS). I am not sure what the meaning of the following comment made by your doctor is about "a little cut to normalize the blood circulation there would be good". The standard procedure for a fissure is Lateral Internal Sphincter (LIS). In this procedure the internal sphincter muscle is cut to allow the passing of stools without straining. Often the internal sphincter is the muscle that is having spasm issue after a BM, and the LIS surgery will often relieve the spasms. On a fissure that has had many re-tears there can scare tissue, sentinel tag, rounded skin edges that prevent the fissure from healing and with LIS these other problems are corrected and the fissure is cauterized so it will heal.

Botox injections is another procedure that many people take that do not want to have surgery. With a two year old fissure you may have a 50/50 chance of healing with Botox and with LIS you have over a 90% chance in healing.

You do need to take the next step as it is unlikely that your 2 year old fissure will heal without some type of medical procedure. You also need to commit to a diet that will keep you regular with soft stools and drink at least 64 oz of water a day. You may want to consider using the stool softener daily.

There is a lot of good information on the web site that you should read before talking to you doctor, so you can be prepared to ask the necessary questions about your procedure.

I wish you the best.
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Re: should i go for surgery or not?

Postby fokojan » 19 Aug 2014, 10:25

Thanks for replying, Roidsfizzmann.

The surgeon is a Colorectal surgeon indeed. I was referred to him by a gastroenterologist. I have already met and spoke to him. What he meant with cutting a bit of the muscle is actually LIS. He said that I am way too tight/spasmic there. He said a very minor LIS could help relax the area and bring proper blood circulation to help the fissure heal.

I am just in a bit of denial. I am a bit of a naturist, fitness freak sort of person and can't settle with the fact that i need to have surgery to sort things out. As you said, however, this has been around for almost 2 years now and the likelihood of it disappearing for good is slim to none.

I just want my life back. Is it still very important to maintain a strict diet after LIS? I just dream about going for fries and steak occasionally without worrying what will happen next.

By the way, doctors didn't recommend Botox as they didn't believe in the positive prognosis.
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Re: should i go for surgery or not?

Postby Jbl22424 » 19 Aug 2014, 10:33

Hi Fokojan - I think if you've been dealing for this that long, it might be time for surgery. There are a few others on here who wish they had done surgery earlier as the issue became more difficult to cure after time. I had surgery about 3 months ago after having a very painful fissure for 4 months. So far, I'm extremely happy I had surgery. I take miralax (movicol) every day because I re-tear if I don't. I expect to wean from the miralax after 6 more months (I tried to wean recently and had a small re-tear). So, I think you do have to keep up your diet but for me, I just eat whatever I want and use miralax to soften things. Diet never made things easier to pass for me, only miralax. It's a pretty minor surgery and it works like a charm for most people, I think. I understand not wanting to get surgery but if it makes you feel back to normal, it might be worth it. Hope that helps.
Developed fissure from constipation due to breastfeeding 7 weeks after delivery (Jan 2014)
Nifedepine
Colace
Magnesium
Miralax - godsend
Nitro - some improvement
LIS (May 2014) - cured for 3 months then setback
Diltiazem
Feeling better for now
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Re: should i go for surgery or not?

Postby Roidsfizzman » 19 Aug 2014, 12:03

Hi Fokojan,

I had a fissure about 3 years and had the hear and re-tear over and over, then, I could not heal and I could not get rid of the pain, so I opted for LIS about 4 months ago. I wish that I did not wait so long to do the surgery. Post LIS, I need both diet and stool softener to keep regular and soft stools. We all are different as JBL notes that she only needs the stool softener, the key is to have regular soft stools once or twice a day. It will take 6 to 8 weeks for the fissure and incision site to heal post LIS and it will take another 3 to 4 months for the skin to gain back 70% strength and a year to two for the skin to get back to 100%. I have found post LIS it is important still to keep the stools soft or I get discomfort from a hard stools for a couple of days.
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