Hello everyone. I'm brand new here, and so glad I found a forum of people who totally understand what I'm going through. I'm a 41 year old mother of two, married to a wonderful man, and we live in the Lone Star state.
In addition to my fissure (which is apparently so deeply cut that it's in the muscle) I have fibromyalgia and chronic myofascial pain. So, this is another new and wonderful aspect of my everyday life. :|
I am considering a fissurectomy, and will see my dr. this Friday for a consult about it, but I want the bold, bare truth. How awful is it? Really. I NEED to know the bare bones here. Is the pain worse than what I am experiencing right now, or is it better? I need to come to a decision because this has been going on now since January. She was completely surprised when she saw the deepness of the fissure, because the stigma of FM tends to make doctors think we don't tolerate pain as well as others.
Any information you can share with me would SO be appreciated. Oh, and another thing, is there somewhere on this site that defines the meaning of the anacronyms you use? I don't even know what LIS is.
Thanks in advance. I 'm looking forward to some real honesty and making some friends!

Hi NW, and welcome to the board! Sorry you're in such straits, but then, you wouldn't be here if you weren't!
When you say fissurectomy, you "probably" mean the LIS (Lateral Internal Sphinctorotomy) which is the most common surgical procedure performed for anal fissure. While there is a "fissurectomy" type procedure, it is not common and may not even be reliable.
LIS involves making a lateral incision across the sphincter, which prevents it from
spasming. The sphincter spasms are what causes the clenching type pain that can last for hours, on and off, after a person with AF has a bowel movement. These same spasms are also the primary reason why the fissure will not heal, because the tightness prevents adequate blood flow to the fissure site, preventing healing. So once you have the LIS surgery, two good things happen: 1) you no longer have the clenching spasming pain, and 2) the fissure can begin to heal (but it will still take the fissure 6 weeks or longer to heal).
I had the LIS one year ago. While the recovery *was* rough, it isn't always as rough for everyone. I was back at work in a week and a half, but I didn't feel *normal* until a month had passed.
When you first "wake up" from the surgery you may have a lot of pain ( I was given pain killers in the hospital post-surgery so I didn't suffer at all), but it quickly dissipates to more like a dull pain, nothing as bad as the fissure pain. But like any surgery, there is residual pain from the incision, which gets a little better day by day. After a week, you just have a weird feeling down there like a strip of leather is up your tail. That goes away, too, in about another week.
If your fissure is deep, then it may take it a bit longer to heal after the surgery. This means you may still have some pain *during* a BM and some bleeding. But the spasming pain will be gone! And slowly, day by day, the fissure will begin to heal and the bleeding will decrease until one day you are "primarily" healed (although it really takes much longer for the fissure to be completely healed, maybe even a year.)
My first question is, what type of pain do you have. Is it just during the BM, or for a period of time after the BM?
Also, many people fear the surgery because they are so afraid of it making them incontinent, but the risk for that is extremely low unless you are elderly or morbidly obese (there may be other risk factors I don't know about).
The LIS has a 97-99% success rate, much higher than other more conservative treatment available.

I just wanted to welcome you! I did not have the surgery but it sounds like in your case it may be warranted. If it is not healing and it has been since January, I think we need to consider alternatives.

Have you tried the creams at all? Nitro, diltiazem or nifedipine?

Feel free to look around at the website. We have lots of information from people who are going through the same thing.

I know having this on top of an underlying pain condition can be very difficult.

Lecia

Hello,
I haven't had surgery, but just wanted to sympathise and say I know what you're going through, and how sorry that you're having such a bad time. Have you tried special diets and supplements?
I was read my consultants letter yesterday, and back in june he'd written that this patient is extremely unlikely to heal without surgery, but with diets, supplements, salt baths, diltiazem cream and valium, I did get my life back, until I got an abcess this week.
So there is always hope!
Wish you luck, whatever you choose,
Val

Thank you all for your responses! And, a special thank you for telling me what LIS means, Kim.
Currently, my CRS has me using Ana Mantle cream (Lidocaine HCI 3% - Hydrocortisone Acetate 0.5%), Diltiazem 0.2% ointment, and Lidocaine ointment USP, 5%. Just yesterday, I was prescribed Trileptal to be taken orally -- supposedly this should help with the pain, having to do with the nerve endings.
Kim, my pain is constant. It never ceases. A bm just makes it so bad that I need (wish) I had a valium to calm myself down afterwards. I literally come out of the bathroom crying from the pain. The ONLY thing that remotely helps is using ice packs. Sexy, huh? LOL Anyway, that's what I have to do -- I just keep the pack there with a pillow between my knees until I am totally "frozen" mimicking the epidural I was given for the botox injection.
My doctor never referred to the procedure as an LIS; she just says "fissurectomy" and so does her website. I didn't get the opportunity to speak to her after my procedure, only my husband did and I really wish I had been able to speak with her. I certainly have a lot of questions.
Anyway, thank you so very much for taking time out of your day to answer my questions. I am a bit panicked over this, with Christmas being around the corner. Having felt so bad for so long, I haven't been mobile, so the shopping hasn't been done. Although I know my hubby will do it without much complaining, I actually enjoyed it, and of course, I want to shop for him!
I'm off to peruse the rest of this site while I am capable of sitting for a few minutes. Thanks again, all!

hi normalcy,
welcome to AF where we will support you 100% and hold your hand in internet land when you need it!
since you will be marking almost a one year anniversary with your AF, some of us opted to live with it for four-six years or a bit more before doing any kind of surgery.
i booked my surgery and at the same time, i gave into macrobiotics - a way of eating. if you have time to get some books and read over it, you may want to try it out if you think you can hold off a bit more from surgery.
other than that, if your body is telling you that now is the time to get the LIS or fissurectomy, then do it! nothing better than being prepared and your body telling you to go for it. it took my body and guts about 3/4 of four years to make that decision. but alas, i didn't have to go thru with it. of course, my case is a bit unusual as no one else on the board has been able to have the same results but then again, macrobiotics is not a simple decision and it takes a bit to get use to all the asian stuff.
if you feel comfortable in sharing your doc's web site with us so we can see what she says about the fissurectomy. or if you can cut and paste......
happy holidays and if you book your fissurectomy, then may you have a happy ass for the new year too!
best, gareth

Hi Gareth,
I have not made up my mind at all. I can not wrap myself around the fact that ANY percentage of persons undergoing this procedure might be incontinent afterwards, or might unwillingly pass gas in public. I am still a lady. Well, and human. Who wants to wear Depends the rest of her life? I realize that only some experience this "side effect" (that term always makes me laugh -- such a small amount of respect for something so life changing) the fact that I always am prone to Murphy's Law makes me know in my bones that I will be IN that percentage.
I checked out your website and it's a lot to digest in one sitting, but I am willing to do anything to avoid this procedure. Anything. It has me scared crapless (oh, how ironic) that they are going to start cutting and snipping and stretching that area of my body.
I'm going Friday for a "consult" about this procedure and am sure she will sell or try to sell it to me, but I am a hard sale. Maye you could in a nutshell share a bit about macrobiotics with me (if you have the time and can withstand the sitting required to type) so that I might go in a bit more knowledgable about the whole thing...but only if you have the time.
Thanks again,
Not-a-Happy-Ass just yet aka NW

The following inofrmation is from:
www.bhj.org/journal/2000_4202_apr00/sp_339.htm+fissurectomy&hl=en&ct=clnk&cd=1&gl=us" target="_blank" rel="nofollow">http://209.85.165.104/search?q=cache:H_1M9XIpZDMJ:www.bhj.org/journal/2000_4202_apr00/sp_339.htm+fissurectomy&hl=en&ct=clnk&cd=1&gl=us
ANAL FISSURE
A Comparison of Conservative Treatment Versus Surgical Methods
Manu G Nariani*, Rajeev Chaturvedi**, Jignesh Jatania**
*Assistant Prof. of General Surgery, Consultant Surgeon; **Resident, Gen. Surgery, Bombay Hospital Institute of Medical Sciences.

Surgical approaches
1.Anal dilation was described by Recamier in 1838. It has undergone several variations and modifications. It is performed under general anaesthesia or local anaesthesia. A gradual insertion and dilation to four to eight fingers lubricated with paraffin, lignocaine jelly, or K-Y jelly achieves reduction of internal sphincteric pressure.[13]
2.Fissurectomy involves excision of the fissure from the anal canal. The wound is left open without suturing.
3.Internal sphincterotomy[14],[15]
The internal sphincter is divided completely in its lower part from the dentate line to the lower margin. The objective of the procedure is to relieve the pressure in the anal canal; the part of the sphincter above the dentate line is left intact. It should be noted that the spasm of the internal sphincter is taken as the key pathogenetic mechanism in the initiation and at least maintaining the fissure.[15-18] There are various approaches to the internal sphincterology; (a) Posterior midline, anterior, or lateral sphincterotomy - based on the site of division of the sphincter, (b) open or closed sphincterotomy - based on whether anoderm is incised or not during the procedure, (c) submucosal or the inter-sphincteric approaches.
4.Carbon dioxide laser surgery involves laser vaporization of the fissure locally. The internal sphincter can be incised using this laser. In long-standing fissures anal stenosis is present. It can be used to give relieving incisions in the three quadrants other than the fissure before the fissure is attended. Cryo-analgesia with liquid nitrogen is given to all wounds distal to the anorectal line.

further:

Fissurectomy, by itself, is an incomplete treatment as the anoderm heals very slowly and the factor initiating and/or aggravating the problem - the internal sphincter spasm - is not tackled. When combined with anal dilatation or sphincterotomy, it may make the procedures more effective.
Sphincterotomy is a very effective procedure. Posterior sphincterotomy is slow to heal and has a tendency to lead to a posterior midline keyhole defect that may cause a persistent seepage or difficulty in continence. It is generally considered an outdated procedure; but it still has its place in selective cases with a posterior midline fissure complicated by a posterior midline fistula and perhaps when a stenotic canal is being repaired with a posteriorly based advancement flap.
The sphincteric mechanism is most weak in the anterior portion, therefore, anterior sphincterotomy should be avoided.
Lateral sphincteromy, especially after the standardization of the closed method, has been chosen by many surgeons.[18] The reasons for this favour are the simplicity of the procedure, minimal anaesthesia requirements, and good results. It takes only 3 to 4 weeks for healing (as compared to 7 to 8 weeks required by posterior sphincterotomy). The success of the procedure depends upon (1) cutting the complete thickness of the internal sphincter in the lower part from dentate line to the lower border of the muscles, and (2) avoiding even a small violation of the integrity of the anoderm and mucosa. If mucosa is punctured, one should convert the procedure to an open internal sphincterotomy. If the above stated simple guidelines are religiously adhered to the recurrence and complication rates of sphincterotomy for primary anal fissures are very low.
The list of complications that can arise due to procedure is formidable; but with careful and experienced hands the procedure is safe and simple.[23] Ecchymosis of the anal canal and perianal skin is the most common complication, it can be quite extensive in the closed technique and Sitz baths are enough for its management; haemorrhage is a rare complication as the bleeding is tamponaded. In open procedure haemorrhage can be managed by careful suturing of the edges of the mucosa. Perianal abscess is associated with only 1% of the closed sphincterotomies; there are always associated with anal fistula and presumed to occur as a result of inadvertent penetration of mucosa by the knife. Recurrence and failure to heal occur in less than 5% cases. If conservative therapy does not help repeat sphincterotomy can be undertaken. Incontinence occurs due to violation of the external sphincter fibers or due to a keyhole deformity due to posterior fissurectomy or posterior midline open sphincterotomy.[28]

You should visit the website/webpage listed above as it has LOTS of good conservative treatments listed for AF...

I am so sorry I wasn't clear. I meant more info about the macrobiotics. I've been looking at that particular site myself, actually. There's a plethora of information out there, and the more I see, the more I don't want to go through with the fissurectomy. I was really referring to your information about macrobiotics. In reading the material on the website you have listed, my head started wobbling. LOL It's a lot to read and digest.
I am not ungrateful, though. You guys certainly are caring and empatheic. Thank you so much for the other information as well, really. I'm sure it took some time out of your day.

Well, it's no wonder you got confused by my post, Kim. It wasn't you at all that was discussing macrobiotics, it was Happy. My memory fog (FM related symptom) has really kicked in with everything else that is going on right now, and I get confused so easily.
Sooooo, Happy, would YOU be able to supply me with a synopsis of macrobiotics in your own words? Just enough for me to know what it is that I'll spend hours poring over finding information. I don't want this procedure, so as I said before, I'm willing to look into anything, even a complete lifestyle change if necessary.
My apologies to you, Kim, for having you work so hard to find me information that I'm sure had your eyes rolling -- "that woman could have done her own work!" Still, I am grateful. Thank you so much.