Hi guys,
Just wanted to get information about Sphincterotomy. I went to a specialist today, and told him that I've been using Diltiazem 2% (which he prescribed me earlier) for about a week and a half now, and have noticed absolutely NO difference whatsoever in my condition. I still have the same painful, bloody BMs, everyday (without exception), and coz of the fear, I'm only going once a day. In the morning, I really have the urge to go, so I go. Otherwise, I don't really have an urge, just a feeling that I could go at other times of the day, but because of fear from the pain and blood, I just avoid it. He suggested to me that I try for about another week or two, and if it still persists, then we could go for a Sphincterotomy. I told him that I haven't heard good things about procedures for AFs. He said it's not true. This particular one has a very high success rate, is an out-patient procedure, very safe, would take about 5 mins (I think he meant that metaphorically though), and is covered by OHIP (for readers who live in Ontario, you'll know what I mean). I also mentioned that I heard AF procedures could sometimes lead to loss of control of BMs. He assured me that that's not the case in people my age (28). That normally happens in older folks (50 or above). The problem with me is that I'm already caught up in some personal situations that require my undivided attention, but this issue has been going on for almost 2 and a half months now, and it's keeping me very depressed, worried, and unable to focus on other things. My older brother and I are working on a project together, and he just wants me to "suck it up" and not worry about my AF and just focus on that instead. That's why I'm just thinking to give the Diltiazem just another week as a formality, and ask the specialist to do the procedure so that I can get done with this atrocity and get back to normal.
Just wanna know that if anyone here has gone through the same procedure, and has had success with it. I guess if anyone has had complications, I should know about those too, though I've been so depressed because of this, I might not listen and still decide to go for the procedure as a last hope of recovering quickly. I honestly don't have the time and will to wait another 2 weeks to see if the Diltiazem works or not.
Appreciate the feedback guys, and apologies for the lengthy post.
Thanks.

Hi,
The current method of Sphincterotomy carried out in hospitals today is often referred to as LIS (Lateral Internal Sphincterotomy) - go the 'considering surgery' section and look for thread titles containing LIS.
I had this surgery 4 weeks ago and my fissure is now healed.
http://anal-fissure.org/t4589-my-lis-diary-march-2012-fully-healed-in-4-weeks
Sorry for the short response (I am on my way out of the door) but if you need any further information let me know.
Dave

The general rule of thumb for Diltiazem, according to my CRS, is that if it is going to work, you should notice a difference in about two weeks. He said Diltiazem heals a fissure in about 70% to 80% of all cases.
I used Diltiazem for awhile, but it didn't work for me. However, my CRS prescribed Nifedipine and it does appear to be working (fingers crossed!). If the Diltiazem doesn't work for you, you may ask about Nifedipine.
You may also ask your CRS to prescribe Valium, which can help with the spasms.
I would also highly recommend using Miralax to keep your stools soft. My CRS told me Miralax is not a true laxative (it just works by keeping water in the stool), so it is safe to use long-term and won't create dependency. You should, of course, check with your CRS, but Miralax has been a life-saver for me. Other stool softeners (such as docusate sodium) never worked for me on a consistent basis.
According to my CRS, an ideal stool is a soft, easy to pass stool that requires no straining and leaves no "residue" when you wipe. It can be very difficult to achieve this, so trial and error is very important. Miralax + too much fiber = too bulky of a stool. Miralax + too little fiber = too loose of a stool. It took me several weeks to find the ideal combination for me.
Good luck!

Just out of interest, can I ask if you are male or female? To explain I have been suffering for over a year now, am 28, and in the UK. I don't want to say anymore to you at the minute ( I have my reasons! I do not want to influence you in any way). The thing I would say is good luck with whatever decision you make. I know this can be horribly depressing but keep positive. Focus on what you can do! I hope you feel better soon

@ Davo: I read about the first couple of pages of your thread on the surgery. Good to know you've recovered. Hope you stay safe from a recurrence of the problem. I think I might have had a couple or so questions for you, but can't seem to remember them at the moment. Maybe they'll come back to me later. Good luck.
@ thisfissurecankissmybutt: I am actually using a stool softener. I've been using docusate sodium for about three days now, but I dont feel it to be working. The problem though is that my BMs aren't exactly hard. The consistency is pretty ok. Like I said in my earlier post, When I go in the morning, I feel a strong urge to do so. I dont really have to strain, and it doesnt come out hard. But it still hurts and bleeds like crazy. I really dont know if I have the patience to give the Diltiazem another 1-2 weeks. And if it doesnt work, I certainly wouldn't have the patience to ask the specialist to prescribe me another medicine and then try that for another 2-3 weeks. I've got other important stuff to focus on, and I need to get over this thing ASAP. I'm literally at that point where I dread waking up every morning because of painful and bleeding BMs, I'm afraid to go to the toilet because of the same reason, and I'm afraid to eat anything because of the same reason. I haven't been able to eat my favourite foods for almost the past 2 and a half months because I've been on a high-fiber, completely vegetarian diet. I'm frankly getting fed up of living like this. That's why I'm seriously contemplating the surgery. Still not sure though what to do.
@ Sue27uk: I'm a male. At this moment, I'm just looking to gather opinions on this surgery, so if you have any experience with it, or have anything else to share, either positive or negative, I'd be grateful.
Thanks everyone.

There are a lot of surgical experiences posted under the surgery forum that are really valuable to read for information. Surgery is surgery, and so there are risks and complications associated with this surgery as there is with any surgery. Those include bleeding, abscess formation, fistula formation, poor healing of the surgical incision, failure of the fissure to heal, and incontinence (regardless of age). Rates of incontinence depend on many factors, but mostly have to do with the experience and skill of the surgeon.
There are members here who have had a breeze of a time with their surgery and were feeling better very quickly after their surgery, and there are people who continue to struggle after their surgery. Unfortunately there isn't any way for any one person to know beforehand.
Key with fissures, whether you decide to have surgery or not is stool consistency, and getting some combination of diet and supplements to ensure stools are soft and easy to pass. Since everyone is different it does take some experimentation with fiber levels, stool softeners, diet elimination, etc. Some members here have success with Miralax or other stool softeners, fiber supplements, drinking plenty of water, prunes or prune juice, magnesium, etc.
The pain of fissures is severe. It isn't easy to just get your mind off of it when you are hurting so much. This isn't a time when you need increased stress as the stress will just exacerbate the fissure by increasing muscular tension. Please be gentle with yourself . :)
I hope you feel better soon.

Hi,
I used to live in Ontario. The Miralax mentioned above is sold in Canada here as restoralax. I never had much luck with docusate. Luckilly metamucil and prune juice work for me, otherwise I would try restoralax.
I second all that JR says. Think BMs the consistency of toothpaste.
With restoralax you should be able to eat more than just vegetables. I actually eat pretty much the same as I did before. I eat meat etc. But in smaller portions and with an extra side of veggies. I haven't bought white flour, white rice or white pasta in years.
Like FCKMB says, you might try nifedipine before you give up on the topicals. I found it worked, but had to quit myself as it was messing up my menstrual cycle. But you won't have that problem! :)
If you decide on surgery, make sure your surgeon has done lots of these ops before and check his online reviews somewhere like ratemds.com.
But remember, you may be feeling better soon after, but it will still take weeks, even months to be fully recovered. I believe Davo posted those numbers somewhere. SO don't go back to bad habits, diet-wise. And drink lots of water. :)
-Tanya
ps. use the search engine on the 'portal' page. click the 'google' and 'post' options and you may find things easier on this forum.

Hi everyone,
I sincerely appreciate everyone's feedback. To be very honest, I still haven't decided whether I want to go for surgery, or give the Diltiazem another 2 weeks, and possibly experiment with another medicine after that. The thing is that I really can't spend much more time on this problem, and need to get done with it ASAP, so I'm still rotating the idea around in my mind. But I have a feeling that, despite the risks of complications and after-effects, I still might go for the sphincterotomy, as that might be the quickest way for me to be on the sure path to recovery. Will have to make a decision within the next couple or so days.
Thanks everyone.

Hey just-someone. I haven't had the sphincterotomy. I am female, and over here in the uk they are very cautious, also because of my age they are not keen to do it. If you are male I think it is different. I had botox injections in November which in my opinion has made it worse, I'm only just back to what I was before I had it done. My 6-8 week follow up is 6 months after the procedure,its on the 8th May and if I'm not happy with what they say I am going to go private. I understand that over in the US things are different and you don't have the NHS waiting times to contend with!! Personally I wouldn't go with the botox. I would give the cream 6 weeks and if it hasn't worked I would go for the op. You do need to give he cream a little time to work but if it hasn't worked by 6 weeks I am led to understand it won't! I was on it 4 months last year, and have been back on it since January as otherwise I would be having major problems and no way to control this. I would recommend drinking alot of water, increasing fibre intake, and use of a stool softener. If all this doesn't work I'd go for the op. I wish I had that option!!!! Sending healing thoughts your way :)

Hi Just-someone,
Apologies for my rapid response earlier and I guess we still haven’t answered your original question requesting further information on Sphincterotomy.
So as you are probably aware the current procedure used is LIS (Lateral Internal Sphincterotomy) which is also sometimes referred to as a tailored sphincterotomy. What we mean by tailored spincterotomy is that the cut to the internal sphincter is exactly the same length as the fissure itself. During previous sphincterotomy surgeries the cut was made up to the dentate line which is a considerably larger cut.
So the main worry on everybody’s mind when undergoing LIS is the risk of incontinence – now to be honest this really isn’t a risk but because there is an extremely slight possibility it has to be mentioned and to be honest it has been completely been blown out of all proportion. In the UK the NHS carried out an extensive study into the risk of permanent incontinence following LIS and the figure quoted is actually less than 1% (in fact it is 0.5% or 1 in every 200 people). The first thing I have to mention is that this relates to gas or liquid stool incontinence and so it does not mean that you are going to have uncontrollable accidents all the time. It would actually mean you would have less ability to control gas and you may have some slight water soiling after a toilet visit. Secondly you have to consider that a number of people who had LIS may be older people who naturally have a weaker sphincter or people with other bowel conditions which may have been affected by the LIS.
Sphincterotomy has had some bad press over the years and I know some websites quote extremely scary figures relating to incontinence rates but bear in mind that the majority of these relate to the older methods of spincterotomy where the cut is made to the dentate line.
Now what is very important is to choose your surgeon very carefully – try and avoid a general surgeon and opt for a specialist so basically a CRS (Colorectal Surgeon) – if you find a good CRS who has carried out many LIS surgeries the risk of any complications is nigh on zero.
In fact the biggest risk during LIS is the risk of infection/fistula post-surgery so you have to be anal about cleaning properly (pardon the pun).
So now for the good bit – LIS can be a fairly quick fix solution to fissures and the success rates average between 95-100% and a full recovery can be experienced in 2-4 weeks with the chances of a fissure recurrence being virtually zero. My fissure healed in about 2 weeks and now I am at 4 weeks post-surgery with no pain, no spasms, no discomfort and I can eat and drink whatever I want again. However please bear in mind that recovery depends upon the individual and the state of your fissure.
Below I have copied from the spincterotomy.net website and this shows the recovery schedule you should expect post LIS surgery
Week 1
This is the week of patience as you will probably not see any improvement to your condition. In fact, you may still be in pain during this week. Taking care of personal hygiene is important during this time to avoid infection. You should also continue with medication prescribed and visit your doctor regularly.
Week 2
You most probably see some improvement during BM during this week. A key to recovery is to make sure you have enough of liquid and fiber intake to prevent hard stools.
Week 3
This is the week of healing. BM will be smooth and with little pain (or none at all). You could probably start doing some normal activities during this week. However, care should still be taken to continous healing.
Week 4 thereafter
After this week, you should be able to start work and your normal activities again. You should feel glad that you took sphincterotomy. BM is painless and spasms rarely occur. Although full recovery may take up to 2 months, with the right care, many sphincterotomy patients see recovery much earlier.
Davo