Anyone else here suffer from a tight sphincter? This makes passing motions quite a trial. I even use the biofeedback breathing technique to ease the stools out, but I still feel they're abnormally tight. I think I had something like a resting pressure of 120, when the normal figure is about 60. Could something like Botox or an LIS be an answer? I developed (another) fissure about 10 days ago.

I've had rectal issues for just under 20 years now and this latest setback is leaving me very frightened for the future. My anxiety levels are off the chart, with a constant knot in my stomach through worry. I am taking Movicol twice a day - morning and evening) and I haven't had any more blood since I first tore myself.

A few years ago I begged my GP to refer to a consultant surgeon for a possible colostomy, just so I could lead a more normal life. I just hate how life has passed me by. I'm 55 with a lovely understanding wife and a 6-year-old daughter I love to bits (we had her late in life). I don't go on holiday, I have the world's most boring diet and I'm just sick to death of how my life as turned out.

I was seeing a lovely female consultant until about 18 months ago when I had sufficient funds for private consultations, but now we're having money worries, that's been put on hold. I can use the NHS, but had a really rough doctor about 5 years ago who pretty much ripped me open with his over vigorous digital exam, so I'm scared to try that route again.

Any advice would be gratefully received. Feeling very needy at the moment

I also forgot to mention I have IBS and hems as well.

Hi,
I too had a resting pressure of over 120 and have both crohns and IBS and numerous hems unfortunately. if you have a fissure and are on the NHS then you should be offered Botox if your sphincter tone is that high, which will temporarily reduce your sphincter tone. Then after Botox you may get LIS which will permanently reduce your resting sphincter tone. In fact as a man they may just give you the LIS straight away.
Just because your not paying private doesn't mean you can't get better. Even your GP should be able to prescribe GTN if you have had fissures before this helps to stop any anal spasms.
I too have asked for a colostomy but there are so many criteria to meet that you would have to go to extremes to get one...and they also bring their own issues for some people.
I totally relate to the diet thing I have spent years not being able to join in eating and drinking due to flare ups, but these past 18 months I have eaten nothing but simple carbs and certain protien, I'm now actually medically malnourished lol.
It must be hard with a young child, at least mine are teenagers and have had years of getting used to living round my bowel issues before this fissure totally overtook me.
I'm sure if you find a good doctor this could be sorted fairly quickly....men get LIS much easier on the NHS than women....and your tone is very high so little risk of incontinence
Good luck and you have my sympathy and understanding

We seem to share many of the same issues. It's very easy to imagine being a special case, so is very reassuring in a bizarre way to know I'm not alone with these problems. Interesting you mentioned the colostomy as well - I'm sure we aren't alone in that one, as it sort of solves the whole issue in a single step. I do know there are other associated problems with them too, so it obviously wouldn't be a simple 'whoopie' moment! But I think the whole point about seeking out ever more drastic solutions is to try to regain some normality in life. I'm sure in a 100, maybe 200 years, they'll run some sort scanner over the wretched things and voila! an instant fix. As for the Botox, I was offered it once, but my consultant felt my condition at the time wasn't bad enough to warrant it. The LIS is seriously scary, but I think I'd probably go for it if it meant a semi permanent solution. It's the associated pain following it that scares me to death.

Yes it is good to know we are not alone and others understand our pain.
I was offered a colostomy years ago during a bad crohns flare up, I refused as I was worried about the recovery....oh if only I had a crystal ball...I would have had it in a flash if I knew about the fissure.
I can't see how with a resting pressure of 120 you are not bad enough. That's strange.
I have had both the Botox and the LIS. The Botox stopped my spasms straight away and the pain went within a month, I was back at the gym with 2 weeks but I only healed 10%. I had LIS in November and I'm not going to lie it was very rough my spasms after were at a level 10 as bad as when my fissure first started...but and this is the important bit my IBS was playing up big time. I think that was what made it so bad. I'm now 5 weeks later and managed to go back to the gym last week now if I only go once a day my pain is a 3 and only last a few hours just stinging no spasms. I can't comment on how it is if I go more than once and I don't want to find out lol.
No one can tell you which is best for you most people recovery very quickly from LIS some are pain free straight away. Your doctor will advise you which is best for you.
All I can say is with hindsight even with all the pain I would still have the LIS as it was the next step on my journey to getting this awful thing healed. Even if your pain is horrendous there are painkillers that do help, including gabapentin. Do to let fear of pain stop you getting yourself healed once and for all.

Thanks so much for that Mpb, I think I'd willingly go through hell for a little while and know I could come out the other side with a potentially better quality of life. I'm not an expert on LIS and wondered if you could fill me in a bit.

1. Will it make passing stools easier as I feel the tightness really isn't allowing anything halfway large to pass through comfortably?

2. Do they treat any other issues during the operation such as piles or scar tissue?

3. Will the resting pressure be permanently altered to something approaching normal?

4. Will this open up foods which have been off the menu for years?

5. What are the chances getting a fissure at some time in the future - slightly reduced or drastically reduced?

6. Did you do any research on your surgeon?

I just wondered what your CR surgeon/consultant had told you regarding the outcome. I just feel I need to get this thing dealt with once and for all. By the way, were you encouraged to try the biofeedback breathing thing first? I spent about £500 on it and to be honest the results are minimal. Incidentally, thanks so much for all your help and encouraging words so far.

For what it's worth, I think you're very brave going for the LIS operation. I had a hernia op a couple years ago under local anaesthetic and the surgeon didn't put enough painkiller on the incision area and I felt the scalpel cutting, so she stopped and refroze it. An 'interesting' experience!

Hi I will answer as best I can

1) yes it should make passing stools a lot easier some people say they just fall out after LIS with no straining at all...I personally haven't found this but I have never had a problem passing normal sized stools so maybe that's why I don't notice much difference. I also have quite a few hems but the majority of people find actually going to the toilet becomes painless

2) this depends on you and your surgeon. They may clean the edges of your fissure to help it heal that's the most common thing....on the nhs they don't often remove the hems with LIS unless they are causing a problem, my surgeon left them alone as we both agreed that would cause extra pain and could lead to more scar tissue and even stenosis...but I have a lot of hems and they don't bother me so I wasn't willing to risk it as long as they weren't stoping my fissure heal.

3) yes in the sense that you should never go back to 120 but it will try and repair itself over time...my surgeon said that my pressure should go down to sround 80 if I was lucky but over time may creep back up to 100 possibly

4) again this is different for everyone if you don't have IBS or mainly suffer from constipation then yes you can eat food you couldn't before. If like me you have severe diarrhoea from your IBS then no I will never touch dairy again and maybe not alcohol either as my surgeon says diarrhoea is the worst as it thins the skin literally striping layers away.

5) again that depends on why you got it if it's constipation or just simply high sphincter tone then it's greatly reduced think he said 1 in 1000 but like above if you have diarrhoea that you don't or can't manage then recurrence is more likely.

6) I had to do a lot of research as I had been turned down for LIS by two other surgeons on the nhs due to my other issues. I found one who specialises in IBD so had experience of my condition and was willing to work with me....I also asked him how many LIS he had done and is still doing as he now teaches too...it's ok being very knowledgable if your experience is all in the past. He has been amazing and very understanding he was kind enough not to say I told you so when I went back crying about the agony. I think it's important to have trust especially if like me you have quite a complicated set of circumstances.

Non of my surgeons mentioned bio feedback as I guess in my case when there is no pushing or straining involved most of the time and my last one said it's rarely useful except in certain cases

You are more than welcome....oh my life I would have kicked her if that had happened to me....she certainly wouldn't be going near my butt ever again. Do you think the hem op may have caused some narrowing. My CRS says he's very reluctant to remove hems on people with fissure for that reason

Thanks so much for you answer. I didn't have a hem operation, it was for a hernia. That was a fun recovery, as you don't realise how many stomach muscles you use during a bowel motion. It was about 4-6" incision. I had mesh put in to protect the stomach's lining and it's largely been a lot better. I can't really lift anything heavy anymore, but if I'm careful I get little or no pain from hernia site. I feel like a walking disaster area sometimes lol!

Going back to the LIS. I'm only guessing but if anyone does get a fissure again, healing would probably be easier as the resting pressure should be less. At least that's what I'm presuming.

Incidentally, how do you go about finding a good surgeon? I wouldn't know where to start. Also, what was your time frame from seeing your CRS to getting to have the op?

Oh gosh that doesn't sound fun, yes I can imagine it's one of those things you don't notice you use until it hurts
Oh yes the recovery if you get another fissure is meant to be much easier and much quicker.
I as have a few friends with colostomies they went on their advice sites and asked for me I'm in South Yorkshire and thankfully Sheffield has a really good teaching hospital so I found my brilliant surgeon there....I paid £300 for a private consultation and then he transferred me to his nhs list I waited 6 weeks for the Botox which he needed to do first to try and make my fissure a bit smaller. Most private surgeons will transfer you to nhs after a consult

That's good to know regarding the private to NHS transfer. I had to go private for my hernia op as the NHS no longer deem it necessary for surgical intervention. My pain certainly wasn't telling me that! It cost me £2,500. Now I'm sadly not in a position to go for a private op if I have the LIS. We do have a brand new hospital building in Bristol, which I'd imagine is more state-of-the-art than the previous incarnation on the site.

Despite the boo-boo with the anaesthetic, my consultant surgeon was pretty good in fixing my hernia, although I wished I'd opted for keyhole as the recovery time is shorter. She was also very gentle with her examinations, which was a big plus for me. I must admit I do try and see female doctors if I can simply because they tend to be gentler and have smaller fingers lol!

Hehehe I have never managed to get to see a female doctor apart from my GP.
I once walked into the DRs office to be greater by this very tall very rotund CRS and he shook my hand I was like...there is no way you are examining me lol.
Yes the price for LIS is £2000 and the waiting time at least where I am wasn't too bad especially as my spasms were kind of under control. If you do go on the NHS phone up twice a week to ask if there are any cancelations once you have had your pre op as there often are because people get colds ect, my friend did that for an ankle op and she got in 5 days after her pre op.