To have Surgery or not?

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To have Surgery or not?

Postby arbguy1 » 03 Nov 2013, 00:50

Hi,

I first got my fissure in Mar 2011. Since then it bothered me only about once in a while for 2-3 days at time and was pretty manageable. However, things took a turn for the worse this April and since then I have been constantly dealing with the fissure. I saw a GI doc in early June who put me on Rectiv and I was on it for three months. When that didn't help I consulted 3 different CRS's since then I have been on Nifedipine for about 1.5 months, again without any improvement.

Each CRS examined me and told me to continue the regimen water/miralax/rectiv/nifedipine and see them in a month, I have gone back to the first two and am going back to the 3rd in a couple of weeks. The first two more or less said that surgery was the only option at this stage and they didn't think I could heal based on conservative measures alone. The first CRS does what is known as Standardized Anal Dilation(SAD), while the second does LIS. The third said that she does both both Botox and LIS. I have more or less ruled out the SAD and Botox (low healing rates and high recurrence rates compared to LIS) and decided that if I have surgery it will be LIS.

I have come here to get some advice on whether to have the surgery. The thing is that my fissure isn't very painful - the bowel movements are painless (thanks to miralax), the pain happens post bm, only when I am sitting down - it is a 3-4 level pain, unlike some of the horror stories that I have read here. The problem however is that dealing with this kind of pain day after day, wears me down mentally and physically. I have been on a strict diet, maintained soft stools with a combination of water/fiber and miralax, done regular sitz baths, tried all kinds of remedies seen here - manuka honey, coconut oil, vitamin B6/B12/C/E etc. but haven't been able to shake off the fissure. I have curtailed my social activities, exercise/running. While thankfully, I can manage OK at work, I am at a stage where I wanted to push hard on the career front, but the fissure prevents me from doing so. More importantly, I have struggled with (thankfully minor) depression in the past and I am worried that the longer the fissure and its collateral damages linger, the higher my chances of relapsing.

At the same time I am fearful of surgery, I am worried about the recovery period and the risks of incontinence. I am less worried about developing incontinence in the short term (I am a 30 year old male), but more about developing incontinence when I get older as LIS will ensure that the sphincter has permanently lost some of its strength.

I am sorry if this sounds like a rant, but any advice will be appreciated.

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Re: To have Surgery or not?

Postby JHH » 03 Nov 2013, 03:50

Sorry about your troubles, sounds like you have tried just about it all. 2,5 year is a very long time, and I totally understand you want to fix the problem now. If I were in your shoes, I would try Botox first for 3 months, and if that doesn't work out, go for SAD or LIS. I'm assuming you are using a stool softener, and have consistent soft stools, otherwise, that would be the place to start.

Oh btw, I need to know one thing. From where do you have the info, that LIS has higher healing rate and lower recurrence rates than SAD?
- Fissure developed in Jan '13
- Started rectogesic in Feb '13 and diltiazem Apr '13.
- Got botox Jun '13
- Healed by Okt '13, although I still had some irritation for about a year.
- Now Feb '16, all is good. Still take magnesia, and squat precautionary.
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Re: To have Surgery or not?

Postby owmybum » 03 Nov 2013, 06:39

Hi,
You have been suffering for around the same length of time as me, and if I was given the option of LIS I would jump at it!

Your symptoms are that associated with a high anal resting pressure.... No pain on bm, pain after... So I would assume LIS would be the answer for you.

At the end of the day though, the ball is in your court, and only you can decide how you want to move forward with this.... If atall.

Good luck with your decision!!

OMB x
fissure after hem banding and tag removal feb 11
Pelvic floor therapy
Diltiazem
Botox June 13
Nitro
Internal flap July 14
EUA and polyps removed Nov 14
Diagnosed with neuropathy Jan 15
Diagnosed with HS EDS type 3 (causes poor wound healing )
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Re: To have Surgery or not?

Postby arbguy1 » 03 Nov 2013, 10:59

Thanks for you replies.

JHH:
I am on a stool softener, I can't imagine going without it.
I meant that LIS is better in terms of healing and recurrence compared to botox alone and did not compare it to SAD. I am sorry if my post conveyed otherwise. My preference for LIS has partly to do with the CRS, I think I prefer the CRS's who do the LIS to the one who does the SAD (they seem more experienced). It is also partly because LIS is the more popular procedure in the US, while I have read the SAD success stories on this forum, I just feel more comfortable with the LIS.

ownmybum:
Thanks for putting my situation in perspective. I guess it is a choice between wanting my life back and the risks of complications.
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Re: To have Surgery or not?

Postby bumtastic » 07 Nov 2013, 17:28

Hi ArbGuy
Based on my experience with LIS and Fissurectomy the first 4-5 days are the hardest. I didnt defecate for 4 days after LIS. that was my major worry. Pain wise it was manageable. I didnt even need pain killers after the 3rd day. I did take a couple. But i could have easily done without it. After that the recovery is pretty smooth. As for incontinence, i had a couple of incidents the first week. But havent had any issues so far. I am glad i did it because my life is so much better now. No more looking after my bum like it is a baby. Surgery is a good option if yours has gotten chronic. So it is upto you. The choice is always yours.
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Re: To have Surgery or not?

Postby FissureHome » 20 Nov 2013, 14:34

I too am worried about incontinence im only 29..its only been 2 months but so sick of "taken care of my bum like its a baby" its so mental draining always having to think about it and worry about it..my doc didnt even offer botox he just said LIS maybe he doesnt do it..but i too have read the botox alot of times only works for a short period and pain comes back..always worried about choosing the right surgeon..
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Re: To have Surgery or not?

Postby arbguy1 » 30 Nov 2013, 01:47

I thought that I should post an update.
I went to my third CRS for a follow up on 18th Nov. and she said that the fissure wasn't getting better and it was time to move on to the next phase and offered me a choice of botox or LIS. I decided that I wanted to end this once and for all and decided to go for LIS. She said that she would also do a colonoscopy at the same time to rule out other issues. She then said to schedule a surgery date with her secretary. I had also decided before hand that of the three CRS this one was the most appropriate.

Before leaving she decided to take a look at the fissure. She said that the fissure was relatively small and asked me if I wanted her to cauterize it with Silver Nitrate. I asked her if that would heal the fissure, she said that fissures are tricky and that you never know. My mind wasn't functioning with complete clarity at that time because my pants were around my ankles and the CRS and a nurse were in the room. So I told her to go ahead. The cauterization wasn't really a big deal, the most painful part was stretching the anus to get at the fissure. The CRS then put a gauze and then left. I didn't think much of the cauterization at that time because I have seen many improvements in the fissure followed by re-tears. In any case I scheduled the surgery for Dec. 17th. The timing was great as it being right before the holiday break, I would have to take a very few days off from work.

After the appointment I went to work and I had a burny/itchy feeling from the cauterization all day. After work, I got home and jumped into the sitz bath and the gauze came off on its own. After the cauterization I seemed to have improved steadily, I have not seen blood on the toilet paper since then and the pain has been reducing significantly. So much so, that I am tempted to cancel/postpone the surgery or talk to the doctor to do a botox instead of the surgery. I am keeping my fingers crossed.

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Re: To have Surgery or not?

Postby pinpin » 30 Nov 2013, 06:42

I saw a lot of positive stories about cauterization on the internet, but was never offered to perform one on me...
07.02.2013 - got open hemorrhoidectomy, leaded to slow healing wound. Link to story
11.12.2013 - LIS surgery
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Re: To have Surgery or not?

Postby FissureHome » 05 Dec 2013, 05:30

Arbguy1 how are you feeling after cauterization are you still going in for your surgery? if you i do i hope you will continue to update us either way on your progress! Good Luck to you!
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Re: To have Surgery or not?

Postby arbguy1 » 18 Jan 2014, 23:10

A long overdue update. A draft that I had written earlier got deleted due to some network problems.

I ended up not having the surgery. I wasn't able to get an appointment with the CRS before the surgery date and talked to her over the phone and she basically told me that it was up to me to decide. After a lot of thought I decided against having the surgery as I was feeling much better. Later on I visited the CRS for a followup appointment and after examining me she said that the fissure was healing up nicely. At the begining of the appointment the CRS said that she might want to do another round of cauterization, but after examining me she said that it wasn't necessary. She told me to continue with the therapy - nifedipine/water/fiber/miralax.

I have been doing quite well since then - I haven't noticed any blood since the cauterization (about two months now) and the pain while sitting/standing/walking has reduced considerably. I still have some minor issues though - if I have a hard bowel movement, I am in some discomfort for a day or two and when I get up after sitting for a long time, my buttocks, perineum, upper thighs feel slightly painful and stiff - but they seem to be resolving slowly. I feel that I am not completely out of the woods yet. I am going by what I have read here - that it can take upto a year for a fissure to heal completely and plan to continue the therapy till then. I have managed to taper down my miralax to half a dose without any problems and hope that in due course of time I will be able to completely wean myself off of it. Hopefully at some point, I will be able to make a post in the success stories section.

Based on my positive experience with Silver Nitrate Cauterization, I urge others to consider it. I feel that the cauterization does not have a high success rate otherwise it would have been more popular, but in some cases such as mine it might work. It might be something to try after ointments have failed but before botox or LIS.

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