As with many on the forum, this is a longer story, so forgive me for the long post!

Background:
I am a 43 year old male with 20 years of anal itching, only at night, without any other problems. I never did anything about this since it did not seem bothersome enough to risk the "embarrassment". In hindsight, the itching was probably due to micro tears after BM and straining. Showering the area directly after a BM caused a stingy feeling. Most of my BMs have always involved straining.

October 2014: Some blood when wiping after BM, but no pain. Applied some nitro, but the problem persisted.

June 2015: Saw a physician assistant (quite common in the US for minor problems) to get to the bottom of this. On a visual inspection he told me "Oh you have hemorrhoids", then proceeded to perform a torture session with his finger, called a digital exam. It was very tight, and he seemed to crank his finger around as if trying to start the stubborn ignition of a broken car. This cause real damage, but he did diagnose a fissure. The BM the following days was really painful. However, the swelling subsided, I quit drinking coffee, and things got better until I thought everything was back to normal. But one hard BM and the pain came back.
Due to the "swelling" I was convinced I had external hemorrhoids and was trying out all sorts of remedies for that, including acupuncture.

November 2015: Saw an internist who took a good look and told me those were no hemorrhoids, but swelling/inflammation from the fissure. She recommended anal stretching. Some research confirmed to me that the procedure seemed outdated.

January 2016: Found a colorectal surgeon who had great yelp reviews and who really took her time explaining to me that my problem was caused by a fissure and tight sphincter. She also told me I did not have hemorrhoids. I told her I wanted to try nitro (which I had stopped using because I thought I had hemorrhoids), before trying other options. At that time my fissure was probably already chronic. At the same time I found the first real remedy I would recommend: Tordynex. This is a German company that sells a small anal plug to heal fissures. I tried it out, and it seemed to work.

April 2016: My colorectal surgeon tells me the fissure is gone. I had no pain, no blood and also couldn't feel anything unusual down there (except for a skin tag which I had had for 15 years). Bingo! Done! That's what I thought at least.

My anal itching had completely stopped ever since my increased fibre intake. So I was surprised to feel an itch after a long time. The base of the skin tag began to itch, and I scratched. Bad choice! Those of you who have had the itch know what I am talking about. The kind where you just cannot stop scratching and massaging. It turned out to be very destructive. My entire butthole seemed inflamed, inside and out. The area felt hot like a sunburn. And shortly after, the fissure reappeared.

May/June 2016: Two sessions of botox, which did loosen things up, but did not heal the fissure.

Since May 2016 I have been yoyo-ing between better, and "almost healed", and then back to square one. I have been using the Tordynex butt plug daily for up to 2 hours, and that seems to keep things at bay for the most part. But it is extremely time consuming. I am also really watching my diet, taking fiber supplement and stool softeners for almost a year.

September 2016: One harder bowel movement, and the familiar pain and blood were back. I know I can probably heal this over the next 4 weeks to some degree, but I now know from experience there will always be relapses, and I am sick and tired of that. It consumes a large part of my daily life. Most of my pain is associated with bowl movements, and sometimes intense burning for several hours after BM. Other days are pretty much pain free.

Still, I would like a permanent solution and want my life back, which is why I am now scheduled for LIS next week. I can't even begin to list how much time has been invested into this butt problem, including what feels like a full time job on the computer researching and re-researching this issue.

Thoughts about LIS: My overruling, number one worry is the pain associated with the days after surgery and during
BMs. I have no illusions in that healing will take weeks, but I am hoping to see good improvement in the first week. I need to drive for work and being able to sit in a car 1 week post op would be great. Incontinence, if temporary, is not really a concern. Of course, permanent incontinence would be horrible, but I think the chances are good enough that it will not happen. Fingers crossed.

I will also have one skin tag removed, and that is almost a bigger worry, since the doctor told me it will be left open to heal. I can't even imagine how I can take a sitzbath with an open wound. All I know is that others have been through this and survived it.

One question which I forgot to ask the doctor: Will the LIS incision, which she performs on the outside, also be left open? Or will there be stitches? Does anybody know?

Another question: the doctor said she cauterize the edges of the fissure. Has anybody experienced this?

Hi happyending,

I'm sorry you've been dealing with this for so long and applaud you for trying more conservative methods first.

I've had the LIS surgery 4 weeks ago and I'm glad I had the surgery.

To address your first question - the physician may or may not give you stitches. I did not know that I had stitches but I started itching really had 1.5 weeks after the surgery and found the stitches when I scratched! The doc confirmed I did in fact have stitches. Not everyone has them though.

I do not know the answer to your follow up question regarding cauterization.. usually docs will cauterize large blood vessels but the purpose of LIS is to increase blood flow.. so I'd be curious to hear what that is about too. Maybe related to hemmorrhoids?

To your indirect question regarding driving.. I work an hour away from my home. Two days after my surgery I drove to work but really regretted it. Pressing the gas was fine but when I had to move semi+quickly to break I thought I was going to rip myself open. I took a few more days off after that before I drove again. 1 full week post surgery and I was driving with no issues.

Hope this response helps in some way! Good luck with your operation!!

Hey Buttpalsteven, thanks for the quick response and the encouraging words. I am glad to hear from somebody who seems to be getting better quickly after LIS!
The doc said she would cauterize the edges of the fissure because with a chronic fissure they are often times not very smooth. So she does it to facilitate healing. But you are right, it seems counter-intuitive.