I am a 37 year old male and new to this forum, but not new to the pain of anal fissures. I have had chronic rectal pain for about 10 years and have been diagnosed with everything from prostatitis to levator syndrome, to pudendal neuralgia and chronic pelvic pain syndrome. About 4 years ago, I developed my first anal fissure. Over the past 4 years, I have developed about one fissure per year, all of which have healed with very conservative treatment in about a month. Unfortunately, I developed another fissure last week. I have a very difficult time with bowel movements due to pretty severe hypertonicity in the anal canal that doesn't allow for relaxation and easy bowel movements even with very soft stool. I have had many doctors discourage me from any type of rectal surgery because of the chronic pain condition that I have, which did not develop as a result of fissures, but as a result of nerve and muscle issues in the pelvic floor and rectum. However, I want to get rid of these recurrent fissures for good and am considering the LIS surgery. I want to know whether this surgery permanently loosens the muscles or if it is just temporary. I don't really want to do the surgery if there is a good chance that I will develop fissures again in the future or if the surgery will not help with my bowel evacuation issues.
Anyone who has experience with LIS please post. I'd appreciate it. Thanks.

Steve Pain is scheduled for LIS tomorrow (in the UK). Plus several other people here have had that surgery. Have you ever had the anal rectal manometry test? I was diagnosed with Pelvic Floor Dysfunction via that test and went through the Pelvic Floor Retraining Class (10 days) at the Mayo Clinic in Minnesota. Where do you live?????

I live in New Mexico, so if I do decide to have the surgery, I will have to find an out of state surgeon, because there are only 2 colorectal surgeons in the state of NM and they will not do LIS because of the risks associated. I was scheduled for anal manometry last year, but developed a fissure and was not able to do the test. I did not reschedule, but I did visit a chronic pelvic pain clinic in Northern California for 3 weeks this past December and also followed up with the clinic for 2 days in January and 2 days in July. I had some pudendal nerve blocks done and some internal manual therapy, but obviously it did not relax my muscles as I have developed another fissure due to incredibly difficult bowel evacuation.

Do you know what the initial cause of your problem was? There is a Mayo Clinic in Arizona, Scotsdale, I think. I don't know how far away that would be for you. I was at my wit's end b/4 I finally got some answers (and some relief) to my digestive (including rectal) problems after having seen several docs in my area (Central Illinois).

I've actually visited the Mayo Clinic in Phoenix/Scottsdale. The colorectal surgeon there was unable to perform and adequate rectal exam because my rectum was so tight. Although, I've never had that issue with any other CS who has examined me in the past, so he may not have been the best CS, even if he was at the Mayo Clinic. He basically diagnosed me with hypertonicity in the anal canal with possible levator syndrome. I was referred to a PT at Mayo in Phoenix, but after seeing him for one visit, he recommended either going to one of the CPPS clinics in Northern California or going to Mayo in Rochester, because they are better suited for this type of disorder. I opted to go to Northern California, but that didn't really work out that well. I have, what I think is a pretty accurate diagnosis for my condition, but I just haven't found a good treatment. My condition really just started suddenly as the "golf ball" sensation in the rectum. Wasn't overly painful, just uncomfortable, mostly to sit. The fissures and hemorrhoids didn't start until about 4 years ago. Believe it or not, I can deal with the "normal" rectal discomfort, but the anal fissures are what makes my life completely miserable. I also didn't really have severe issues with bowel movements until about 4 years ago. Before that, I could just eat fiber and drink water and I'd have a pretty easy bm each morning. Now, even with soft stool, it's like giving birth each day. So did you have surgery or did you find relief from the program at Mayo? Did you suffer with anal fissures? If so, did they resolve without invasive treatment and how often did you get them? Thanks.

I have not had any rectal surgeries! I gradually started to improve while I awaited taking the Pelvic Floor Retraining Class after being diagnosed with Pelvic Floor Dysfunction. I was diagnosed with an AF in April of 2008, shortly b/4 I joined this group. It was an up and down trajectory of gradual healing for me with the help of an A/D, seeing a local psychiatrist, adjusting my Miralax, Benefiber, and Metamucil supplements, and finally taking the Mayo class a little over a year ago. I have been seen by both the GI department and CRS department at Mayos in Rochester. I gradually started to improve over time, but still used my Diliatzem ointment as needed when I would have a problem. The last time I had an issue with my butt was last December. As I recall, I had some pain, but no blood. I think Mayos in Rochester might be better (bigger) than their 2 satellites (Arizona and Florida). If you can afford it and it would work with your schedule, I would strongly urge you to try to schedule an appointment at Mayos in Rochester. If you want the name of my GI doc there, you can send me a PM. The nurse that I worked with during my Pelvic Floor Retraining Class told me that often times people with rectal troubles think (or are told) that their sphincter is the problem, but really the problem for many people is their pelvic floor muscles (training them to relax and stay relaxed). When I took the anal rectal manometry test, I could not expel the inserted balloon. After completing the 2-week class, I could. They have a 70% success rate in Rochester of helping people overcome Pelvic Floor Dysfunction. How old are you??? Our conditions might be different. I don't recall feeling like I had a golf ball in my rectum!!

Thank you for the information. I am 37 years old. I do think that what you're describing is something that could benefit me, however, I can't imagine that it could be helpful while I'm dealing with an anal fissure. I think that I would need to get the fissure issue resolved before I have anyone putting anything into my rectum. How did you end up at Mayo? Did you just call and request an appointment for the program or did you have to see a doctor first and be referred to the program?

I know what you mean about having anyone touch your rectum while suffering from an AF!!! My local CRS first diagnosed me by gently pulling the buttocks apart (no anuscope).
My main troubles prior to getting the AF were ab pain and constipation. I was treated by a local GI doc who tried me on various prescription meds for constipation and had me have a CT scan, an MRI, a barium enema, and a flex sig. I did all of that and still had ab pain. I had basically lost all confidence in my local GI and had no luck with other docs in my area that I also saw for my problem. Two of my relatives who have both been treated at Mayos surgically suggested I go there. Many people from our area go to Rochester Mayo because we are only 6 hours driving distance from there. I know of another person from our area who recently had surgery there, and many people go there for a second opinion. I went there to urology in 1990, so I was somewhat familiar with the place, and my dad had open heart surgery there in the 80's and was always very impressed with Mayos. He had been to Mayo Scotsdale and maybe Jacksonville, Florida, also. I'm not sure if they have the Pelvic Floor Retraining Class in Arizona and Florida or not. My GI doc has since become head of the Department of Medicine at Rochester Mayo. He now supervises 800 people, but is not arrogant or pompous!!

Hey there,
I had LIS and so have a bunch of others here. Many are not active on the boards anymore because they've healed and moved on, but some still are. There are no guarantees whether you opt for LIS or not. For most people, the long term results are good, but you can't say with 100% certainty that it will fix the problem for good or that there won't be complications from surgery. But the odds are in your favor.
BTW what have you tried so far for your latest and most persistent fissure besides nerve blocks and physical therapy? Have you tried any of the ointments like nitroglycerin, nifedipine, or diltiazem? What about stool softeners? Or even Botox injections? If you do have severe hypertonicity issues, then it may be that nothing short of surgery will cure it, but there are definitely other things you can try first.
Also, are you thinking of getting the surgery done in Nor Cal? I'm surprised there are only two colorectal surgeons in NM but we have plenty here in both Nor Cal and So Cal. I'm sure you'd be able to get some recommendations if that's where you decide to end up going for it.
I'm 3 months after LIS and haven't arrived at a firm conclusion as to whether I think it was worth it yet. But that's mostly because my fissure wasn't too painful before surgery. If I were in severe pain before surgery, I would definitely say it was worth it at this point. You can find a huge thread with all my post-op whining a few threads down in this forum if you're interested :)

My rectal pain problems were not the result of anal fissures in the beginning. The anal fissures developed much later. Most of the treatment that I've received over the years has been aimed at the nerve and muscle problems that I have in the rectum. I have not tried botox, but I have used nifedipine with no success. Since 2006, I've had about 1 fissure per year and they have each healed with conservative treatment in about 4 to 6 weeks. I have just developed another fissure within the past two weeks and I am wondering if I'm at a point where I need to consider surgery to reduce the chances of continued development of fissures in the future. I live in New Mexico and there are only 2 board certified colorectal surgeons in the state and neither one of them have offered LIS surgery as an option for me, because they feel that the risks are too great. I have been researching surgeons in nearby states, such as Texas and Arizona, but I don't know anything about these surgeons other than what I read on their websites. I am considering Mayo Clinic in Phoenix as an option. I just wanted to know if anyone has had the surgery and what the outcomes were.