So sorry to hear about your frustrations.
IMHO It sounds to me like your crs is maybe conservative when it comes to cutting - I mean, you said that he had that reputation on "rate my doctor", and then he was just going to "look and cut if necessary", and ... I know you've had LIS before and it didn't seem to work... did he cut conservatively the first time? This is just my guess from reading what you've written. You might want to ask him some specific questions about the cut he made before and what the plan is for this LIS, and see if anyone here has any opinions on it? Just a thought...
As far as what he did or didn't do last time, can you get a copy of your medical journal?

Yes you're right about the conservative cut, that was his main theory of why it didn't heal. He said 5% of patients go on to need an additional surgery. When I asked him about his incontinent rates, he said 2% but no one lost stool, just gas and perhaps minor soiling. He said no one's problems were bad enough to warrant a surgery to correct it. He also said he used to do tons of LIS's but ever since nifedeprine came on the market it is not needed much anymore, but then we are all here aren't we? It is nice to have this group around and know you are not alone. As for my medical journal, I actually took a sneak peek while in the hospital. A nurse came over and gave me complete @|$ for it, but they are the ones that left it on my bed! If I really wanted a copy I'd have to pay and sign papers at the local records office, and it would take time. I already did that in my home town, which is how I knew that doctors were calling me "paranoid" and that my symptoms were "inconsistent" because they actually wrote that in thier notes! Bastards!!!! At my last consult I told my CRS this and he is writing a detailed letter to my primary doc about how debilitating this is for me and what he thinks is causing it and future recommendations. He appologized for doctors everywhere and said their labelling of me was just plain wrong. Right now, he's the only one in my corner, so I think.

I don't know if it is the state that I live in, but have never had any trouble getting my records, in fact I always get them. Even managed to get them from Denmark. They are YOUR records. That is awful what the doctors wrote. Usually they go out of their way in their descriptions of their patients, to be polite.

In Canada, we have something called PHIPA which basically allows the patients rights to their records but it takes money and time. I paid $50.00 and waited three weeks last time and had two appointments booked with a clerk. Once for viewing and the other to pick up my file. They make it a hassle. As for the labelling of me, I know it sounds nuts but it is true. We have a 70% turnover rate in physicians every year. We either get brand new physicians from foreign coutries or physicians that would not be employable in other places. Everytime I've seen a doctor in the capital city its been a good experience.

I forgot to add my problem is not just fissures, it is pelvic floor dysfunction(levator ani) and seperation of my pubic bone. So when they didn' t know why my pain was so intense they concluded it was in my head. At the time I was seeing those doctors I didn't have much of a diagnosis yet either. It is an ego - driven response by them. After the doctor heard my complaints, decided they didn't know what to do with me, they would flip back to the last doctor's note in my chart. That is how the labelling happened.

Yes! The typical response - A hysterical woman! (or it can be a man with this). I think it is interesting too, all the mention we see here of AF in conjunction with other near-by pain, whether men or women.
Ooo, separation of the pubic bone, sounds very painful.

So March 4th is my new date......
I'm totally consumed right now of whether or not I am going through with it. I'm looking for advice on what you would do if you were me. Keep in mind that getting a second opinion from a qualified CRS within the next short while is near impossible because of wait times. I could ask a gp but they don't know much. I was misdiagnosed with hemmeroids for years by them.
Current problem with rectal area:
1. Last 6 days BM's have not hurt (extremely mild burning - but one could expect that without a fissure). Last time I had blood was three weeks ago with moderate burning lasting about 1 minute afterward. No need to push at all with movements. After I switched back to Metamucil there has been 0 clean up problems either. Occassional "zingers" not related to bm - 2 this week. But this procta fugax may or may not be related.
2. Pressure sensations are relentless. This is by far the most distressing symptom. It is 24/7! NSAIDS do not help at all. I've recently started an anti-depressant and added Ativan to the mix which helps me sleep. The Ativan (muscle relaxant properties) is gentle on my stomach and I feel somewhat less pressure the following day, however still very uncomfortable.
The pressure feels like my sphincter is warm and swollen and it extends higher up in the canal, spreading to perenium/vagina. My sphincter even looks swollen at the top as described as the skin there is redder than the rest of the sphincter. I feel the same in the a.m as in the p.m. Like there is something lodged there. I know this is pelvic floor dysfunction (levetor ani) But what I do not know is how much the fissure is aggravating it or causing it for that matter. But the weird part is the sphincter is swollen particularly at the top (anterior - closest to vagina). I have a small skin tag there from an old fissure. My fissure that I can see sometimes is deeper set in the canal and at the posterior position (closer to tailbone). Today I am wondering it is healed as it is difficult to see. I think it depends on how irritated it is, by the day as it is deeper set.
When I use my nifediprine it no longer hurts at all to insert my finger and rub the paste around (as it did before LIS #1).
Do you think I should still proceed? I'm on dissability right now as this whole thing is soooo annooying, frustrating, painful and caused me stress to the point I cry on a daily basis.
I just want my life back, to be a mom, loving wife, successful teacher and smile and have fun like I used to. This thing has destroyed who I am or used to be. I'm crying right now as I type this.... My husband really wants me to do the surgery again, but what I fear is that it will make my problems worse by not curing the pressure sensation and now will have an incontinet issue. I've done so much research on line and don't think I'll stumble accross anything new. I really am so scared. If it is fissure related, why don't I have the shard of glass feeling anymore? Any thoughts? Personal experience with spasms/pain? Do you ever have periods of painless bm's? If you were me, would you go through with it? I also live 8 hours away from CRS so can't stop in for a check up before my surgery date. I fear if I call him he'll just cancel my surgery.
Thanks for listening!

Poor you, this is a tough choice.
You are against a wall with time considerations and I understand how hard it is for you to get a second opinion. I take it you don't currently have any incontinence issues? For what it's worth, you wouldn't be the first board member here to have to do the surgery more than once...a member called Nancyfezz had to do it three times even.
I have had times when I noticed swelling at the top like you mention--no idea what that was about and it's gone now. The question is--do you still think your sphincter is tight? How easy is it to pass a BM? Does your CRS think it's still too tight? He does sound like a conservative guy, maybe when he did the first surgery he just didn't want to cut too much and therefore ended up not cutting enough.
No one has any idea what's causing your pressure sensations? Am I right in thinking that's your main concern, rather than fissure pain/bleeding? I feel for you.
I wouldn't begin to know how to tell you what to do...but I understand you have to do something to get your life back. Best wishes with what you decide!

I haven't had LIS, but I did have a few thoughts...
One was like alpine - do you have a feeling for how tight your sphincter is? Can you pass gas?
I have had painless BMs for the past month, the zingers have disappeared, and I'm left with something similar to what you describe (though not as bad, since it disappears usually after 4 or 5 hours) - a pressure feeling which feels "high up" which often feels like it is swollen to the extent that it makes my vagina walls ache. I find it aggravates things to stand or walk (possibly leading to more painful spasms and increased pressure), so I just lie down for a couple hours after my morning BM. I've also had very little blood. However, passing gas is now possible for me (it wasn't some months ago). Anyway... since I was just at the doctors yesterday, I know that I have a small, unhealed fissure (with skin tag). I thought maybe mine was healed, but he said it wasn't, as it did bleed yesterday when examined. He said my sphincter was tight but not super tight.
So, it's fully possible that your fissure is still active, but that you have symptoms like you describe, IMHO.
I'm thinking a little about Bambi, whose surgeon said just before surgery that her sphincter was really tight... is there someway you can get some feeling about this - and if it is really tight, maybe this is an indication that you should consider this???
I know what you mean about getting your life back, and really sympathize with you.

Hey Desperate,
I'm so sorry you're going through this! I had the pressure feeling before my lis and it would last all day, and get worse when I needed to have a bm. I did not always have the shards of glass feeling during the 8 months with my fissure. That happened a couple of time because of foods I had eaten or what have you... I would soak , correct my diet and by two weeks the shards of glass would be under control. I did have the mild burning often and no blood for weeks at a time. It sounds like you may still be having spasms by the way you describe the pressure?!
It seems like your quality of life isn't the best right now to say the least. I'm so sorry and can understand how hard this is on a person. I was so depressed before I healed....
Here's my 2 cents... If it were me and I didn't get the results I expected after my first LIS and I trusted my CRS, then I would have to gamble to get my life back by having a second one. This is no way to live and suffer when all you may need is the second one because the cut wasn't sufficient the first time. I know this sucks and I hope I never have to do the surgery again, but things aren't going to get better without going the next step.
I think the second LIS just may be the charm for you. Look at Fissy and many others who got the results they had hoped for after going that second time. I know it's a terrible place to be in but stay strong and try and get your life back.