One Week Since my LIS Surgery!

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One Week Since my LIS Surgery!

Postby TheBoognish » 03 Apr 2011, 19:19

I've been on this message board a lot the past 8 months and I wanted to share my Anal Fissure experience and how it treated it. I hope that those who read this will feel more informed and be less apprehensive about the various medical options so they can recover quickly from this incredibly painful condition. Anal Fissures are embarrassing, control your life, and can be totally debilitating. You feel like you can't talk about it with anyone, so please know that you aren't alone.
I'm a 28 year old male and began experiencing rectal pain in September 2010. I never had pain during bowel movements but I would experience incredibly painful spasms for about 5-8 hours after using the bathroom. I figured it was an anal fissure...I've had acute fissures in the past so I took stool softeners, drank lots of water, and kept a bland/high fiber diet. Nothing seemed to work and the pain got worse over the next few weeks.
I saw a Gastroenterologist in early November 2010. He didn't find an anal fissure so he scheduled a colonoscopy because my older & younger sisters both suffer from IBS (Ulcerative Colitis and Crohn's respectively). The colonoscopy found evidence of Crohn's so he started treating me for that. He prescribed Entocort, Pentasa, and Canasa for the Crohn's. Ultracet (Tramadol Acetaminophen) and Lidocaine cream were prescribed for the rectal pain.
In January 2011, the pain got so bad that that I scheduled an emergency doctor appointment. My regular Gastroenterologist wasn't in so I saw one of his colleagues. He immediately found an anal fissure in the 6 o'clock position. Naturally, I decided to switch to this doctor right away. He told me to take Sitz baths as needed for the pain (ah, he relief!) and Nifedpine 0.2% cream. I also took Metamucil 3 times a day and 3 Colace pills before bedtime. This made me feel a little better but the monster always poked his head out again after a few days. It got real bad after about 3 weeks, so I saw the doctor again. He did a sigmoidosopy and closely examined the fissure. He also took a biopsy to see if there was any correlation between the fissure and the Crohn's disease. Luckily, there wasn't. In fact, my Crohn's isn't active and never has been. Hopefully, it will stay that way.
The Gastroenterologist recommended a colorectal surgeon so I made an appointment for the following day. The surgeon was adamant that we try Botox injections because surgery could cause problems later on if my Crohn's disease ever became active (I liked him already)! The Botox provided huge relief because it paralyzed the internal sphincter muscle (I didn't know that we have two) and the internal spasms were my biggest problem. I was able to control the external Sphincter spasms with sitz baths and Lidocaine cream. From February to mid-March the pain was at a level 3-5 instead of a 10.
However, the Botox never fully healed the fissure. The surgeon said that Botox isn't as controlled as surgery. The Lateral Internal Sphincterotomy surgery (LIS) reduces the pressure in the exact area of the fissure. Botox achieves the same result but it isn't permanent and spreads out over a greater area.
I saw the surgeon a month later for my follow-up. He said that we explored all medical options and that the only way to fix this was with the LIS surgery. He opted not to do a fissurectomy, which he said just creates a bigger Fissure. We talked about the risks of incontinence and he assured me that he'd done the surgery at least 100 times a year (he's been practicing for over 20 years) and never had any instances of permanent incontinence. He said that the biggest thing to worry about was infection, which is normal with any surgery.
I had the LIS a week ago (Monday, 3/28/11) and I was incredibly nervous the week prior. I just buried myself in my work (when I was able to stay out of pain) so I wouldn't think about it. Luckily, I can work from home so my boss is allowing me to stay home for two weeks after the surgery. I only needed sick days for the first 3 days.
Sunday night, I stopped eating and drinking at 12 o'clock. I took a fleet enema, which isn't fun when you have an anal fissure. The next morning I took another enema and a sitz bath. They put me out for the surgery, so my mother drove me to and from the hospital. The anesthesiologist also gave me a "block" in my lower spine, which kept me numb for the next 12 hours.
The LIS was a breeze. I was in and out of the hospital in 5 hours. The doctor prescribed me Vicodin, which I only took for the first day as a precaution. I'm not even sure that I needed it.
The next day, I was sore but it wasn't too bad. I was able to walk and use the stairs. I had some trouble sitting but I was still able to do it for short periods. I was really nervous about the 1st bowel movement but it never came.
I finally had a bowel movement two days after the surgery. I was really nervous that it was going to hurt but it wasn't any worse than the pain before the surgery (the Botox still hadn't worn off). Actually, it was better than that and felt like a healthier pain (no spasms, just consistent soreness). I'm pretty sure that that this was from the surgery and not from the fissure.
I still have blood in my stool and on the toilet paper but I expected this after the surgery. The blood is decreasing everyday and it looks like it will stop in a few days.
I started to feel a lot better by the 4th day and I'm now on Day 6. I still take sitz baths after bowel movements but I no longer feel an urgency to do this immediately. I still am, however, because old habits die hard. Two to three hours after I move my bowels and take a sitz bath, I experience "pressure" in the fissure/surgery area. It's really just discomfort and I wouldn't call it pain. Another sitz bath takes care of the pressure and I'm fine for the rest of the day. The "pressure" lessons everyday.
I EXPERIENCED NO INCONTINENCE ISSUES AT ALL!
It's been a rough 8 months but I finally feel like I'm starting to have my life back. I'm beginning to feel like I can be active again and live days where I don't have to make plans around my bowel movements. If you have rectal pain, don't wait to get treatment. They're embarrassing but fissures are very common. I'm glad that I explored all medical options before having the LIS. If all else fails, please feel confident going for the LIS. It's really a walk in the park. The recovery isn't that bad and the incontinence risks are over-exaggerated.
Best of luck to everyone dealing with Anal Fissures! I'll send another update later this week. Feel free to ask me any questions.
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Re: One Week Since my LIS Surgery!

Postby cherylk » 03 Apr 2011, 19:39

Boog,
Thank you for taking the time to post such a detailed personal story which gives hope to many that are still suffering from an AF. My younger son has CD. I hope yours stays inactive. In fact, my husband and I are going to a Crohn's conference in Rosemont (near Chicago) this coming Saturday. Image
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Re: One Week Since my LIS Surgery!

Postby alpinestrawberry » 04 Apr 2011, 08:08

TheBoognish wrote: The surgeon said that Botox isn't as controlled as surgery. The Lateral Internal Sphincterotomy surgery (LIS) reduces the pressure in the exact area of the fissure. Botox achieves the same result but it isn't permanent and spreads out over a greater area.

What an interesting thing...I had never heard this but it makes sense. It helps explain why so many people on this board haven't gotten great results from Botox. I never wanted the botox and wasn't pushed by my surgeon to try it (for which I'm so grateful!) I had surgery 12 days ago, and like you, I've experienced no problems with incontinence or leakage of any sort.
Welcome to the board, and happy healing!
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Re: One Week Since my LIS Surgery!

Postby Elphie » 04 Apr 2011, 18:02

Yes, thanx for that detailed post! I am 23 days away from my surgery and reading positive outcomes eases my fear and confirms to me it's the right thing to do.
Good luck I hope it heals quickly for you!
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Re: One Week Since my LIS Surgery!

Postby TheBoognish » 08 Apr 2011, 08:35

Thank you, everyone, for the kind words. I'm real sorry to hear about your son, Cherylk. My sister has had CD since she was 12 (she's 21 now). She seems to have learned how to cope with it now that she is older. Her biggest problem is the rheumatoid arthritis, which came along with the CD.
I'm happy to say that yesterday (10 Days post LIS) I had my first bowel movement in 8 months where I didn't need to take any sort of pain relief - no lidocaine cream, sitz baths, or oral pain killers! I have a little soreness in the fissure area but it might just be from the surgery...I really can't tell anymore. The soreness lasts for about an hour and then for the rest of the day I have an itch that comes, goes away, and then comes back (likes the spasms). I'm assuming that this is similar to a scab from a healing cut. I have my follow up with the CRS next thursday, so I'm keeping my fingers crossed that all is going well.
I also forgot to mention something about the Botox my initial post. I've read that the injections hurt but I didn't find them to be too bad...it was just a little pinch. It did, however, feel like I got punched inside my butt for the rest of the day (like a booster shot). Although the Botox didn't work, I'd still recommend trying it if your insurance covers it.
I'll update again in a few days. The LIS is a miracle surgery that worked almost instantly and I had NO INCONTINENCE ISSUES.
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Re: One Week Since my LIS Surgery!

Postby Savaici » 08 Apr 2011, 08:39

Good luck! Sounds like you are on your way. I have Behcet's Disease, like Crohn's an autoimmune problem. But no idea if this is the cause of anything I am going through now.
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Re: One Week Since my LIS Surgery!

Postby TheBoognish » 08 Apr 2011, 09:58

Thanks, Savaici. I'm not familiar with Behcet's disease but my Gastroenterologist said that Crohn's can cause infection in the anal canal, which weakens the area making one prone for anal fissures. Recurring fissures after LIS are usually from a condition like CD. My GE did a sigmoidoscopy and took a biopsy of the fissure to make sure that there wasn't any correlation between the two before I consulted with a colorectal surgeon. I got lucky and the biopsy came back negative for Crohn's.
I'm still planning to drink 8-10 glasses of water a day, keep a high fiber diet (fruits, vegetables, whole wheat, etc.), take metamucil 3 times a day, and take colace 3 times a day. I want to get myself off of the colace and reduce the metamucil to 2 times a day but I will to talk with the CRS about it on Thursday.
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Re: One Week Since my LIS Surgery!

Postby PaulsPain » 08 Apr 2011, 20:04

Hi Boog-
Do you know what they tested for when the biopsied your fissure? Granuloma? I am kind of curious. I was just been diagnosed with Crohn's this last fall. All of my biopsies came back negative in my peri-anal area. It was biopsied on two separate occasions - 9 months apart. I did research and was told that granuloma isn't always present with Crohn's disease - so it can't be used as the only indicator. I battled with fissures for about 5 years and then when I was on the operating table, getting a LIS, is when my CRS thought it "looked" like Crohn's. Then I got an abscess and another fistula the later in the year. My CD disease is mainly impacting my peri-anal area with one other small area on my ileocecal valve. My remission will hopefully be the healing of the fistula and fissures that come and go. Still trying to get to that point.....
I wish you continued healing and remission of your Crohn's disease.
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Re: One Week Since my LIS Surgery!

Postby ss616 » 12 Apr 2011, 17:51

Boognish - glad to hear the surgery went so well for you! I had my AF appear 2 months after you, Dec but it did heal in 3 weeks. Now it's back... in the middle of the healing process.
I too am a 28 y/o male, my wife still doesn't believe me when I say how painful an AF is.... you have to have one to understand.
How are you doing now post-LIS? Would love it if you could keep us updated on your recovery/healing so we can use that to determine if surgery is the right path for us as well.
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Re: One Week Since my LIS Surgery!

Postby frustrated » 13 Apr 2011, 13:56

Thanks for the info...I am having surgery on April 25th and any bit of information I get eases my anxiety.
Boognish...I've had my fissure since September also...it's been a rough winter hasn't it? I am looking forward to this summer more than ever now that my surgery is scheduled.
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