Hello all,
I used to be very active on these boards. But I haven't had much time to participate lately since life has thrown a few curve balls :( But it's now just over one year since I had LIS, so I wanted share my overall impressions now that I've got some distance between my fissure days and the operation. Hopefully this will help those of you who are deciding whether to pull the trigger or wondering what some of the ups and downs might be. I've tried to break things down into sections based on the most common questions and keep it as concise as possible. My goal is not to be for LIS or against LIS. It is just to give you my impressions without any BS or filters, just the straight dope.
MY FISSURE HISTORY
First, a brief background. I got my fissure in summer of 2009 after diarrhea and constipation from antibiotics. I tried all manner of creams and ointments, including nifedipine, diltiazem, plus nitroglycerin. They brought some measure of relief, but none healed the fissure. I also tried Botox injections, which fully healed the fissure for several months. But eventually it returned.
So after one year of messing around, I decided that enough was enough, and finally had LIS (closed limited without skin tag removal or fissurectomy) on May 3rd of 2010. The operation itself was largely unremarkable, but I developed a perianal abscess as a complication. So just two weeks later on May 14th of 2010, I had to go in for a second operation to drain and debride the abscess. Not fun, but hey, you've gotta do what you've gotta do.
AM I GLAD I HAD LIS?
Yes. No question here. My fissure had toyed with me for long enough. I'm glad I went through with the operation, and would do it again knowing what I know now.
But I would temper my expectations as far as recovery timeline, whether I expect to achieve a complete recovery, etc. More on these below.
AM I NOW 100% BACK TO MY PRE-FISSURE LIFESTYLE?
No. And I don't think I ever will be. I still take Miralax every day, and I plan to do so indefinitely.
I can no longer eat junk food all day with very little water intake and get away with it. I can't drink beer to the point of excess, I can't eat very spicy foods, and in short I can't simply eat with reckless abandon like I used to. If I do -- and believe me, I've done so at times due to overconfidence -- then some butt problems will return. For instance, I will get bad irritation or some blood on the toilet paper. It seems that the area remains more sensitive than normal once it's been through trauma (it's fair to note that I still have hemorrhoid flares from time to time which doesn't help things).
CONTINENCE
This is the big question that's on everyone's mind going into LIS: will I become incontinent? In general, this is not something I would advise dwelling upon going into LIS. I know it's hard, but it's truly not a big concern.
So what's the answer to the million dollar question then: has my continence been affected? 99.99% of the time, the answer would be no, not at all. But if pressed, I would have to say yes, but very, very, VERY mildly, and only in certain situations.
I want to be clear: I'm not pooping my pants. Turds are not randomly slipping out into my underwear of their own volition. And I'm not uncontrollably farting during company meetings.
When I say that my continence seems to have been affected ever so slightly, here's what I mean... When I get diarrhea, it feels like it's harder to hold in, like the urgency is greater. Also, if I have several watery stools in a row, there's a good chance that some very slight "leakage" (think of a "skid mark" volume wise) will be present minutes later, even if I wiped real good the first time. Finally, not to be overly graphic or juvenile, but the chances of a "wet f@rt" seem to be higher than they used to be.
Disclaimer: I can't say that some of this isn't due to Miralax usage. I know others have reported anal leakage when using Miralax. But in my case, I doubt Miralax is the culprit, because I'd been taking Miralax long before I had LIS and never observed any of this.
SUMMARY
The key takeaway from all this, I think, is #1 that if you're considering LIS, there's probably a pretty good reason for it. You've probably tried conservative measures already and they've failed. You're probably trying to make peace with the idea of going through with surgery. You're probably worried about incontinence. Try not to focus too much on any of those -- if you're considering LIS, odds are very good that it's the right choice. While LIS isn't perfect, very few people come out worse because of it.
That having been said, be aware that the procedure isn't bulletproof. It can fail, and it can have complications. And while some people recover very quickly, many take much longer. If your surgeon says you will be fine in a week, that's something to hope for and shoot for, but I would strongly recommend making backup plans in case that doesn't come to fruition. For many people, it doesn't. Give yourself ample time to recover! If that means months, then that's okay. You're not alone. Many of us takes months and months to recover. It was at least 6 months (and probably closer to 8 or 9 months) before I felt anything close to what I'd call "mostly recovered." I had setbacks along the way, but overall I slowly made forward progress.
And some people are able to return to their previous lifestyles after LIS. Some aren't. I would say that more people are able to return to their old pre-fissure lifestyles than not, so the odds are probably in your favor. But don't be totally surprised if you still have to be very careful with your diet and butt even after surgery.
Oh yeah, and what CRS's say is true: don't use soap on your butt when showering or bathing! I always thought that was the weirdest piece of advice. But it really is true. Since my fissure and LIS, I've noticed that washing my butt with soap really does irritate it. It took some firsthand trial and error to convince myself, but now I'm a believer. Soap dries out the skin and makes it more prone to get chafed and bleed when wiping with toilet paper. Try it with and without soap and you'll see.
Ok I'm starting to ramble on now so I'll end this here. I hope my impressions have been useful, and that I've neither scared anyone away from surgery nor made anything think it's the magic bullet they've been looking for. It all really depends. Overall I'm happy I did it, but wish I'd have known more about what to expect ahead of time.
If you have any questions, please feel free to ask.

This was really helpful and reassuring, so thanks.
Answers all the right questions and concerns with LIS.
I am thinking it's time to have it now, but I'm concerned about recovery. I didn't realize it could take months.
How long were you recovering for, and were you completely out of action? How long until you were able to go back to work?

Oops sorry yeah I should clarify the recovery bit. I was out of work for about a month total. But remember that I had two surgeries (the LIS plus the abscess drainage) two weeks apart in that time period.
Also I worked from home for a little bit. I probably could have gotten back into the office a bit earlier with the aid of some painkillers if I had to, but I opted to just work from home a little longer. Finally, if I had a ride to and from work, that would have shortened the timeline even more, but driving wasn't comfortable for me for a while so that was another factor (especially since my car is a stick which isn't fun in rush hour of course).
So basically nope I definitely wasn't completely out of action. I was kind of stuck in the house for maybe 2 weeks after surgery, and after that I could get around with some limitations as long as I didn't have to drive. The months and months thing just means how long my butt didn't quite feel like itself after surgery. I got different sensations at different points and those took a long time to settle down.

NG - it is nice to hear from you! I've read your posts and I feel like I know you by now. It's very generous of you to come back and share your experiences. I am glad that you are doing better. I hope those curve balls are no longer being tossed at you. I really appreciate your honesty. Because of this forum I will not have overly optimistic expectations about recovery and I will give myself lots of time to heal. I hope you are having a great life, even without eating everything you might want to!

Hey there, I hope reading my previous experiences didn't freak you out too much :) I had a lot of ups and downs during my fissure saga, and I didn't hesitate to post about them and whine a lot. This board was great for that, but it also leaves behind a trail of doom 'n gloom posts haha.
That's part of the reason I felt it was important to post my impressions after 1 year. It's difficult to see or think clearly when you're in the midst of it all, so I think my impressions now are more objective and clear than they were back when I was thinking about my fissure all the stinkin' time.
And that's the main thing really: I think LIS has some drawbacks, but overall it's a net positive for sure. And the best thing is that I'm no longer thinking about my butt all the time. Sure, there will be occasional times when I have an uncooperative poop or just "bad poop day" that causes some pain or discomfort, but that's the exception and not the rule. It's one of those subtle things where after a while you realize "hey it's been a while since I've been obsessed with my ass."
If I had to sum everything up in a nutshell, I'd say that LIS wasn't a night-and-day thing like I was expecting. It was more of an incremental gradual process -- inches at a time rather than miles. Most people get there, but it's hard not to get a little impatient especially if you head in with really high hopes.
BTW I don't know your particular background HopeToHeal -- are you scheduled for LIS soon?

Hi again NG - your posts were actually very helpful. You provided so much detail and honest information I felt much better about getting the surgery because I felt like I had the information I needed to know what I was getting into. I really thank you for that! I was also so impressed by how supportive and helpful everybody is here - I really don't know what I would do without this site.
I am so glad that you are recovering ... I know you really went through a helluva time. It makes me really happy to know that, for the most part, you are living happily with your butt these days.
I had the LIS 8 days ago - and speaking of freaking people out, my adventure might do just that, which is why I also intend to stick around for a while and even return down the road so that people can get the complete story. If you've got some time, you can read about my LIS experience here:
http://anal-fissure.org/t2935-its-done-and-i-survived
I really don't know what I would have done if not for the folks here - so many people rallied to help me out, it made a huge difference. I'm doing pretty good right now and so far.
Thanks again for keeping in touch - it really helps to have someone with your knowledge and perspective pop by to offer your insights :D

Nice of you to post your summary, NG. Will be helpful and reassuring to many, I am sure!!

good to hear from your NG, glad you are doing well and thats for the update!
All your posts have been helpful and i have now put myself in the NG and Steve file of the long time healers lol

Thanks guys! It's the least I can do after all this forum has done for me. When I first stumbled upon this place, I was a TOTAL wreck. Kim, Fissulyna, Tabby, CherylK, and a bunch of the "old timers" here helped me get through it all by sharing their experiences and tips. We have such a poorly understood malady that the least we can do is help each other out, because goodness knows the rest of the world is ignorant as to what a fissure is and the suffering it can cause.
And yep, we have people joining the "long time healer's club" all the time -- glad to have you on board New Mum! Hopefully with time everyone will get back the "ass of their dreams!"

NG, you are so articulate in your descriptions, I think you should write a novel! I've been reading and before LIS read all the old LIS posts and you were a big help to me as well, I'm glad you came back with that summary. I must tell you, you were the source of a few of my rare laughs during the AF suffering because of your writing style. That being said, I don't think I'll ever be like I was when I was 25, (can't believe how I treated my butt back then!) I also still have hemmeroids but now I measure my discomfort on a different scale due to AF. I hope to be where you are in a year but for now, I got my laugh back and that's the important thing, nobody should have to suffer through this. Thanks again!