Hi Everyone,
I am so glad this group exists. I have been dealing with an anal fissure for 5 years, and occasional hemorrhoids, internal and external, for 6. I have tried diltiazem, nifedepine, and a Botox injection. (I just started trying Manuka honey, but that was just a few days ago so I don't have anything to report about that yet). Each seems to have provided some temporary assistance, but like many of you have reported, it didn't last. With Miralax on a daily basis, I have been able to manage periods of a few weeks to a few months without any fissue pain or bleeding, but it always comes back. I have seen 5 different colorectal surgeons, including one at the Mayo Clinic in Jacksonville, Florida. I also have a rectocele that, as far as I know or have been told, is without complications and for me, doesn't seem to cause any problems. I do wonder, however, if it has any complicating effect on the fissure.
I am considering LIS, which three of the doctors have recommended. One doctor has recommended the flap advancement surgery, but the Mayo doctor advised against it, and I don't really want to have that anyway, if it can be avoided.
I am 46 years old and in reasonably good health (no Olympic athlete, but also no underlying medical problems). I do not have diabetes.
I have two worries about LIS, and if anyone can offer any insight on it, I'd be very grateful.
1) If my fissure hasn't healed in 5 years, even with the sphincter-relaxing remedies I've already tried, what reason do I have for believing that the LIS incision will heal? What happens if _that_ doesn't heal?
2) I am aware of the current statistics on post-LIS incontinence. Does anyone have personal experience with it? I teach for a living, and standing in front of a large class of students with gas incontinence would make my job difficult.
One final question: Many of you have reported severe pain, and I surely have experienced that, on and off, for the last 5 years. The post-surgical pain from the Botox injection was off the charts hellish, even though it wasn't supposed to be. I am able to receive a limited amount of pain medication, but for good reason, that amount is quite limited, and reserved only for the worst pain periods. So - (finally) here is my last question:
3) Do any of you have any suggestions for dealing with chronic pain (besides narcotic pain relievers)?
Thank you for whatever insights and suggestions you might offer. I am so happy this group exists!javascript:emoticonp('')

Hi VW,
I have not had LIS myself, but have been delving into the dark depths of this board for several months and have not read one person who had more than transient incontinence after LIS. I read one lady on another forum, who does experience the odd bit of uncontrollable gas now and then but says she would still do the LIS if she had to do over again.
The few cases I've read of elsewhere who did get incontinence had the old kind of sphincter cutting where they cut at the bottom or top and a key-hole deformity can occur, and even then it wasn't incontinence of stool.
You don't need to worry about that.
My second opinion guy said so long as your sphincter muscle is strong, you don't need to worry about incontinence. He tested mine by simply putting his finger in and asking me to 'squeeze'. Not very scientific,(lol) but I trust his judgment.
I've never heard of an LIS incision not healing. What does rarely happen though is infection leading to fistulas.
That's what I fear the most.
for chronic pain;
I muscle tension last year that could be painful and I couldn't take pain killers, so I was doing a lot of meditation and hypnosis.
I liked Holly-Holmes Meredith, becoming pain-free.
http://www.youtube.com/watch?v=Y0lTxaeB4UE
So I have a question for you...
You mentioned Botox pain and, I will be talking to my crs about botox this week. So I was wondering what caused the pain? Was it the needles or just the botox stuff itself?
So sorry you have been suffering so long! IMO I would choose the LIS over flap surgery any day!
-Tanya

Hi Tanya,
Thanks so much for your informative reply!
During the Botox injection, I was completely anaesthetized. It was when I awoke that it hurt like nothing in this world. I don't really know what caused the pain, but they tell me it was more than was usual.
The CR put a small stitch in the fissure while he was in there, but I don't think that was the source of the pain. I don't really know for sure.
After about 3-4 days, the pain largely subsided. The first 24 hours were the worst.
I will share whatever else I learn. I expect to go back to Mayo in a few months.
Thanks again!
Jennifer

Hi Jennifer!
I'm so sorry for your pain. Unfortunately we are all on this forum for the same reason, but there is a lot of great information on here and a tremendous amount of support. It is the one place you can talk freely about your anal issues and not feel embarrassed!
There is not much I can add to what workingonit said above, but I do have a question for you: did you like the CRS you saw at the Mayo Clinic in Jacksonville? I live near Jacksonville and have thought about going to see them. I would LOVE (!) to hear anything you can tell me about your experience there. Also, which CRS did you see?
Thanks!

Hi TFCKMYB,
There are two main CRs at Mayo-Jax. One is Philip Metzger, the other is Ron Landmann. If you Google Mayo Clinic Jacksonville colorectal surgery, it will take you to the site where you can then click on "doctors". (I originally pasted the links in for you, but new members aren't allowed to post links for 7 days so it wouldn't send that way).
I saw Dr. Metzger, but not because initially there was any reason to prefer one over the other - it was a coin toss.
I have no complaints about Dr. Metzger, but I will probably see the other guy next time just to get as fully informed as I can and to see if there are any other alternatives to LIS I haven't yet tried. If I had to go back to Metzger for some reason, I would have no hesitation about it.
Dr. Metzger was attentive and answered several of my questions. He seemed kind and patient, and was careful during the exam. The exam was similar to a colonoscopy, but I was awake and the scope wasn't as long and didn't go as far. I had to do the whole cleanout routine the night before, similar to what you do with a colonoscopy. There was also an intern there who fielded several of my questions. I suppose my only reservation was that I was not convinced that all of the relevant medical history I had been required to send had been reviewed carefully before I saw him. For example, I had to have the actual biopsy slides themselves sent from when I had the Botox injection (they took a small sample then for biopsy since I was already anaesthetized). The support staff said those had to be in before my appointment, but when I saw Metzger, he wasn't aware that the slides were even there. That may not have been his fault.
He's at a good age for a surgeon: old enough to have had tons of experience, but young enough so his hands are still reliable. He's dealt with situations far worse than AFs, such as major, reconstructive post-cancer surgeries.
My experience with Mayo itself was generally good. I stayed at the hotel that adjoins the hospital itself so I didn't have to commute the morning of the exam. It was just a short walk there, and a short walk back to my hotel bed!
If there's anything else I can say that would help, let me know and I'll try to remember. It was about a year and a half ago.
Jennifer

Hi Jennifer:
Thanks for the information! The good news is that both of them were named among the top colorectal surgeons in the country by U.S. News & World Report.
Just like you, I like to get multiple opinions from multiple sources. I have personally been to three different colorectal surgeons (so far!). It's amazing how they seem to give completely different advice sometimes.