I've lurked for quite a while on this site (when it was at the other address) and got some valuable help and moral support from people here.
You may have read a lot of this stuff already in other places, but I figured I'd share my story in the hopes that something I say may help someone else, or at least let them know there are others that have felt the same type of pain they are going through.

I am a 30-yr old male and developed a fissure in late 2010.
I've never had problems with constipation so I really don't know why I had a fissure to begin with. In the end my CRS and I believe that I naturally had too tight of muscles down there and it would have eventually happened. I also think this is why LIS was so successful for me. At first I was very ignorant of colorectal issues and I assumed my problem was internal hemorrhoids so I just started using prep H with the applicator. That didn't work so I went to my PCP who said he didn't see any hemorrhoids and diagnosed the fissure, then started me on the nitroglycerine compound along with hydrocortisone cream and suppositories. He also told me to use Colace. The hydrocortisone didn't seem to do much but the nitro provided relief.

Eventually he referred me to a colorectal surgeon who put me on a high fiber diet and Miralax (he said Colace tends to stop working after a while, which it did). Miralax did what it was supposed to do. My CRS explained what LIS was and after reading a little bit about it online I got worried about permanent incontinence so I decided I'd try everything else first. Again I got some relief but I had a few re-tears. The pain would sometimes get pretty bad and then for a few weeks I'd manage to heal to some degree. Then one night the pain got incredibly intense, much more than I had felt before. I think this is the pain I've read some people describe. I was miserable and couldn't sleep. It's probably one of the most painful things I've ever felt.

I decided to go back to my CRS and ask him for Botox. He told me he'd be happy to try it but he thought LIS would be better for me. He said he usually reserves Botox for his female patients because of future childbirth or something, and since I was a male that wasn't a concern. He told me he wouldn't try to push me into the LIS so we did the Botox.
He also did a fissurectomy and "banded" a hemorrhoid that he thought might be possibly responsible for stopping the healing.

The recovery was a bit painful for a week and the bleeding went on and on for 3 entire months (this is how long he said I had to heal before the Botox wore off). Although there was slight bleeding the pain was pretty much zero, I suppose thanks to the Botox.

The Botox experience was interesting...I could certainly tell that the muscles down there were somewhat weakened/paralyzed. There were a few times where I nearly had an accident because it was time to go and I almost didn't have the strength to "hold it in." Let me quickly point out here that this was my Botox experience, NOT the post-LIS which was quite different, and much better. My CRS explained that it's sort of a guessing game as to how much Botox is the correct amount for each person.

Well everything was fine for a while and then gradually I started feeling pain again. The CRS said that means it most likely didn't work and he suggested I consider LIS. He told me that he's performed many of them and the worst side effect he's ever seen are some occasional inability to hold gas in, but never stool, but that it's very rare in his experience. I decided to go with the LIS, not only because I felt the risks were exaggerated but that I didn't want to live with extreme pain all the time.

The post-surgery pain, bleeding, etc. was a lot like the Botox since he again smoothed out the granulation/scar tissue.
But this time the recovery gradually got better and better until I had no more pain, bleeding or discharge. One unpleasant thing I had to deal with was the post-op visits where he had to "burn" off the granulation/scar tissue with some sort of acid or something on a stick that looked like a Q-tip. It was quite painful, although not as bad as the peak of the fissure pain itself, plus any slight bleeding that had been happening quickly stopped after those visits.
Each time he had less and less to "burn off" until he had none and the fissure was healed.
That was about 8 months ago and things have been great since then.

I am still careful about drinking enough water, taking the right kind of fiber supplements (make sure you read below about this...) and I'll take magnesium for the rest of my life.

I do have to point out a few things I've noticed.
I suspect this may be a side effect of taking the Miralax still (I'm gradually reducing it and plan to stop taking it within a month or two). About 30 min after having a BW I tend to have to go clean up again, then I'm good to go for about another 24 hours. I also occasionally get a bit inflamed, sort of like a small kid gets a diaper rash.
I think this may also be to over-use of toilet paper or again the Miralax.

I thought I'd pass on a few things I learned that I wish someone else had told me sooner. I either figured them out on my own or someone on a website (maybe this one) advised me. Your body might be different so use your own discretion when following my advice:

- DO NOT use Metamucil (psyllium), it bulks up the stools and makes you rip even more. I suspect this may have even been one of the causes of my fissure b/c I got my first one a few months after beginning to use it. Instead use Benefiber (ingredient is wheat dextrin). You can get the generic almost anywhere. It's tasteless, inexpensive and does NOT make your stool get larger. Another great type of fiber is the fiber choice wafers and the fiber advance gummies. These are inulin and so they also don't make your stool large like the Metamucil.


- If you have a discharge that either smells, causes irritation or makes you feel unclean, use calmoseptine. It is a wonderful product for these issues and can be found near the adult diapers in drug stores.

- If you want a really good CRS to do your LIS, come to Houston and have Dr. Omar Madriz do it. He is board certified and actually trains other CRSs. I have a church friend who also used him to do some extreme procedure that involved removing his entire large intestine and stretching his small intestine down to the sphincter. It worked very well and he's doing great. Dr Madriz has a great personality and will make you feel better about your issue, plus he has a very conservative approach to LIS - he says he's "anal" about cutting as little muscle as possible because he can always come back and cut more.

- Take a good magnesium supplement, and take a large enough dose to work, but not to give you the runs, probably somewhere around 400 mg per day. Magnesium really does soften things up and reduce muscle spasms, at least for me it does. There are many types out there, the two I like are Vitacost brand Magnesium Ultra and also their magnesium citrate (be careful b/c this one is known to be more of a laxative than the others, plus it's a bit more expensive). The magnesium ultra is a complex since there are many forms of magnesium and some people say they absorb differently. I just do the shotgun approach and take the combined type. I also split the dose in half - once in the morning and once at night. If I take too much at night I'll usually have an ahead-of-schedule BM in the morning.

-Don't get lazy and miss a single drink of water, medication/supplment, intake of fiber or other part of your routine.

I'll be happy to answer any questions.

Houston..thanks for your post..be4 your surgery were you having pain sitting down as most of my fissure pain is when sitting down..BM's arent even that bad at all..So i was wondering if your have pain sitting and if LIS helped that or if its only to help with BM's?

FissureHome wrote:Houston..thanks for your post..be4 your surgery were you having pain sitting down as most of my fissure pain is when sitting down..BM's arent even that bad at all..So i was wondering if your have pain sitting and if LIS helped that or if its only to help with BM's?

Yes, I did have pain when sitting down. I didn't really have that much pain during the BM (just a little) but what was really painful were the spasms for hours after. I sit all day at work and I could generally get into a somewhat comfortable position but would still get sharp pain as I adjusted. The LIS took care of everything, pain during, after, sitting, etc. If the cause of the pain is the fissure the LIS should let it heal and get rid of the pain. If it's hemmrhoids then you have a separate problem, but the surgeon could probably take care of those while he's in there. I do have to warn you that for about 3 days after the surgery it was not fun to sit down. I tried either standing, laying down, slouching a LOT in a chair, or sitting on a sofa. I didn't feel anything within the first 12-18 hours after the surgery b/c I guess he put some sort of nerve block in, but there was pain. Nowhere NEAR the maximum pain of the fissure itself, though!

Thanks for your story Houston. Success stories are just great :)

HoustonTX wrote:I suspect this may be a side effect of taking the Miralax still (I'm gradually reducing it and plan to stop taking it within a month or two). About 30 min after having a BW I tend to have to go clean up again, then I'm good to go for about another 24 hours.

Sorry to break it to you, but this could also be a side effect of LIS. Some seems to have this issue, but for some it disappears again. The muscle takes up to a year to build up strength after LIS, so dont give up hope.

the-leakage-after-lis-t7222.html

Regardless, I would swap the fissure pain for this minor issue any day, and like you wrote, stopping miralax might fix this.

Best of luck, and thanks again.
JHH

I hope so, but like you said, given the choice of the extreme pain and inconvenience of a fissure, I don't need more than a second to choose having to wipe again 30 min after a BM. I suppose it's a bit irritating (mentally and literally) but I've been able to "time" myself to go at night before my evening shower and so I'll live with it for good if need be.

Thank you very much for this post, I've been dealing on and off with a fissure since 2011, and they are no fun. I'm an avid mountain biker, so you can imagine! I have to be out of the trails for however long it takes for my fissure to heal, and even then I'm all freaked out about a re-tear which in 2013 it has been happening almost every other month. Not to mention the spasm...which I believe it's the cause of the pain after each BM, and it lasts the whole day!!!! Makes it unbearable to sit and it makes me cranky.

I have a CRS appointment today, and I hope he can schedule my LIS early 2014.

Quick question, I read there are two options for LIS, open and close. Which one your Dr. performed on you? and Why (if you know)?

Thanks.

Sorry, I don't know whether it was open or closed. I remember reading about the difference but I don't think I asked Dr. Madriz about it before the procedure. I did ask him if he would be weakening the inner our outer muscles (I know...the "I" in "LIS" is for inner) and obviously he said he only weakens the inner sphincter.

Edit to add:

I just re-read my original post and maybe my opinion on the Metamucil came off a bit too strong. My body did not take well to Metamucil. I could never seem to drink enough water to get soft stools. I realize some people here do take it and maybe it works better for them.

Thanks for your reply.

I had my appointment yesterday with my CRS, and he gave me the Nitro ointment again. He said my fissure is not long, but very deep and the pain after the BM's that lasts for hours is the spasm of the sphincter which is not a surprise for me.

He will schedule my LIS for early February but to be honest it was my decision to go for it, not because he wanted to do it. I will start using the Nitro hoping that the fissure will get better by the surgery so I will only have to deal with the pain of the surgery incision itself and nothing else.

On a side note, the doctor that will perform my surgery is the one that wrote this article, his name is Michael Valente. That kind of makes me feel a little more secure about the outcome I guess...

http://www.fascrs.org/patients/conditio ... formation/

How are you doing. I got mild irritation and blood after 2 months post op lis and am freaking out. BM was lil tight so I guess new fissure.