I have 3 fissures that keep returning. I believe the scar tissue is ripping. The fissures heal, and rip again each time I dilate my anus. Is it possible that I need to have anoplasty (advancement flap) done on the 3 fissures? That way, I'll have stretchable healthy tissue instead of scar tissue that tears with dilation. I have no other diseases besides these fissures. I had LIS last October, and it hasn't kept the fissures from reopening. I also have soft bowel movements, and I don't strain. I have scar tissue from having 3 hemorrhoidectomys. I don't have anal stenosis.

Hi Endfissure. My situation is very much the same. My first fissure was about 2 years ago and when I first found out I was bound and determined to get it healed. All conservative tx failed. I had an LIS last April. Since then no healing of fissure and at my last exam I now have 2 fissures. I had 2 previous hemorrhoid surgeries in the past. At that exam CRS said these will not heal without an anoplasty due to scar tissue. Scar tissue does not stretch so no matter how soft BM's are kept there is always re-tearing at some point. So sorry we seem to be on a similar path but only your Dr. can answer this question with certainty. I am in the process of seeing one more CRS for his opinion before I make a decision on the anoplasty.

I have an appointment with a new (to me) CRS on Tuesday. He's a military doctor. I think I need to give these fissures a lot of time to heal (like 3 months or more before dilation), or I need to have these problem areas removed and replaced with healthy tissue that won't tear. I read online that scar tissue (in general) takes 1 month to reach approx. 30% strength, 2 months to reach 50% and 3 months to reach 70-80% tensile strength. It's important that I dilate, because if I don't, I develop upper digestive tract constipation in my chest. I don't have a problem with my fissures closing, and the pain stopping. It's just with dilation, they return every time, in the same exact locations. LIS has been great at keeping the internal sphincter relaxed and pain levels to a minimum, however, it can't make scars elastic. I just want this to be over with. I wonder if my doctor will even consider an anoplasty since at the moment, my fissures are not open and appear to be healing.

Hi End Fissure and Wounded Spirit,
I too think that I am in this situation, although I haven't had LIS, I think I have a lot of scar tissue from 3 chronic fissures and hem banding. I had Botox back in April last year and since then on and off I am in varying degrees of pain... Prickling on BM, which I think is when I re-tear, feeling like my muscle is throbbing, soreness, like a hot rod is up there. The CRS just kept telling me to keep going with diet, stool softeners etc... The first time after Botox he said I had a new Fissure, then last time he said I was healed! No way, I said I wasn't happy as this has ruined my life, and I have cut my hours at work too. He then proceeded to refer me to another CRS. I just want this to end....so scared they will say I need to just live with it....
I do everything possible to keep my stools soft, and it just isn't good enough. I know in the UK if you are considered healed they won't perform surgery.... X sending my best wishes to both of you.

My best to both of you as well. End Fissure - that is interesting information about scar tissue. Thank you. So it seems that if you did not have to dilate your fissures would heal for good? How frustrating that must be. So sorry. And yes, even though my fissures did not heal from LIS, it did help a lot with the spasms post BM. I wonder if your doctor would consider anoplasty for just scar tissue removal? Hummmm.... I too long for the day this will be over. I know I will have to be very mindful for the rest of my life but just to get back to a bit of the way my life used to be keeps me hopeful
Rachael - it is fearful to think we would have to live the rest of our lives like this. Keep going to the doctor no matter how many doctors. There are treatments out there and there are many stories of people who kept seeking treatment and finally got better one way or another! As with me, if you are keeping stools as soft as possible then there is probably something out of your control preventing healing. Although the LIS did not work for me, it does have a 90% success rate. It was an easy surgery to me. Maybe that is all it will take for you! So it sounds like you need a doctor that does not consider it to be healed? Maybe if you saw someone during one of those times it seems active? I wish you the best and don't give up hope and don't stop trying to find the right help. God Bless.

In order for me to have LIS in the first place, I had to dilate my anus. No doctor I saw would even operate without an open fissure. I'm fearing that I'll have to dilate before I see my CRS on Tuesday, but then I'll be left with a fissure for at least a week. It takes a week for them to generally close and appear healed in my case. I need to work with someone that is as ambitious and aggressive with seeking a resolution as I am.

Rachel 1984: I've heard that some fissure's will stop occurring after LIS due to the less tight internal sphincter. Even though I'm having complications, I would still look into LIS for yourself.

Woundedspirit: Yes, the info on scar tissue is interesting. I'm fine with not dilating for 3 months, if it means I'll have scar tissue that won't tear when I dilate. I mean, what's 3 months compared to a lifetime? I'm just skeptical that I'm looking for anything to calm my nerves-meaning it'll make no difference. I think it's time to give up on scar tissue and just swap it with healthy tissue.

endfissure2013 why do you have to dialate? if theres no pain just leave it alone...

splinterboy2013: I will have to dilate at some point, because it helps with my upper digestive tract constipation. Stool softeners and Miralax don't help. The area needs to be physically stretched. My condition is unique.

I have been reading medical articles today, and I now believe I have anal stenosis. I believe it's from my 3 hemmorhoidectomys. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2675080/ When I see my CRS, I'm going to suggest surgery for anal stenosis.

Hi, I had the surgery for anal stenosis. It involved two advancement flaps. It helps so much. I still technically have stenosis but it's functional now. The doctors can fix things to a certain degree but they can't make my bum like it was before all of this. Unfortunately the longer you let it go the worse it gets. I waited 5 years to work up the courage to have the surgery and I wish I hadn't waited so long. Part of my recovery has been dilation and it helps a lot. I have a few different dilators, the largest one is 19 mm. My CRS told me if I can manage that one I should be able to live the rest of my life fairly normal. The surgery itself takes a while to recover from. That area stays tender for a long time. I do good most of the time. Bms are good. On occasion the area can get irritated by diarrhea or too many bms but it's nothing like before the surgery. Treatment for anal stenosis requires stool softener and fiber and in severe cases surgery. Even after surgery stool softener may be required but it's more a maintenance thing. If you need the surgery don't over think it like I did. Make sure you have a good doctor and get it done. I had a hemorrhoidectomy, followed by LIS but the LIS didn't help me because of the stenosis. For me LIS only added to the scar tissue. Hope everyone finds a solution soon. Suzy