Two fissures but only treating one

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Two fissures but only treating one

Postby normajeanchariot » 25 Mar 2017, 02:01

Has anyone had two fissures and received treatment (botox, lis, etc) for only one of them?

I have two fissures. The first fissure I got years and years ago is not a problem any more - but it resulted in a much higher resting pressure. The second fissure I've had for a bit over a year and is a problem. If I get a sphincterotomy (lis) on the problematic fissure, I'd suspect healing will not occur because the first fissure will keep the resting pressure high..

Has anyone gone through this and actually had their problematic fissure heal?
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Re: Two fissures but only treating one

Postby GilmoreGirl » 25 Mar 2017, 06:43

The way LIS works, I would think it would help both to heal. It's a small cut in the internal anal sphincter, which forces it to relax. The sphincter is a circular muscle, the cut in one area will cause a decrease in resting tone throughout the whole muscle.

Depending where your fissures are, there may be more of a relaxation near one than near the other, since LIS is done on either the left or right side of the anus. But as I said you will get some relaxation throughout the whole muscle. This will allow an increase in blood flow and healing.

That's the way I understand it to be - I have two fissures, one anterior and one posterior and will be having LIS just to the right of the anus.

Hope that helps!
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Re: Two fissures but only treating one

Postby normajeanchariot » 25 Mar 2017, 08:31

I don't know if I should get it done. My 'bad' fissure is causing more discomfort than pain. If I sit down in a chair I have to sit down carefully, get up carefully, stuff like that. I'm trying to decide if I should just live with it because I'm scared of becoming incontinent to some degree. argh :/
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Re: Two fissures but only treating one

Postby GilmoreGirl » 25 Mar 2017, 08:47

Well, one thing is that if you're resting pressure is high, the LIS will just bring you down to a normal resting pressure. It may help prevent fissures in the future or allow them to heal more quickly if you do get them. It makes sense - if your pressure is high, you're more likely to have a tear with bowel movements than if it is a little lower.

Of course, it's totally a personal choice, and there is a risk of incontinence, but it is slight.

In my situation, I put off LIS because I thought I was improving. 4 months later and I'm still in pain, and I'm having LIS in less than 2 weeks. I developed other issues in the meantime - hemorrhoids - since I've had to strain with bms due to the tight sphincter.

It's a very tricky decision - I know! You could ask about Botox if you're really not sure about the LIS. Or just wait and see how things go!

Oh and have you used any topical treatments like nitroglycerin or nifedipine cream?
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Re: Two fissures but only treating one

Postby normajeanchariot » 25 Mar 2017, 22:16

The creams are something I'm just thinking about now.. I used rectogesic for 8 weeks about twice a day, after which my surgeon told me you have to apply it 3 times a day to work (even though the instructions on the pamphlet say twice a day).

I was trying diltiazem, 3 times a day but had to stop after about 6 weeks and 6 days because i got a really bad concussion and it wouldn't have been ok to use it because it could've caused bleeding in the brain while I was in that state. Anyways, so now I'm thinking maybe I should try diltiazem again and this time use it for say 14 weeks.. I've just read a study saying that something like 75% of people in the study healed after using diltiazem for 2-3 months. If I just have the lis now it would be 15 months since I got the fissure. If I postpone it to allow time to apply diltiazem again it would be about 18 months.

I don't really know what to do. I can't remember if I had experienced any improvement from the first round of diltiazem but I'm guessing any improvement wouldn't have been significant. I'm leaning towards doing another course of diltiazem but I'm worried that waiting an extra 3 months could really reduce the chances of the surgery working. I've also read that fissures more than 12 months old that are also accompanied with a skin tag (like mine) have much lower healing rates (I'm sure they're still in the 90% range though, unfortunately the study didn't provide further details).
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Re: Two fissures but only treating one

Postby GilmoreGirl » 26 Mar 2017, 06:06

Ah ok. Are you seeing a colorectal surgeon already? If so, do they have an opinion?

You could always book the LIS and ask to try the cream in the meantime - it may be a bit of a wait before your surgery can be booked. And then if the cream works, you can just cancel.
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Re: Two fissures but only treating one

Postby normajeanchariot » 26 Mar 2017, 06:40

Yeh I had surgery booked when I tried diltiazem. So now the surgery is about 2 weeks away. I haven't asked my surgeon about using diltiazem again. After going through some studies, I'm here: If I go with the LIS I have say a 90% chance of healing since I would be at 15 months. If I try Diltiazem and it doesn't work, the chances LIS will work after that go down to about 85% (since another 3 months would have passed). These numbers are extremely rough (could be very very wrong - probably are!) but that's what I'm guessing from looking at studies. If I try diltiazem again I think I'd have about a 10% chance of it working at the most. I'm sort of thinking of just doing the LIS now.

Another study said 83% healed from diltiazem in 8 weeks. Much more than the 75% in 13 weeks I quoted above. In other words, using diltiazem for more than 8 weeks may not be of any benefit at all.

I guess I'm just going with LIS then.

I sort of feel like putting together a program where we can input our duration of symptoms and it will tell us exactly what our healing rates are for different treatments based on many studies.
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Re: Two fissures but only treating one

Postby GilmoreGirl » 26 Mar 2017, 06:47

It would be so helpful for a lot of us if that existed! Just from personal experience, I wish I had just had LIS sooner. When I first had a fissure a couple of years ago, nifedipine offered pretty instant relief, as it just stopped the spasms short. I had lingering pain for a couple of weeks but it cleared up no problem. This time around, nifedipine seems completely useless...I feel if it doesn't at least improve things within a couple weeks, then topical probably aren't going to work. But that's just my opinion from personal experience.

Glad to see you're using the scientific literature as a guide - it's always good policy to go straight to the research with these things, I think!
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Re: Two fissures but only treating one

Postby missy moo » 27 May 2017, 21:14

Did you end up having lis? Gilmore girl can you tell me your story you probably already have? And which is better diltiazem or nefidpine? I read one of them can make your skin become sensitive?
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Re: Two fissures but only treating one

Postby normajeanchariot » 30 May 2017, 05:50

I haven't had my surgery yet. And with regards to this thread, I now plan on getting both fissures treated as it seems that only treating one fissure may not result in any healing to take place. The uncertainty surrounding the issue makes me decide to just get them both treated. Unfortunately I've had to postpone my surgery because I'm suffering from some sort of sickness that is suppressing my immune system. I still don't know what's wrong with me but I suspect I either have mould poisoning (the place I was living in up until about a week ago has bad water damage) or I'm sick from being exposed to second hand cigarette smoke (the people in my house were always smoking right outside my room despite many requests for them to smoke elsewhere). Anyway, not sure what the point of telling you all that was. I guess just that I want surgery like today but can't because of my immune system.
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