Had a follow up with my CRS yesterday and scheduled my LIS surgery.
History:
*Constipation as a kid
*First of many hemorrhoids at age 15
*First fissure at 32 (successfully treated with one month of nifedipine)
*Had a round of internal hemorrhoids banded also at 32
*Bowels shifted to chronic diarrhea in my mid 30s.
*IBS symptoms became difficult to manage about a year ago - I'm 39 now. Started having urgency, upset stomach after most meals, nothing but 6s and 7s on the Bristol Chart - I mentioned this to my GP and he did a C Reactive Protein test to check for Crohn's indicator and it came back negative - so he thinks I most likely have IBS-D Prominent.
So 3 months ago I felt a stretch during a BM with a burning sensation that lasted for hours after. Felt like fissure so I made an appointment with my CRS. He tried to do a rectal exam but couldn't due to sphincter spasm. He suspected fissure and sent me home with nifedipine. Used it for a month. Had ups and downs but felt pretty good at the 1 month follow up. CRS tried to do the rectal exam again and couldn't due to pain and spasm. He still suspects fissure and starts to talk about surgery options. He says I have an incredibly tight sphincter muscle which may be adding to my BM problems. He also mentions I may have Pelvic Floor Dys and that there is a possibility of anal stenosis occurring if my sphincter stays in the current state that it is in. It was a lot of information to take in, but I decided to stick with nifedipine for another 1.5 months to see if I can fix the problem because surgery sounds excruciating.
So for the next 45 days I live in my bathtub and start working with a nutritionist on the LOW FODMAP diet to try and get my IBS under control. I do everything in my power to get better. Nifedipine 4x per day...I give up alcohol, sugar, gluten and dairy... my whole life shifts to try to get a handle on this. I go in for another follow up (now after 12 weeks of conservative treatment) and he still can't do the rectal exam because of spasm and pain. I'm fed up. He says he was impressed that I gave it such great effort (more than most of his patients do) and he thinks that LIS would really help me, so I sign up for surgery next week... and of course now my mind is racing and I'm having second thoughts.
I mean my symptoms aren't that bad now... and I'm operating around 70% most of the time. I do feel a sore spot on the right side but the pain there only comes sometimes after BMs and sometimes at night if I've eaten something that bloats me. My hemms swell all over back there at times, but it comes and goes. And there's some burning but I'm used to that living with IBS-D. Some days I'm freaking out that I may have an abscess because the swelling bothers me so much... but then it all calms down and I calm down. I was having pain with driving about a month ago and lost a few nights of sleep, but that has subsided. And since the doc hasn't been able to SEE the fissure due to spasm... could this be something else like Levator Syndrome or Proctal Fugax? Have any of you had similar problems with tight sphincter pain / spasm and the digital exam not being possible? Has the spasm always turned out to be because of fissure? Is LIS also used for sphincter tone issues without fissure? My CRS has performed thousands of successful LIS surgeries which has me feeling great, but when I asked if he will perform the surgery without seeing the fissure, he said yes because fissure heals over and recurs. Would you move ahead with surgery if you were me? Thanks in advance for taking the time to read this.