This is a long post with some background info. Hopefully this will be helpful to others. This forum was very helpful to me last summer.
A little background: I’m 53 years old, male and live in the NW US. I have had a history of hemorrhoids going back at least 12 years, probably self inflicted. As a younger man, I never had any problems going to the toilet every 1-3 days. Never really had any issues with constipation, except the few times I have taken opiate pain relievers prescribed to me.
In my thirties I read that you need to be “regular”, so I forced myself to have a bowel movement every morning before a shower. This was OK for a year or two, until I started developing (what I later knew to be) external hemorrhoids in about 2002. This coincided with a move from the eastern US to the Northwest.
I had the typical extreme pain after a bowel movement that lasted a couple of hours. I could feel the external swellings and got some relief from Preparation H. This occurred probably for 3 or 4 days a week and movements were approximately 1-3 times a day.
When I got a full time job in the west (And my stress level diminished), normal bowel habits returned and I had no more roid issues from late 2008 until November 2013 (except for one episode in July 2009).
Then it hit me, what I thought was hemorrhoids (the pain felt similar) started on Thanksgiving Day 2013 (late November), when I had to go to the can 8 times on one day.
I rarely have diarrhea nor constipation, trying to pass a large stool. Between 2002 and 2013 I would normally have to go once in the morning, but sometimes especially after a weekend I would have to go 3-4 times a day. Again, never hard or large, if anything small but frequent.
After late November 2013, I started to have hemorrhoid like pain (but no external swelling and no blood) about once a week. Other episodes of multiple bowel movements had me in extreme pain in December and January. In mid-March 2014 I finally went to the urgent care clinic where the Dr. gave me my first rectal exam and nearly caused me to faint. The drive home was extremely painful. He thought it might be hemorrhoids and gave me cortisone suppositories and external cream. I asked about AF, but he said that since I have been seeing no blood, it probably wasn’t. He told me to call my primary care doctor if no improvement in one week. I was sleeping on the couch many nights to not disturb my wife, but I didn’t see any improvement. I called my family doctor and made an appointment.
He diagnosed a fissure and prescribed diltiazem cream in mid- March. I started using it and things seemed to be better, no extreme pain, just discomfort during bowel movements that seemed to originate on the left side (9 o’clock looking from the back). I kept using the prescription and kept a log describing daily bowel habits (I call it my butt log-double entendre given my work in the forest industry). I did not see any blood on toilet paper or in the toilet bowl.
I still had the discomfort that lasted a short time after the toilet, but no severe pain from March until June 22, 2014. Then things got painful. It was back to the pain that kept me from sleeping in my bed. It wasn’t the spasm pain that I would come know in late July and August, but it was no walk in the park. I visited my GP doctor on July 21. Given that I was out of the diltiazem, I asked for the nitroglycerin cream (Rectiv 0.4%) and used it for 8 days. No real relief so I went to the GI doctor (that performed my colonoscopy in April and confirmed a fissure) on July 29th. He suggested an LIS, saying that he did approximately 20 per year, but I was not sure, I wanted a specialist to do it if I went this route. All during this time I was checking this forum and WebMD for options. The pain was getting rally intense towards the end of July to the extent that I could not sleep or work. The spasm pain lasted for 6-14 hours, all the while going to the can 2-5 times a day. Pain relievers like tramadol and hydrocodone did very little to relieve the pain.
Something had to change, so I got a referral to the only CRS in the Spokane area that was in my insurance network. I went to see him on August 12th and he suggested the LIS to stop the pain. I scheduled it for August 20th, 2014. I had been taking the Rectiv for 3 weeks and had not seen any real improvement or relief from the spasms. I could not go on without a change.
I had been taking sitz baths in the bath tub since mid-July. They seemed to slow the pain, but it returned after I dried off. Remember that this was happening about 2-4 times a day. The only times I could go to work was on the days that I didn’t have a BM.
I received the LIS procedure on August 20th. I arrived at the office at 8:30 AM, and was weighed. I was down to 178 lbs (81 kg) from a normal 205 (93 kg). I received an IV and was on the operating table by 10:00. I received GA, and the last thing I remember was having the doctor taping by buttocks apart. I woke up some time later a little groggy but in no pain. My wife drove me home and I was back on the couch by 12:30 PM.
I was prescribed: ducosate sodium (the same strength available over the counter), 600 mg ibuprofen, 5 mg hydrocodone, and 5% lidocaine. I was told to alternate the ibuprofen and the hydrocodone every 6 hours, and apply the lidocaine to rolled up gauze and apply 2X a day for the first two days. I was to take a stool softener 2x a day.
I later learned that I received the internal LIS procedure and there was one stitch on the left side. I experienced very little bleeding, most of it was during the first two days. The Dr. said that I might still experience some spasms initially and to take sitz baths several times a day and after every BM.
I did not have a bowel movement for about 3 days, with some trepidation. I was told to take milk of magnesia if no BM after 48 hours. I was still taking the ducosate so I was not too freaked. I had a few small BM’s with no major discomfort after about 72 hrs, taking sitz baths regularly through the day. The first normal BM occurred 6 days after surgery, and there were no spasms, just what I call discomfort, mostly on the left side where I suspected the incision took place. On Aug 29th I had some quite large BM’s, larger than I have seen in years, but again no spasms, just some discomfort. I was trying to wean off the hydrocodone at this point, while still taking docusate until the prescription was used (about 2 weeks).
I was eating normally at this point, and I took one week off from work. I expected some pain and discomfort, but overall, the surgery was a success, and I had no real issues and no blood after the surgery. Far better than immediately before the surgery. I continued to keep my log noting the number of BM’s and any pain or discomfort.
What is the verdict? I had no real incontinence issues. Some gas incontinence early on, but nothing with stool. I would get the errant skid mark now and then, but that occurred before the surgery too. The anal architecture did change, and I am going to the can once a day, sometimes every other day. My stools are larger and longer, but I don’t often feel the need to go multiple times a day, which is a blessing. Still no issues with constipation or hard stools.
It has been almost 12 months since the surgery and I have absolutely no regrets. It has gotten me back to normal. Here are some observations:
I experienced some pain sitting down for several months after the surgery. It was what I called “stitch” pain. Like when you had a stitch that was starting to heal, and you feel like the skin is pulled together. This largely disappeared by November.
I have absolutely NO fissure issues, and have not had anything resembling it since a few days after the surgery.
I had very little blood after the surgery. Maybe a few days of weeping after the surgery, but nothing since.
I think my method of sitz bathing caused a return to mild hemorrhoid symptoms. I would sit in the bathtub several times a day after movements. Sitting on the hard tub for 20 minutes 3-5 times a day, probably put pressure in that area. No intense pain, but even now I do feel some external roids after some bowel movements. I’ll take this any day. It is not the severe hemorrhoid pain I knew in the early 2000’s.
I do not have a set time to go to the can. It happens when it happens. This can be a challenge when you work in the woods. Sitting on the can for long periods is not helpful.
My procedure was internal LIS, left side with one stitch. I have no details on amount cut, etc.
I tried to use my riding lawn mower 12 days after surgery. BAD MOVE!
If you are male, think seriously about the surgery. I have no regrets, and have had no incontinence issues.
One year ago, from late July to the end of August I was checking this forum several times a day. It was very helpful knowing others’ experiences. Thank you.