Hi everyone,
I've been using these forums as a source of help and comfort over the past 2 months and wanted to relay my own experience to help others.
At the end of November 2015 I suffered a very sudden onset of piles (which I'd had on and off during my life). The pain usually settles down very quickly for me and it did this time, except that the haemorrhoid pain was quickly replaced with that of a fissure within a day or so. After reading around it seems that fissures are quite common occurrences when you have an onset of piles simply because the piles occupy too much space within the back passage, meaning that when you pass even a regular stool the anus takes the strain and can split.
I went to see my GP and they prescribed me Scheriproct ointment and suppositories and told me to go on a high fibre diet and to stay hydrated. Because the pain was so bad when going to the toilet, I adopted the 'high fibre' advice to an extreme level, and just wound up giving myself copious gas, bloating and cramps. in any case, the cream and supps did not work so I asked for a referral to a CRS. He examined me and said the fissure was small and acute and would heal within a week. I'll tell you, hearing that my injury was 'small' was not what I wanted to hear as the pain was ... well, you know!
I'll fast forward 6 weeks which included the Christmas period. Here are the highlights:
- I managed to nail the high fibre diet:
1. 2 x Weetabix for breakfast with 15 ml lactulose.
2. 2 x pieces fruit at 10:30 for snack
3. Baked potato with either fish or chicken and either beans or green vegetables and one slice of wholemeal bread with butter. 15 ml lactulose.
4. Large bowl of Bran Flakes with 7 ml lactulose.
My stools were text book J - "Mr Whippy" but not too loose.
- Around 5 pints of water per day. Basically, without going overboard I made sure my urine was largely running clear at all times (but don't go crazy so you lose your salts). I occasionally (every 3 days) added a Diarolyte sachet to one drink to replace lost salts.
- Exercise once per day. I walked for around 1 mile, typically after my main meal and this was a fantastic aid to maintaining regular BMs.
- I applied topical "cream of the week" (see below) after each BM. Typically this was GTN ointment. I was lucky to only suffer mild headaches.
- I took baths after each BM.
My BMs were like clockwork - 08:00 and 18:00 typically, which gave some comfort in that they were predictable so you could plan to be at home with all therequired paraphanalia around you that you need to support yourself.
*** None of the above fixed the fissure ***
Christmas was a torrid time, not least of which from watching everyone overload on nice food while I stuck to my baked potato and lactulose diet! Also, the doctors had tried me on something like 5 topical creams, prescribing me Anoheal (Diltiazem hydrochloride 2% Cream). I applied this 3 times, starting on Christmas Eve: 1st time gave me itching. 2nd and 3rd time (Xmas day: bad itching + a little burning). 4th time (Boxing day) intense burning like napalm in the back passage that lasted 3.5 hours! It was horrible and I wondered if I was going to have to call an ambulance. I realised I was either allergic to it or had developed contact dermatitis through all of the different medicines prescribed to me.
I went back to my CRS in desperation. He examined me and said he could hardly see a fissure (!!). I told him it was there, that I'd been robbed of my life and I wanted the lateral internal sphincterotomy no matter what. He offered Botox. I said "LIS!". He booked me in for the following week.
I had the LIS under general anaesthetic. Guys I am here to tell you, it was the best decision of my life.
The op itself is a 5-10 minute procedure but I didn't want to be conscious for it. However the GA itself does complicate things in that it all but paralyses the digestive tract for 48-72 hours after the op. Also, because you have to starve for nearly 24 hours beforehand, it means your first BM after the op is going to be at least 2 days out. For fissure sufferers that obsess over good BM maintenance and regularity this is in my opinion the most difficult aspect of having an LIS. I had considerable apprehension around having my first BM post-op. Would it be painful? Would I bleed? Would I get an infection? Well, after a fraught 48 hours and 4 attempted and aborted trips to the toilet, I'm here to tell you - when I finally went it was *** PAIN FREE!! *** I cannot remember feeling more relieved (in all regards) in my life!!
I did have one complication post-op: I immediately developed piles again. I searched around and found others that reported the same after an LIS. For me, there was a lot of absolutely unavoidable straining for that first BM because my colon was dead from the GA and using a step etc didn't do it on its own. It absolutely would not come without some pushing, and the unfortunate cost was piles. However, these are easy to treat so I thought "I'll take it". Getting tht first BM done was the first day of the rest of my life as the conveyor belt then kicked in.
I am +1 week after the LIS. BMs are easy (there is more slack to play with). I actually think I was too tight back there previously which may be why I had suffered with fissures during my life (but just a theory). I have slight incontinence to wind (again, I'll take it) and that may improve. Piles are settling. Baths after each BM are highly recommended (but please, keep the water WARM not HOT - I read people on here having hot baths for piles, don't do it as it encourages blood flow to the inflamed area!).
One thing that was never mentioned to me by my CRS: for the first 4 days post-surgery I got occasional cramp/spasms in my back passage. They were really quite painful – sudden grips that happened usually as a precursor to passing wind. They would wake me up say 3 or 4 times in the night. I haven’t had the them after day 4.
I just wanted to share this because I went through 2 months of hell and if this helps a single person I will be delighted. My fissure was apparently small, but felt like the Grand Canyon during a BM. That said I read accounts on this site of people with fissures ten times worse than my own and they have my utmost sympathy. I was used to doing sport 5 days per week and that stopped dead suring this episode and depressed me considerably. I read on here of some people suffering for 6 months to many years without having had an LIS. Hopefully this will offer some encouragement. After micro-managing the conservative treatments for 6 weeks my fissure was as fresh as the it was on day 1. After an LIS I felt zero pain from it on day 2.
Stay strong people and best wishes for a speedy recovery!