What is normal?

Seeking advice on when to be concerned.

Are you having, or have you had a Lateral Internal Sphincterotomy (LIS)? Please share your experiences here, or ask any questions.

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What is normal?

Postby johnnyp433 » 07 Aug 2020, 10:56

I posted recently about losing faith in fully healing after LIS surgery. Recovery has been slow; however, I’ve noticed improvement in pain and function (I’m able to have semi-normal BMs). What I’m really concerned about is that I’m 9 weeks post-op and still experiencing bleeding. Today, I passed a slightly harder stool so there appeared to be more blood than usual. Some days, it’s only visible on the paper. Some questions that I have are:

Can recovery take this long?

Is there a point when I should start being concerned? (I’m sick of being examined and told to just apply lidocaine and increase my fiber.)

Is healing still possible even after almost 3 months? Does it sometimes take 6 months to a year?

Has anyone been prescribed nifedipine or diltiazem to help AFTER LIS?

Thank you so much. I’m just trying to ease my mind so that I can focus on healing.
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Re: What is normal?

Postby johnnyp433 » 10 Aug 2020, 09:26

Would really appreciate some feedback...feeling pretty down & hopeless...
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Re: What is normal?

Postby StarrySky » 10 Aug 2020, 17:54

Hi johnny,

Sorry nobody is really answering you. There aren't many people on this forum anymore since most of healed and moved on (lucky them!).

I understand how you can feel hopeless and down. I'm feeling that way myself. Unfortunately, these take a long time to heal, even with surgery, and depends on your particular situation.

If you still have some bleeding, you should probably see your CRS and get checked out. Are your stools soft? Are you taking stool softeners?

I know it's rough, but things will get better in time. If you're still having issues, perhaps getting a second opinion would help. I am supposed to see someone else about my skin issues at UCSF whenever I get any appointment since my current CRS can not really do any thing else to help me other than prescribe ointments.

I am currently on Nifedipine just to aid in healing. It doesn't hurt to keep applying it as long as your skin can tolerate it (you have no allergies or itching). A lot of people have done that in order to speed up healing. I myself had a full tube of it and wanted to just use it to see if it helped (plus I spent over $90 on it since my insurance sucks and wouldn't cover it).

Sometimes it can take months to heal. I've even heard it takes a whole year for the tissue in that area to recover fully.

I know you asked a question about the muscle strength after LIS. My CRS today said that it's rare that he ever does a second LIS. As long as you cut enough muscle, the sphincter should never go into those debilitating spasms it did pre-surgery. It gradually gets more tone as the year goes on, but will never be the same strength as pre-surgery.

I hope that helps. Hang in there and take care. : )
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Re: What is normal?

Postby johnnyp433 » 10 Aug 2020, 19:14

Thank you SO MUCH for replying! I was seen by the PA (my CRS was in surgery) about 3 weeks ago and she said that the incision looked granulated most likely due to diarrhea. Though, I can definitely tell when the fissure is aggravated because I have pain on both sides (it’s so weird to be able to tell the difference). I’ve been keeping my poo soft but formed with 1 packet of Metamucil after dinner and 1 colace before bed. Unfortunately, I passed a rather hard BM on Friday that caused a bit more bleeding. I feel like I’m trying to come back from that now.

I’m hesitant to make another appointment because it’s going to cost me $130. I know that she can’t do more surgery at this point and I happened to have a refill of nifedipine available. I’m not sure if that’s what she would recommend but I saw that people were prescribed it to aid in healing. I’m glad to see that you are using it too. I’m applying it 2x/day to see if I notice a difference.

Thank you for that last nugget of information—I definitely freaked myself out seeing that people had to have a 2nd LIS. I just can’t go through this again!

Best of luck to you with resolving your skin issues. Thanks again for the words of support :)

-Johnny

StarrySky wrote:Hi johnny,

Sorry nobody is really answering you. There aren't many people on this forum anymore since most of healed and moved on (lucky them!).

I understand how you can feel hopeless and down. I'm feeling that way myself. Unfortunately, these take a long time to heal, even with surgery, and depends on your particular situation.

If you still have some bleeding, you should probably see your CRS and get checked out. Are your stools soft? Are you taking stool softeners?

I know it's rough, but things will get better in time. If you're still having issues, perhaps getting a second opinion would help. I am supposed to see someone else about my skin issues at UCSF whenever I get any appointment since my current CRS can not really do any thing else to help me other than prescribe ointments.

I am currently on Nifedipine just to aid in healing. It doesn't hurt to keep applying it as long as your skin can tolerate it (you have no allergies or itching). A lot of people have done that in order to speed up healing. I myself had a full tube of it and wanted to just use it to see if it helped (plus I spent over $90 on it since my insurance sucks and wouldn't cover it).

Sometimes it can take months to heal. I've even heard it takes a whole year for the tissue in that area to recover fully.

I know you asked a question about the muscle strength after LIS. My CRS today said that it's rare that he ever does a second LIS. As long as you cut enough muscle, the sphincter should never go into those debilitating spasms it did pre-surgery. It gradually gets more tone as the year goes on, but will never be the same strength as pre-surgery.

I hope that helps. Hang in there and take care. : )
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Re: What is normal?

Postby missy moo » 14 Aug 2020, 15:05

1 helpful thing a surgeon said to me if it's not painful that's good don't look for blood to determine if your well or not go by how you feel. He also said stop looking. I've heard it takes some people 12 months to fully recover. Have a positive mindset you'll get there.
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Re: What is normal?

Postby johnnyp433 » 14 Aug 2020, 15:43

Thank you Missy Moo. This reply came at just the right time. I just had another bout of diarrhea and bled a bunch. I feel better in ways than I did before surgery but I’m just so worried that my fissure will never heal.
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Re: What is normal?

Postby AKDad37 » 23 Aug 2020, 17:57

Just thought I'd chip in.

I had surgery late April. I'm still "healing". I've had regression many many times.

I honestly think that my surgeon was way too conservative with his incision and cut. He described me as extremely tight and honestly I'm still extremely tight after surgery.

I had a period of like a month that I felt like I finally beat this thing and then BOOM I reopened one of the fissures.

I honestly think it will take me a year to fully heal. The area down there is extremely sensitive and I have been manually dilating and using Nifedipine post surgery to aid and it helped a lot, but I think that if these don't fully heal by April I'll need to look into Botox or something
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Re: What is normal?

Postby AKDad37 » 23 Aug 2020, 18:02

johnnyp433 wrote:I posted recently about losing faith in fully healing after LIS surgery. Recovery has been slow; however, I’ve noticed improvement in pain and function (I’m able to have semi-normal BMs). What I’m really concerned about is that I’m 9 weeks post-op and still experiencing bleeding. Today, I passed a slightly harder stool so there appeared to be more blood than usual. Some days, it’s only visible on the paper. Some questions that I have are:

Can recovery take this long?

Is there a point when I should start being concerned? (I’m sick of being examined and told to just apply lidocaine and increase my fiber.)

Is healing still possible even after almost 3 months? Does it sometimes take 6 months to a year?

Has anyone been prescribed nifedipine or diltiazem to help AFTER LIS?

Thank you so much. I’m just trying to ease my mind so that I can focus on healing.

You sound like you're in the same boat as me. I was repeatedly told to increase fiber and take sitz baths. I didn't see real significant improvement for almost 12 weeks after surgery, and of course I'm still healing as I previously stated in my last post.

Hang in there man I'm 37 years old, a pretty normal dude with a family and this stuff had me depressed and suicidal after surgery. Don't let this make you fall into a hole like it did for me. Just know that it will get better, even if it takes a really long time. Take a day that you don't see blood or have pain as a win and don't obsess over it. The biggest thing for me was I started to obsess over it and it took over my life.
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Re: What is normal?

Postby johnnyp433 » 02 Sep 2020, 19:25

Hey AKDad37, thanks for the advice. I’m definitely still right after surgery as well. I’m starting to wonder if my periods of regression have created a new stenosis. I’m going to continue using the nifedipine before bed and in the morning before my BM. It seems to help greatly. I did stop using it after I no longer saw blood and then bam, just like that, I had bleeding again. I hope that this thing will heal and NEVER come back.

I hope your healing is still moving in the right direction.
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Re: What is normal?

Postby Keystonegal » 16 Mar 2021, 13:00

Following this. My fissure seemingly has retorn 6 weeks post op and Im not a happy woman.
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