Where to go from here

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Where to go from here

Postby tiredjay » 23 May 2016, 13:27

Hey everyone! It's been a while since I posted but thought I'd share my story so you all can weigh in on where I should go from here. My issues started back in November 2011 with my first fissure after a hard bm (so much blood). That initial fissure healed after a month but i would retear every 3 months or so after a difficult bm. I eventually got nifedipine in the summer of 2012, which seemed to help heal my fissures faster, but I would retear again and was back at square one. In late August of 2012, I saw a CRS who said that he didn't see any fissures and wouldn't recommend surgery because he said my tone felt normal (he never addressed any of the re-tears and didn't do any tests...) Fast forward to late winter 2013, where I was seen by a differentboard certified CRS who tried Botox to address the retears. He seemed to think that the fissures where never given a time to he's properly before tearing again and thought the Botox would help.The Botox never really seemed to help because I kept retearing despite my sphincter feeling a bit looser. After continuing to have retears, my CRS suggested LIS. I was terrified of this suggestion out of fears of incontinence instilled in me by my first CRS. After a discussion with him and the fact that I had an incidence of uncontrollable gas on the Botox (a fart slipped out once while I was walking), my CRS performed a house flap procedure. Since that procedure I have not had any issues with fissures in that location (they were all in the 12 o clock posterior position). I had pelvic floor dysfunction after the trauma from the surgery and finished my physical therapy in late summer of 2015. I was finally starting to relax and feel that this point of my life was behind me (so to speak). I was even able to have pain free anal intercourse with my fiancé for the first time since the 2011 incident (I am an ano-receptive gay man).

However, things changed in September of 2015 when I had a hard bm and developed a mild fissure in the anterior (6 o clock position). I was devastated. While the fissure itself healed within a week, the spasms triggered my levator ani syndrome, which caused me to go back into physical therapy to release the trigger points. I was finally pain free again in January until I had another hard stool at the end of January and developed another fissure in the anterior midline. This too healed within a week and I felt like I had recovers until I had another hard bm this past Saturday and retore in the same spot.

I don't know what to do anymore and feel like giving up hope. I thought this part of my life would be over after my house flap and these last 7 months have been an emotional roller coaster. I am starting to regret not doing the LIS like my surgeon initially suggested. I have scheduled an appointment with him for June 6 to discuss my options. The thought of another surgery terrifies me (the recovery from the first surgery was a nightmare), but part of me wants to try LIS to see if this will prevent any future fissures from forming. I feel like it might be a good option since I feel like I have to push extra hard to have a bm (it never feels like my sphincter wants to open despite needing to go). I'm terrified of the recovery or how this will fit into my life especially since I am very social. On top of that, I am getting married next June and need to start wedding plans. Anyway, just thought I'd get on here to vent and ask for any advice. I've read mixed statements on here about how LIS may or may not prevent future fissures. Btw, I take miralax every day and eat the recommended 32 grams of fiber a day. The "hard" bms were also not particularly hard...just a bit dry.
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Re: Where to go from here

Postby Manitourose » 24 May 2016, 17:14

Hi tiredjay. Good to see you again on here but I'm sorry it's under such circumstances. :( I haven't had LIS but plenty have on here so hopefully others can assist you with your questions. Were you diagnosed with a tight sphincter? Also have you seen a GI doctor regarding your BM's since you are getting plenty of fiber? I'd definitely chat with one if you can. I was constantly told more fiber by CRS and from reading about fissures, but needed a bit more professional gut guidance from a GI to get things figured out.
I really hope you are able to relax soon, you deserve to enjoy things especially planning your wedding.
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Re: Where to go from here

Postby tiredjay » 01 Jun 2016, 19:13

Thanks for your response, Manitourose. He did not specifically state that I have a tight sphincter, but he did say that i have a high resting tone and most likely experiencing the "overshoot phenomenon." I actually saw my CRS this past Friday and he suggested the LIS. He was a little disappointed that the advancement flap didn't permanently fix the issue, though he wasn't entirely surprised because he said it was more for patients with stenosis or low pressure fissures, which I do not have. I stated that i was really nervous about the operation and he said that there is not much to worry about. He told me that there is a 15% chance of incontinence of wind or some very light soiling but that in his 17 years of operating, he has never had a patient complain of those (knock on wood). He said that the risks are even less since I am young (i just turned 29) and male. That put me slightly at ease, but I am still freaking out a lot about the procedure and am nervous about trading one problem for another (recurrent fissures vs incontinence). I am also a bit nervous because my fissures tend to heal within a couple of weeks, but then recur every 3-4 months...I don't seem to have the crippling spasms that seem to last for days like some other people on this forum.

Anyway, my LIS is scheduled for 6/26. He's doing it outpatient with light anesthesia. He said the recovery is so much easier than what I experienced with an advancement flap.

I am trying to get an appointment with another CRS before then to get a second opinion before the surgery just to put my mind at ease a bit. I really do have a lot of confidence in this CRS though, but I want to be sure since this is somewhat elective.
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Re: Where to go from here

Postby Tight » 03 Jun 2016, 07:32

Hello tired jay - you seem to have multiple fissure, I have something isimilar in that the whole tearing/ healing cycle - I usually recover within a week thanks to stool softener - the only procedure I have had is Botox and it made me bleed more but things healed faster but importantly I did not swell. I may also want to opt for LIS and can understand your situation. One thing that sometimes helped me was turmeric mixed with mustard oil - I would heati the mixture in a tea spoon and then apply cotton bud to absorb the mixture and heat. I would then apply to anus but would make sure before that it was not to hot to burn, by applying it to my hand/Palm first. Also have you considered anti inflammatory foods, it could be a reaction or simply it could be a tight sphincter!!
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