lateral internal sphincterotomy…. boom!

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Instead of getting in on existing conversation I have hopes that this post will get read more as a new topic.  

I, just like anyone on this forum am a sufferer of chronic anal fissures.  Im a 30 year old otherwise super healthy and fit male.  Ive been suffering from fissures for 12 years. Let me clarify that over the 12 years it wasnt a constant ordeal.  Some years id only be affected for a week, two weeks, or maybe three. In the beginning it was a little blood here and there and a sore  rear for a couple of days. As the years went on the occurances became more frequent and heal times were growing in length.  Battled it with the common suggestions: lean light diet, high fiber intake, supplemental fiber, and gallons of water.  All are great things but when the problem becomes chronic the requirements to obtain health (in my case) were more than that.  This year has been the worst... i own my own small business and am fourtinate that things had been going exceptionally well (and im penny mc pincher and save every dollar i can) because 3 weeks ago i reached a point to where i could not work any longer.  A year ago in my mind surgery was out of the question.  Im a control freak (hence me working for myself) and the thought of being put under while someone with a scalpel operates on an area that is of up most sensitivity was out of the question. Plus the fear of the unknown just scared me to death.  3 weeks ago i came to the realization that there were no other options... unless i could make a living doing construction while laying on my couch... Went to my general physician because i needed a refferal to get to a specialist.  No problem there, he hooks me up with a surgeon and i make a consultation appointment.  That appointment took place this past Monday at 7 am.  I meet him, instantly like him.  Hes a busy man so he was to the point.  That was fine with me.  Didnt need a hug from a doctor, i needed a doctor to look me in my eyes and tell me he could help me.  He did just that, in fact he told me it would only take him 15 minutes (the procedure ended up taking 20 becasue i had a polyp he removed as well) to help me and that i was going to be very upset with myself for letting this rob me of my quality of life over the last 12 years.  Since the procedure is so short he scheduled me for the next morning at 7AM.  He typically didnt get to work until 8 but wanted to help me so he began his day an hour early to take care of me.  What a blessing!  I was there early, got hooked up with a good nurse and at 7:15 they knocked me out.  I woke up in what felt like 5 seconds but was actually 2 hours and it was over.  I didnt get to see the surgeon again because he was so busy but he told my mom that i was in much worse shape than hed originally thought.  Told her he didnt see how i was living my life!  By 1130 AM i was back at home on my couch!!!  Nauseous from the drugs but local numbing shots had the rear end feeling no pain at all!  They gave me a perscription of 25 325 MG hydrocodones (not super strong) pain pills.  I know that pain pills can and will constipate you so i went into this whole thing with the goal of ONLY taking them if i absolutely NEEDED them. if you have a fissure youve dealt with pain.  so the day of the operation i ate nothing, didnt want too.  Numbness wore off that night at 930 and it was rough but nothing i hadnt dealt with before. Actually i defined it as a 7/10 as to where the day before i was an 8 or 9/10 after a bowel movement.  I took one pill that night (they wanted me taking 1-2 every four hours) to go to sleep.  Day two still didnt eat.  Some of that was fear of making myself go to the bathroom part of it my stomach just wasnt feeling it.  Day two i did not go to the bathroom either.  Had me super nervous because im SUPER regular.  I go every morning within 20 of being awake.  I chocked it up to the fact i hadnt eaten either day and that i hadnt eaten much the two days before the procedure.  I was also soaking in the tub 3 times every day... tub is amazing!  I took one pain pill night two to help me sleep.  Day 3 i woke up and could tell i was headed in the right direction.  Ate oatmeal for breakfast and bounced from the couch to the tub.  That night i did use the bathroom some.  Of course i was scared to death, new stitches, a sore in an area thats been miserably painful!  Just like he said,  the feces never once hurt my fissure.  Sure, it felt weird going having stitches there and yes there was some blood at the incision site but after the BM i got in the tub and it helped relax it all.  I also ate a huge salad that night.  If i am taking stool softners i always take them before the meal then a serving of mineral oil after the meal.  Never took a pain pill on day 3.  Day 4 i woke up and the bowels wanted their regularity back.  Scared to death but cant hold it in for ever (hahaha) i went, and i went a lot.  Again, absolutely NO fissure pain.  Just that odd pressure from having the stitches.  That specific BM took me 50 minutes but it wasnt anything more than a 3/10 on the pain scale!  Then, 30 minutes after that BM pain hit me.  But, id just really stretched that area out for the first time so it was to be expected.  I instantly took two pain pills and got in the tub.  Sat in the tub for 45 min.  By the time i got out of the tub the pills were working and it wasnt a big deal.  probably a 4/10.  The rest of the day was all good.  Tub to couch, couch to tub.  I didnt even have to take a pill to sleep and slept pretty good.  Today is the 5th day after the procedure and the bowels were regular again this morning... went a lot again.  So instead of waiting on things to hurt again i took 2 pills and a bath.  Boom! same result.  Now its 6:15 in the evening, my pain hasnt been over a 3 today (last week every freakin day was a freakin 8!!!!!! a 10 being my a$$ is going to the hospital).  Yesterday i ate a squash fried in heavy olive oil and today ive eaten a big salad again.  Its crazy where i was mentally (where you all are now) a week ago.  Just the fear and the lack of trust is what kept me from doing this years ago.  If your problem is chronic i find it very doubtful that diet, fiber, and water are going to fix it.  My problem... plain and simple... my hole was too small.  Nothing was going to fix that except for a surgeon and a scapel.  Im a big believer in God and prayed heavily on this for a long time.  The way it went for me was sent from him.  Everything from start to finish.  I tell you what else helped me a lot, i met someone two years ago on a job and he saw me drinking my fiber and asked why i did.  long story short he had the same problems and had the surgery 6 years ago... hes never had a problem since and he swore to me that the surgery (if performed correctly) was absolutely nothing compared to dealing with it daily.  He was 100% right and i was very thankful to have him on my side.  Ive bombarded him with questions and hes been amazing about it.  Very thankful for him.  

See a specialist

Make sure you like your specialist (as soon as i met mine i liked him)

If they can confidently look at you and tell you they can help you let them help you

Pray ( you should do that every morning and night anyway wink)

Ive used Calmoseptime ointment a lot, before going as a lubricant, after going as a soother.  Ive even been using it after the procedure because it is a skin protectant from infection (get it on your finger one time and youll see what i mean haha).

Be strict about what you eat, that has never been a problem of mine but im sure it is for some people.  If you put it in the top its gonna come out the bottom and you can control what goes in, in turn, means you can control what comes out.  You eat salads daily your gonna be better off than eating steaks daily... duh.  Good luck everyone!  Tomorrow morning i start my 6th day of recovery and I havent had a smile like this on my face in months.  GET  THE  SURGERY  

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  • Posted

    Hi all-

    My first time posting here but I have been reading everyone's comments the last 2 months while I have been battling a terrible anal fissure that completely took over my life. So I wanted to thank Eric and everyone else whose words of encouragement led me to make the decision to have a lateral sphincterectomy at Kaiser in LA 2 days ago. 

    The relief I have felt since the operation has been immediate. I just had my first BM post-surgery this morning and while painful it was not nearly as painful as the BM's I was having with the fissure. And after 1/2 an hour in a hot bath I felt pretty good again, whereas after pooping with the fissure it would sometimes take hours to recover. 

    Last night was the first night in weeks that I slept 8 hours without waking up in pain throughout the night. Prior to the surgery I was taking a 10mg Norco and a sleeping pill before bed and STILL waking up in pain at 3am. Last night no sleeping pill needed, although I did take a 5mg Norco about 6pm. To reiterate, I am taking less pain meds and less sleeping pills 2 days after the surgery than I was before it. 

    My colorectal surgeon was great, he does hundreds of these and told me they have all been successful with no incontinence issues. He also said that surgery was my only recourse, that botox or trying to heal thru diet etc were not going to get me fully healed. 

    I'm only 2 days in but I'm so greatful that I did the surgery and am healing as well as I am: less pain than before, no blood, no incontinence and feeling better by the minute. 

    I hope this helps anyone who is tossing up as to whether to have the surgery or not. My advice: do it but make sure you have a really good, specialized colorectal surgeon with a good track record of these surgeries. 

     

    • Posted

      You are beyond welcome on my behalf. I smiled really big after reading this! So happy for you and i don't even know you lol. Fissures are a real pain in the a$$! Hopefully that's over for you! I mean I can dunk a basketball now... before surgery I couldn't. Just kidding I can't dunk

    • Posted

      Hi

      Im scheduled for a lateral sphincterotomy this Monday and I am terrified. I have had the fissure for about 6 weeks. Went to see a proctologist yesterday and he scheduled me in for surgery Monday..I'm still in shock!! I am debating if I should just try another 3 weeks with Metamucil and sitz baths rather than the surgery.

    • Posted

      If the fiber and baths haven't done it yet they probably won't... I had that same mentality. Except I did it for 12 years. Lots of lost time!! My procedure (call it a procedure, a triple by pass is a surgery... this is simple stuff) was June 21. Not ONE problem since. I'm very thankful

    • Posted

      Thanks for replying Eric so happy that your procedure went well. I decided to wait the 3 weeks concentrating on diet and Metamucil. My pain after bm is not intense burning anymore but a dull ache. I'm hoping that it's healing..

      My appt is with the Rudd clinic with Dr. De La Rocha.. Has anyone gone to him?? Thx

  • Posted

    Hello I just had my operation LIS 2 days ago

    . I like Eric suffered in excess of ten years..

    I can Say honestly feel better already then I did pre operation. It still hurts when I have a BM but the duration of the pain actually seems less and going was no problem at all.. A delayed pain did hit me afterwards.. It appears there is more room to go now.. I *hit like a little puppy dog before lol.. Small no room, spasms and shooting pain was the norm. I went to go see a doctor the other day and I broke down in tears. I'm a 230 pound considered to be pretty rugged guy and this was just buckling pain for years and years that I could not take anymore.The doctor felt so bad for me he got me in for surgery the very next day.

    Ill report on progress but no regrets here on day two.

    If anyone any questions I'd be happy to try and answer them. Operation was pretty easy put me to sleep wake up done.

    • Posted

      Super glad to hear this. Give it a week or so and you should be in great shape. It's an amazing feeling to feel good but it still is on my mind daily

    • Posted

      Hi Eric

      Thank you . I know I will never forget the agony of this either. I think it will alway be on my mind as well.. I will be forever grateful to not feel this pain as you sound.

      Good for you ! I will be there soon too.

      Im going to give the doc a hug and a gift on my follow up appointment..lol .Its no way to live with a fissure..I had to face that it would not heal after 10yrs lol. Umm . Ok

      Thanks for being there boss man.. I am happy there is light at the end of tunnel. For those who choose to live with it; there is no light !!! It got to the point where I did not care about complications or even if I *hit my pants once in awile. The pain was that bad and im not a runway model .. Who cares.!. But the doc assured me it would not happen anyway and if it did it would be tiny bit..I think complications are way overblown and thats whats scares everyone and me frankly for years.

      ON THE MEND IN Massachusetts !! Thanks

    • Posted

      Right now 5.5 days into recovery and bowel movements have been fine with some delayed pain and this morning after a BM and during the pain reached the level of pre-op pain for the first time. In the tub reeling from pain. Eric talked about pain reaching pre- op status one time.. I hope this is my one and last time.

      Last night I felt really good and was walking around better and sitting better.. but today at 5.5 I'm feeling the pain after the dreaded BM.

      🤕🙏

    • Posted

      I remember not using the bathroom the day of procedure and then the following two days I didn't go either. Day 3 I did and it hurt... the next few days it hurt afterwards too. It wasn't the fissure hurting though. It was clear to tell it the muscle they'd just cut. I'm never went backwards though. Every day got better (THANK THE LORD!!) and ever since I've never had a bad bm. Praying for you my man!! Hope it keeps getting better. Keep that diet good

  • Posted

    Hi Eric..I see its been almost a year since your post..so hope you see this post. I have had rectal fissure disease for 30 years. It started after I delivered my daughter by C-section..the fissure is due to post partum constipation. The first was more external and I was able to get healing on my own. However, later fissures were internal but still I managed these with cortisone prescribed type creams. Over the last month I have a new fissure..this one is the worst. Last week I can say my pain with it was a 10/10! This week after 3 or 4 sitz/dakon baths a day plus creams and heating pad its a 3. I did go to a new Doc whom I have only seen twice in two years..my Doc of 30 years retired. The current Doc I liked right off because he in character is much like my old Doc. He recommended a fissurectomy to get that bugger and its scar tissue plus scars that I myself have felt when applying creams with my finger probably from past fissures. He also wants to do a sphincterotomy to relieve any spasms and the tightness involved. I am terrified because I cannot take antibiotics due to an issue where I was on a course of them way too long which caused ulcerative colitis in me. Its only active with antibiotic use..but I am so close to C dif it could be fatal. I am scheduled for surgery in 5 days. I pray I am doing the right thing. Tired of pain and being tied to my tub. Another huge fear is incontinence. Have you had any issue with infection and incontinence? I know this is not a major surgery but having a knife in my tail is not my idea of a great day and I am so afraid I have considered backing out. My Doc is a certified colo rectal surgeon with 39 years experience and zero malpractice against him. He has said on the incontinence issue that its very unlikely and there are Docs out there who dont know how to properly do the cut..thats when you get in trouble. He states infection is highly unlikely due to the abundant blood flow in that vicinity plus hygiene which I am deligent with as I have never had an infection from my fissures. I am happy for you you are doing so well..and thank you for sharing your experience. If you dont mind letting me know about the questions above I would consider it a blessing from above.

    Thanks and God bless,

    E

    • Posted

      So I do still keep an eye on here just not as regularly as i should.  I see it's been about a month since your comment... did you go through with it?  

  • Posted

    Hi Eric,

    Thank you to you and everyone on this forum for sharing your stories. I've probably read the stories 100 times and they provide so much comfort and guidance for dealing with the dreaded fissure. I am 30 years old, super fit and had a fissure for 13 years. When I read your post I could instantly relate. Just like you my condition got worst over the years until I could no longer take it and I had an anal sphincterotomy on 10 Oct 17. I wish i had done this operation when I first had the fissure all those years ago! For those who are suffering from a chronic fissure, please go get the operation done, the relief is immediate.

    I had the anal sphincterotomy exactly 1 week ago. When I have a BM there is still a stinging feeling maybe a 3/10 on the pain scale but no pain afterwards. My questions are, how long before the pain stops? Has there been a re-occurence of the fissure? Does the anal sphincterotomy last forever or does it gradually get tighter again?

    Cheers,

    Mike

  • Posted

    I am a little late to the party but I wanted to share my fissure ordeal, in hopes someone else who is reading this thread is in the same boat as me. Right now I am scheduled for an LIS in one week and I am terrified...

    A little background... I am a 27 yr old female, active and healthy, located in the U.S. Last winter I had quite a traumatic health scare that resulted in severe anxiety and stress which I attribute to the partial cause of my first, now chronic, fissure. My fissure resulted from over-exertion passing an abnormally large BM. Immediate blood and pain which stayed pretty constant for several weeks until I first sought the advice of a CRS. BTW this was all over Christmas, so I didn't see the CRS until about 5 weeks after the fissure happened. I would absolutely DREAD going to the bathroom, because during this time it felt like pooping glass.... however I did not experience excruciating spasms like most seem to do. I also went straight to the CRS bypassing my GP. I was obviously diagnosed with a fissure and put on Nifedipine Ointment. This was in January of this year (2017). After 9 months of using this therapy I still have the fissure but I have little to no pain when having a BM and only have occasional bleeding (usually when I know I've reopened a little). I actually really didn't bleed that much after the 1st month of this ordeal, besides slight pinkish streak on toilet paper occasionally. To be honest, my biggest symptom is that I have PTSD (as I call it) when I got to the bathroom, which causes me to tense up then re-tear a bit.

    At my last appointment with my CRS, she said the fissure is still there and the granualtion (healing tissue) is not good healing tissue. She said my body is unable to heal this on my own (because of the muscle) and the only route to fully resolve this curse is either Botox or LIS. She actually prefers NOT to do the Botox because she feels LIS is a much better procedure in terms of low reoccurence/low rate of incontinence, but she of course does not like the idea of doing the LIS on me because I am pretty asymptomatic (I have minimal pain and bleeding).... but again, the fissure is still there and is chronic.

    I decided to go with the LIS because this has taken a year of my life away, just being stressed and the constant fear of going to the bathroom.... but of course I am scared. I am scared that I will probably be worse off (for a bit) after surgery... because I am not in pain now. But I would go through pain all over again to have this curse gone for good.

    Eric- thanks so much for your story.... I can't imagine living through 12 years of this. Did your doctor prescribe you the Calmoseptine or did you decide to use on your own? I am so worried about infection too.... although I have never had any symptoms of infection throughout the fissure. Also, I know my doctor went over this but I honestly zoned out last time I was there due to the "shock" that surgery was in my future..... but where exactly do they make the incision? Is it on the external part of your anal canal or inside the canal? Do they use stitches?

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