My experience with Lateral Internal Sphincterotomy (LIS) for my Chronic Anal Fissure
Iím writing this because I suffered with a chronic anal fissure for a year and a half before I finally had the Lateral internal sphincterotomy surgery done. This is a long story, so for those of you who want the short version, here are the main points:
1) Try all conservative therapies first
2) If it doesnít heal, have the LIS done by an EXPERIENCED COLORECTAL surgeon
So mine started with a hard stool one day. I remained constipated with hard stools, so it never got better. The pain was pretty bad, and would bleed a little with each BM. At first, my GI doctor told me to soften stools with Miralax and fiber. I tried that Ė it still didnít go away. After about 3 months of trying fiber and miralax and colace, I finally caved and saw a colorectal surgeon.
The colorectal surgeon told me I could try nifedipine cream, but even if it worked temporarily, the fissure would likely return. He was right. Within 2 weeks, the fissure pain was gone! I was so happy. I continued therapy for 6 weeks and within 1 week of stopping, the fissure pain returned. It was so depressing!
One thing I must note is that the pain I had from my fissure was nowhere near as bad as some people post about. Mine was maybe 5/10 and was a burning and spasm but would only last 5 minutes after each BM. So I didnít think it was severe enough to warrant having surgery.
Well after the relapse, I saw another GI doctor who told me to try Benefiber and colace, and continue on the nifedipine cream. I did that for a total of 6 months and everytime Iíd stop applying the nifedipine cream Ė the fissure would relapse!
I finally caved and found a GI doctor who does BOTOX. He said Iíd have a 70% chance of the botox working. I gave it a shot. The procedure itself was done under conscious sedation in a hospital (like a colonoscopy) and didnít hurt at all. Unfortunately, it didnít work either. Apparently my fissure, like most chronic fissures had fibrotic edges, which impair its ability to heal.
I decided to see if I could just ďlive with the discomfortĒ and after 2 months decided living in fear of a BM was no way to live. Despite the risk of incontinence and infection, I decided the risk was worth it. So I found the most highly recommended colorectal surgeon and gave it a shot. He told me heíd done around 2,000 of these and NEVER had one incontinence, infection or a recurrent fissure. I thought the odds were good so I had it done.
The surgery itself was done under conscious sedation and I didnít feel a thing! Apparently it only took 10 minutes. He did the LIS and put a stitch through his incision to minimize the bleeding. I did NOT have the fissurectomy done. That whole day my anus was numb from the local anesthesia, and only 8 hours later did I begin to feel some soreness. I did have some incontinence to flatus for the first day, mostly because I couldnít feel my sphincter.
There was also some blood on the dressing, but no leakage or bleeding after that.
I went home and took a nice warm bath. That night I took some ibuprofen and went to bed. The next morning and for the next several days I was very sore down there but NEVER needed to take the percocet he prescribed for me. I used 600 mg ibuprofen 3 times a day and that worked great. I also took 2 full weeks off of work. The first 5 days I had pretty severe pain at the sphincterotomy site (left side) after each BM. The first BM was bad, but not as bad as I expected Ė it stung like crazy but I immediately jumped into the warm tub and it only last 5 minutes. I was a little discouraged because this pain lasted well into 5 days, but by day 7 was much improved. I never had any bleeding or drainage.
By day 14 I had no pain with BMs but I did feel soreness on my anus, and an itchy feeling. On day 21, at my followup, he said it was the stitch causing the itch and he removed it. Since then, Iíve had no itchiness or pain.
Itís now day 28 Ė 4 weeks exactly and Iíve 100% better! No pain, no spasm, and no incontinence (thank God)!!! I continue to use benefiber and colace and am hoping to wean myself off of the colace soon.
I decided to post this because I relied so heavily on everyone elseís posts when I was agonizing with the decision to have surgery. NO ONE should live with pain Ė the surgery is not that bad and if you have it done by an experience colorectal (NOT a general surgeon) surgeon you can minimize the risks. But, to be fair, the risks still exist and you must make a calculated decision.
So, I say to those who suffer from chronic anal fissures: try the conservative ways first, and if you can live with it, thatís fine. But if you suffer every day, please consider having the LIS done Ė it works so well for so many people. Good luck and God bless you all.