:D Greeting everyone.

First, let thank everyone on this board for all their wonderful information regarding anal fissures. I've had a fissure flare up off and on for 2 years. Unfortunately, I recently suffered a bad case of strained obliques that escalated the pressure in my rectum and thus irritated my fissure something horrible.

I've recently visited a proctologist for the first time and he's prescribed the usual conservative treatment for 6 weeks. Frankly, I'm tired of not having a normal life, so after reading all the great information on this board, I'm considering a Sphincterotomy. There is A LOT of information on this topic here, but I wanted to pull together some very specific information for myself, and for other readers potentially considered a Sphincterotomy or other treatments. That being said, here are my questions. In the unspecific questions, please rate them on a scale of 1-10, with 10 being the worst and 1being the least.

1. What was the pain level of the Sphincterotomy operation?

2. What was the pain level 1-2 days following the Sphincterotomy?

3. In days, how long did it take for you to go back to work?

4. In days, how long did you wish you had off from work to heal?

5. How long ago did you have the operation?

6. How long did it take for the fissure to fully heal after the operation?

7. Were you ever able to return to eating "regular food?" Of course, anyone that doesn't change there diet after this is just plain nuts :dizzy: , so when I ask this question, assume I mean eating a fast food meal 2-3 times a week, going out to dinner on the weekends, but also maintain a proper hydration level and using fiber supplements with a balanced diet otherwise.

8. Did you ever get another fissure after the operation?

9. Past week 3, did you experience any bouts of incontinence?

10. Not wishing this one anyone, but I think this is really a good test of the operations pain to benefit ratio...if you got a new fissure and you knew the opertion would heal it, would you have the operation done again?

11. Have you used botox at all?

12. Did botox work?

13. If so, did your insurance cover it, or was it out of pocket?

14. If botox, what was the out of pocket cost?

Thank you to everyone and anyone who will take the time to answer these questions! As a new person to this board who has read most of the anal fissure posts, I think this thread will help new users like myself get right to a lot of information that is on their minds after reading all the posts. :D

chris0007,

I'll take a stab at answering these questions for you since I suffered from a fissure last year and had the LIS surgery. First off, best decision I made and if I had it to do over again I would not have played the conservative route as long as I did hoping it would heal on its own. Bottom line, once they become chronic the chances of it healing on its own are pretty darn slim. Now, onto your questions:

1. 2 - less pain immediately after the surgery than from the fissure. Pure heaven! Given the pain I was in when I had mine, which was pretty much constant as I was now in chronic anal spasm.

2. Its hard trying to rate the pain level as I honestly have to admit, that the pain level from the surgery was nothing. I, based on my experience, did not consider it pain, it was more like a soreness, like a bruised muscle feeling. Your going to be a little sore naturally but honestly I was more irritated being laid up for a few days. If I have to rate based on my personal experience, at this time in recovery I would say a 1 as there was slight discomfort.

3. 6 days. My surgery was Friday, Aug. 18th 2006 and I went back to work the following Thursday Aug. 24th. It was only part time for about a week as I sit at a computer programming for 10 hours a day so sitting for that long wasn't happening as you do have to be careful sitting so you don't pop a stitch. I was instructed to not even try sitting until at least day 4 after the surgery and then it had to be on a pillow and on your good cheek as any pressure on the side of your incision could cause the stitches to pop. I consider my colo/rectal surgeon "Man of the Year" for 2006. I came out of the surgery with only 1 stitch and no pain....

4. Looking back, another 4 days making it an even 10 days but I was fine doing what I did.

5. Not quite 10 months. Aug. 18th 2006(two days after my birthday, what a present, LOL)

6. About 3 months fully. Mine was bad, torn into the anal muscle so it took awhile but I couldn't tell it wasn't healed right after the surgery as all the pain from the fissure was gone.

7. I have returned to normal eating habits with a lot of diet modifications. I eat a very high fiber diet, take a fiber supplement twice daily, drink plenty of fluids daily, actually water is the only thing I drink now. I make sure I get 25-30 grams of fiber daily. I do eat take out but I limit myself to once a week and try to choose the healthiest thing on the menu that interests me.

8. No, I haven't. I make it my first priority everyday to make sure I get my fiber and fluids and this does require some pre-planning on occasion. I make it a point to never be anywhere without water and some kind of fiber snacks, etc. I hope to never have another one but am not stupid enough to think I can never get another one. Yes, the anal sphincter is cut which is a permanent relaxing of that muscle but if don't develop good bowel habits and a healthy, properly functioning digestive system then you are setting yourself up to get another one. After all, that's probably what gets most of us in this predicament in the first place, I know it was mine.

9. I experienced some passing of gas without trying to do so, LOL. Anyone that knows what your going through now will understand your temporary little problem. Heck, most of my coworkers have adjusted their eating habits because of me. I work in a small, family owned office and everyone is like one big family. They were all so supportive and understanding.

10. ABSOLUTELY!!!! I wish I had not kept putting it off in the first place. Key thing: MAKE SURE you have a good surgeon performing the surgery. Mine has been doing it for 24 years.

11. No. It was offered but I was at the point that I did not want to have to worry in the future that I would reopen the thing and have to go through it all again. Botox, Nifedipine, Nitro, they are all drugs that will temporarily relax the sphincter muscle allowing the fissure to heal without the spasms. At this point, I was not settling for a possible, temporary fix. I wanted permanent. This surgery, when properly performed, and a healthy diet is maintained on the patients part, has a 97% chance of success at healing and keeping the fissure away. Most people who have had a fissure return or a new one develop after having the LIS will admit that they slipped, didn't drink enough, very little fiber or supplement in diet, etc. which caused them to become constipated and the development of a new fissure. Healthy but normal diet is possible, I do it. I lost 62 pounds when I had my fissure. Not a diet plan I would recommend to anyone.

12. Didn't use it.

13. n/a

14. n/a

I hope this answers your questions satisfactorily. I'll be glad to answer any questions you may have as I fully understand what you are going through.

Purpleladyfish,

Thank you so much for ALL of your information. In my opinion, its been as valuable as an doctor's information. Thank you again!

chris0007,

You are very welcome for the information. I frequently check this board solely to try and help people like yourself. I know it is a painful ailment and a long process of trying to heal conservatively and avoid surgery. Please keep posting, I would like to know how things go for you especially if you decide to have the surgery. You are in my thoughts, keep smiling, it does get better ;-)

Hello, I had the sphincterotomy. It immediately gave me fecal incontinence (more like seepage after each bowel movement.) It lasted for 7 years and finally had a sphincteroplasty to repair the muscle. There has been improvement but will probably always be somewhat incontinent. I sugget you stay away from sphincteroplasty!

Sorry, I meant stay away from the sphincterotomy.

If you don't mind me asking...who did your surgery. I'm IL as well and would like to know. Also, what type of doctor was it?

Thanks!

Dr. James Wielgoleski, a Colon-Rectal Surgeon. Avoid him!

Dr. James Wielgoleski, a Colon-Rectal Surgeon. Avoid him!

If you don't mind me asking...who did your surgery. I'm IL as well and would like to know. Also, what type of doctor was it?

Thanks!

Hi, I am new to these message boards. I am on the computer today looking for help and information. I had a lateral sphincterotomy on a chronic anal fissure about 6 weeks ago. I had been suffering with the fissure for almost a year, and decided surgery was the best route to go because I wanted my life back. My recovery was going well and I was feeling so happy during the past 6 weeks. Well this morning I had a harder than usual stool, and almost cried when I saw blood on the stool and toilet paper. I also felt that "pinch" when I was going to the bathroom, and knew that it must be what I thought it was. I believe the fissure has reoccured, or maybe it hadn't quite finished healing over from the surgery, and it opened up when I had the stool. How could this possibly be happening....
I am at a loss for what to do. I have already scheduled an appointment for next week with the doctor that performed the surgery to see what she has to say. Of course I do not want to have surgery a second time, but my question is... what are the outcomes of a second sphincterotomy? Can you do this twice? How many times will a surgeon perform this procedure before they say "no more!?" I am wondering if the fissure isn't in quite as bad condition as before the surgery, but I know something is different. It feels like it is back. I am devastated. I was very pleased with how I was recovering from surgery, and how the pain of the fissure had gone away. Now it seems I am back at square one, and I'm mortified.
After already having the surgery once, will it be in my best interest to do the home remedies for a certain period of time before heading back into more invasive options? Or is is better to combat it with a second surgery back-to-back with the first surgery? Will this be a lifelong problem? It is so very frustrating. I know this is not a life-threatening problem, and for that I am thankful...but living with a fissure has made my quality of life go down. If you have any information or advice on surgeries/other medical options for fissures, please let me know. Thank you.

Sorry you are having problems. Hope your appointment goes well and you are already feeling better! :)

I am dealing with a fissure problem right now and know what a pain :( that is.

Take care.

Thanks Kcind.

Hi, I am new to these message boards. I am on the computer today looking for help and information. I had a lateral sphincterotomy on a chronic anal fissure about 6 weeks ago. I had been suffering with the fissure for almost a year, and decided surgery was the best route to go because I wanted my life back. My recovery was going well and I was feeling so happy during the past 6 weeks. Well this morning I had a harder than usual stool, and almost cried when I saw blood on the stool and toilet paper. I also felt that "pinch" when I was going to the bathroom, and knew that it must be what I thought it was. I believe the fissure has reoccured, or maybe it hadn't quite finished healing over from the surgery, and it opened up when I had the stool. How could this possibly be happening....
I am at a loss for what to do. I have already scheduled an appointment for next week with the doctor that performed the surgery to see what she has to say. Of course I do not want to have surgery a second time, but my question is... what are the outcomes of a second sphincterotomy? Can you do this twice? How many times will a surgeon perform this procedure before they say "no more!?" I am wondering if the fissure isn't in quite as bad condition as before the surgery, but I know something is different. It feels like it is back. I am devastated. I was very pleased with how I was recovering from surgery, and how the pain of the fissure had gone away. Now it seems I am back at square one, and I'm mortified.
After already having the surgery once, will it be in my best interest to do the home remedies for a certain period of time before heading back into more invasive options? Or is is better to combat it with a second surgery back-to-back with the first surgery? Will this be a lifelong problem? It is so very frustrating. I know this is not a life-threatening problem, and for that I am thankful...but living with a fissure has made my quality of life go down. If you have any information or advice on surgeries/other medical options for fissures, please let me know. Thank you.

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I can relate to your story... I have been suffering with a chronic fissure for 8 months. I attempted all conventional therapy (baths, stool softners, various creams and ointments etc) Eventually in January I had surgery (Lateral Sphinc.) The first week was painfull, the second better, then the blood and pain returned. This went on for 6 weeks and eventually things never got better just bad to worse. I went to another colo-rectal surgeon who felt that the first surgeyr may have been incomplete...to make a long story short he repeated the surgery in late March. It is now 4 weeks since the second surgery. The fissure pain in much better, the wound still hurts a bit....but like you, every time I feel a pinch I get really scared...It has dominated my life for 8 months. I hope over the coming weeks I will completely heal both physically and mentally.... So far surgery #2 seemed to have helped (fingers crossed). Hope that gives you some hope.

Thank you so much Johnny for your reply. Yes, what you said does give me some reassurance. I guess I am just scared to go through the surgery again for a second time. I'm afraid to have that delicate muscle cut twice.....let alone once! My fear is that the sphincter muscle is weakened now after having surgery, and to cut it again is a scary thought. So you had surgery within 2 months time, huh? I was curious about what the minimum amount of time would be between surgeries, but your story kinda settled that for me. Did you have similar concerns? What were the facts/stats you got from your doctor about doing the surgery twice? You haven't experienced any incontinence with doing surgery twice? Did you ever consider the botox, or did your doc suggest it?

Thank you so much Johnny for your reply. Yes, what you said does give me some reassurance. I guess I am just scared to go through the surgery again for a second time. I'm afraid to have that delicate muscle cut twice.....let alone once! My fear is that the sphincter muscle is weakened now after having surgery, and to cut it again is a scary thought. So you had surgery within 2 months time, huh? I was curious about what the minimum amount of time would be between surgeries, but your story kinda settled that for me. Did you have similar concerns? What were the facts/stats you got from your doctor about doing the surgery twice? You haven't experienced any incontinence with doing surgery twice? Did you ever consider the botox, or did your doc suggest it?

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Hey, Yes I had the exact same fears as you regarding incontinence. When I asked the doc about cutting twice he simply said, in my experience people in there 20's or 30's don't usually have this problem. (but generally docs have always been carefull not to make any guarenttees for obvious reasons.)
It was almost 3 months post 1st surgery...and they did not even consider the time issue when they saw how much pain I was in....I would guess if after 8 weeks things are still bad it did not work...
Every time I mentioned Botox to family docs or specialist they brushed it off..saying they don't do it, or still not mainstream etc...One surgeon told me it is only really a 50-60% success rate and surgery much better option...
It is now week 4, so far so good (fingers crossed) still feel a bit of pinch hear and there and a bit sore near incisionbut much better....I pray this time it works....Just keep thinking it works 95% of the time and you should be in that group especially twice.
Oh one thing the doc told me that the reason it did not work the first time was that it was an "incomplete sphincterectomy" muscle was not cut deep enough...perhaps this is case with you.

Good luck

Thank you for your info Johnny. I really hope your recovery from the second surgery goes smoothly for you. It is so nice to read these forum posts, because no one really understands this unless you've lived with it. I appreciate hearing from people like you in the same boat. I was told too, that it works 95% of the time, so when I felt pain again the other day I thought: great, I'm the 5%. Part of me wonders if I re-opened the incision that the surgeon made. Maybe that incision didn't heal completely in 6 weeks, and I happened to open it.? But the other part of me wonders if the fissure hadn't quite healed, and I opened that again. It's hard to know. I think the better of the two would be the muscle that the surgeon cut, because that would probably heal on its own again in time. I go to see the surgeon on Tuesday, so I will know then. Gee, how many more times can I have a rectal exam done? I'm getting sick of this! Again, I do hope you heal completely and can move on with your life. Thanks again.