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My fissurectomy and lateral internal sphyncterotomy

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Old 11-26-2009, 08:02 PM   #1
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eman1968 HB User
My fissurectomy and lateral internal sphyncterotomy

Hi everyone. First, let me say that this is a great forum.

On Tuesday of this week (11/24), I had a fissurectomy and lateral internal sphyncterotomy. I was pretty nauseas on Tuesday (probably from the anesthesia), but I was feeling much better on Wednesday.

For the past two days, I really haven't eaten much -- just some soup and some mini wheats. I've had several glasses of metamucil, and I also took some mineral oil last night.

Today is Thursday, and so far so good. I had my first BM this afternoon. It was a pretty scary experience. I was so apprehensive. I kept fighting off the urge until I couldn't fight it any longer. It definitely didn't feel good to go, but it wasn't that bad either. To my surprise, there was absolutely no blood.

My one concern is that I still feel like there's some packing in there. I'm guessing it's just some swelling or the sutures from the fissurectomy, but I don't know for sure. Has anyone else had this experience? The best way to describe it is that it feels like something is stuck in my anus. I know it's only been 2 days, so hopefully it will go away with time.

I'd love to hear from anyone who had one or both of these procedures to help me with what I should expect over the coming days. My doctor told me that I should expect to miss about a week of work, but I'm hoping I can go back to work on Monday.

Thanks in advance for your comments.


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Old 11-28-2009, 06:18 AM   #2
Ali Hilal
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Ali Hilal HB User
Re: My fissurectomy and lateral internal sphyncterotomy

hi eman >> i had my surgery done 3 weaks ago... i had anal fissure, 3 internal hemorrhoids and an anal abscess..
i stayed the first week at home.. the first day was disaster but then i have improved gradually...
i still have some discomfort when i sit .. but my BM now is better because of laxative.. now i have no pain during or after BM comparing by the the past where i have severe pain, constipation, tenderness and back pain ..
my doctor says that the discomfort im experiencing now because of the unhealed wound of the surgery .. he says that by 15 dec i will be pain free and can exercise ..!!

Old 11-28-2009, 08:54 PM   #3
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eman1968 HB User
Re: My fissurectomy and lateral internal sphyncterotomy

Thanks for your reply.

I think I may have turned a corner tonight. I'm still uncomfortable, but the discomfort is bearable. I haven't taken any pain medication, because I'm afraid it will constipate me. I've watched my diet, had plenty of Metamucil and mineral oil, and sat in a warm bath 2-3 times a day.

I'm getting a strange discharge from the wound site. Not to be too graphic, but it's a clearish, pinkish fluid that smells like rotten fish. Hopefully it's just a sign that the wound is healing. I really hope it's not a sign of an infection. If anyone has any insight on this, I'd appreciate it.

Oh, and one other thing. So many people on this site have shared their experience with their "procedure." I think it's critically important to be very specific when you're referring to the "procedure." My procedure entailed a fissurectomy and lateral internal sphyncterotomy. Many people who have had the procedure have reported experiencing no pain and returning back to normal life within a day or two. I can honestly say that there is no way that anyone who has had a fissurectomy can be pain-free after 1-2 days. I believe those who report no pain and being back to normal after a few days have probably only had a lateral internal sphyncterotomy.

My doctor explained it to me this way. If your fissure happened relatively recently, there most likely won't be a lot of scar tissue, and he wouldn't necessarily need to perform a fissurectomy, but only a sphyncterotomy as that would loosen the muscle and allow the fissure to heal on its own. If, however, the fissure is chronic and there is a lot of scar tissue, you need to perform a fissurectomy in order to clean away all of the scar tissue that has built up over time to give the fissure a clean wound and a chance at healing properly (along with a lateral internal sphyncterotomy to loosen the muscle to allow the fissure to heal).

Hopefully all of this makes sense. I'd love to hear what others have to say about this. Thanks.


Old 11-30-2009, 09:39 AM   #4
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wantrelief HB Userwantrelief HB User
Re: My fissurectomy and lateral internal sphyncterotomy

i have an appt my talk to a colon and rectal surgeon this wednesday. i've been dealing with what i think are anal fissures since i gave birth to my son over 2 years ago.

i went to my ob/gyn last week and she said she couldn't see any fissure on the outside or feel any on the inside. at the same time i wasn't experiencing a flare up while i was there.

i don't know what else i would have. i have all the symptoms of an anal fissure and it is probably considered chronic since i've had it so long now.

do you always need a fissurectomy with a chronic anal fissure or does it also depend on the severity of the fissure/s?

i am hoping to not have a fissurectomy and just have the lateral internal sphincterectomy.

i can get myself to a point where it doesn't hurt or doesn't hurt very much when i have b.m.s if i eat right and drink enough fluids, but if something is off in my diet and i have a hard stool or a bout of diarrhea i am back to square one for several days with pain during b.m.s and usually there will be blood on the tissue paper.

i will update about my condition once i've seen the specialist this wednesday and see what he says. i am hoping i can get the surgery done before the new year

Old 11-30-2009, 08:04 PM   #5
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eman1968 HB User
Re: My fissurectomy and lateral internal sphyncterotomy

I don't think you need to have both procedures, but if your condition is chronic, you'll want both procedures. If you don't get the fissurectomy, there's a chance that a chronic fissure won't heal properly, and you may find yourself back to square 1 in the future.

Old 02-04-2010, 08:33 PM   #6
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eman1968 HB User
Re: My fissurectomy and lateral internal sphyncterotomy

Hi everyone. It looks like my last post was 6 days post-surgery, so here's an update.

It's been just over 11 weeks (I think). The first few weeks were hard. I was in a lot of pain during and after every bowel movement. It just seemed like the darned thing wasn't healing at all. I continued to take a lot of warm baths and drank a lot of Metamucil. I was incontinent as to gas for at least 3 weeks. I also had this strange clear discharge that smelled very foul.

At 6 weeks, I went back to the doctor. He said that the fissure was 80% healed (to my surprise), but that the LIS site was not healing properly. He applied something to the area (silver nitrate, I think) to cauterize the area. It stung a bit, but it wasn't too bad. The discharge I was experiencing stopped immediately (which was a relief). However, BMs were still painful. It felt as if the area was still too tight and every time I went to the bathroom it felt as if I was really stretching (but not ripping or tearing) the area.

Anyway, to make a long story short, I am now at around 11 weeks and as of last Monday (about a week and a half ago), everything is completely back to normal. In fact, I can't remember the last time going to the bathroom was so normal. I had been dealing with this fissure for at least the last 4.5 years. Every trip to the bathroom was an adventure. No more. It was a long process, but I am SO GLAD I went through with the LIS and fissurectomy.

If anyone has any questions, please post them to this thread and I will try to answer them as best I can.


Old 04-06-2010, 11:52 AM   #7
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sman34 HB User
Re: My fissurectomy and lateral internal sphyncterotomy

Hi eman, I was wondering if you could answer me a couple of questions.

I'm 6 days post op, and have a few questions for folks who've had surgery.

I had a fissurectomy, with an advancement flap and botox.

The way it was explained to me, was that the dead skin around the fissure is cut away, a stamp size piece of skin is then excised from just above the fissure and then stitched over the wound from where the fissure had previously been.
Botox is then injected into the muscles around the wound to stop them from spasming.

The surgery went well I was told, and then sent off with just some paracetamol and ibuprofen.
At this point I demanded something a little stronger, as I didnt believe that would be enough. I was given some tramadol.

I'm now 6 days after the op and in a lot of pain.
BM is about as painful as before the op, in much the same sort of way, with a reasonable amount of blood each time.

I am using Lactulose as a softener, but this seems to have a mind of its own. Some days it will result in nigh on diarrhoea, which is fine with me as its easy to pass, though does make for a fairly miserable day with your stomach churning away whilst you put off the inevitable. Other days it doesnt seem to soften stools much at all resulting in much more painful BMs.

On the whole, its perhaps maybe 10% more painful than pre op at present.

What I didnt expect though, was all the external damage? From the way the op was described to me, I didnt expect to see any stitches as that would have all gone on up inside the pipes.
However I seem to have quite a number of stitches going in various directions around the opening. I also seem to have what appear to be very big pinched blisters - perhaps where some sort of instrument has been clamped on the cheeks to keep them open?
The pain in touching myself around the bottom area is high. So there's this to content with aswell as the BM pain.

I wanted to ask if this is what you had? Did you see stitches externally and what might have caused the pinching? Did you have that?

Should I be demanding stronger pain killers maybe?

I'm glad yours was worth it though, I'll keep my fingers crossed.



Last edited by sman34; 04-06-2010 at 11:53 AM.

Old 04-12-2010, 02:53 PM   #8
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YorkPDF HB User
Re: My fissurectomy and lateral internal sphyncterotomy

Hello everyone!! Well, I guess I'm now part of the "group" that has been diagnosed with an anal fissure. I have been battling it for 3 weeks and the last couple of days have had me on my wits end. I even asked the nurse if anal fissure is on the top 10 lists for people on suicide watch. I had to sit in the bath tub for over 4 hrs yesterday just to get relief. I'm sure most of you have been there so I won't go into the details.

I'm actually here to see if anyone has any wisdom on how I should go about finding the right surgeon and what questions I should ask. I'm meeting with one a week from today and I want to make sure I have a list of questions to ask so I get all of the information I need to make a sound decision.

Does anyone have any suggestion on what I should ask? I know the obvious ones like how many have you done and of those, how many had complications. Are there others?

If I decide to go forward with the surgery, I will probably post more so that others like me know there are people out there that have dealt with this awful feeling.

I honestly don't know how people that have been battling with a fissure can take it for years, let alone weeks. I used to think I had a high pain threshold but this experience has changed my mind. I've been lying on the bathroom floor crying for my mommy multiple times because of the pain. I don't have much pain during the BM, but after that, it is something I could never describe. I guess these are the spasms that everyone talks about. They are unbearable.

I would love to hear from anyone that has suggestions on what questions I should consider.



Old 04-15-2010, 05:59 PM   #9
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YorkPDF HB User
Re: My fissurectomy and lateral internal sphyncterotomy

I'm back. I met with my surgeon today and I'm scheduled for next Fri. I'm hoping I can make it that long. For those that have dealt with it for years, do you have spasms? My spasms last 10-12 hours a day. I've had this going on for 8 days now since it my fissure appeared on March 25. I've had 2 emotional breakdowns during what I consider my peak pain period. This past weekend it was level 9+ for 3 straight days because I couldn't get my inner muscle to relax. Every BM caused more tearing...I could feel it and I was afraid of the toilet!! I have 8 days for the cream to work but I'm not holding out hope. I can't take it any more.

I do have a question for those that have had this condition. I have a symptom that I want to make sure is common. I'm calling my doctor tomorrow but thought I would see if anyone else has had the same. I feel like I have stool "poking" me from the inside but there is nothing there. I'm extremely regular right now to the point that I know what time I'm getting up in the morning to use the bathroom (only time a day right now). It comes and goes and it is very uncomfortable. Just wondering if this is a common symptom or if this could be something else. He did say it is chronic but fortunately I don't need a fissurectomy because I don't have any scar tissue or skin tags covering it. So I'm just going for the LIS.

Thanks for listening. I hope that no one ever has to experience the pain I have been going through. Have a great evening...

Old 06-22-2010, 01:09 PM   #10
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LISsurvivor HB User
Anal Abscess after LIS surgery! Anyone else go though this?

Hello all,

I had the LIS and fissurotomy surgery nearly 2 months ago (after three years of conservative treatment that included sitz baths, fiber supplements and diltiazem cream).

At my two-week post-op checkup, my colorectal surgeon noticed some pus draining from the surgical site, so he put me on Flagyl and told me to come back in two weeks.

About a week later, I began to notice a palpable mass at the opening of my anus, just "south" of the surgical site. When I pushed it, I noticed drainage coming from the surgical site. My wife is a physician (an OB) and she recognized it as a possible abscess...the one thing I feared most about having the LIS surgery. I'm told it only happens to 1-3% of LIS patients. Lucky me.

After an excrutiatingly painful office visit, in which my surgeon sodomized me with an anoscope and suctioned out pus from the wound (without any anesthetic), he told me it was indeed an abscess that was partially draining. He told me to give it another week to see if it could drain on its own.

Needless to say, it did not drain, and the heavy duty anti-biotics I was taking, did nothing to help the situation.

Last week, I went back under the knife to have the abscess drained. It was in an OR under general anesthesia, and it left me with a gaping wound that stretches from the original surgical site "south" to where I first noticed the nodule. The first two days after surgery were manageable...the nerves down there likely hadn't woken up and I didn't have a bowel movement, thanks to bowel prep I took the night before surgery.

My first bowel movement was pure hell. I've NEVER experienced pain as intense and as searing as this (even from the fissure when it was at its angriest). The only saving grace was a hot bath right after the bowel movement. My wife expertly packed the wound with gauze and 800 milligrams of advil seemed to help.

My surgeon had told me I could return to work the following Monday, but there was no way that could happen with such debilitating pain. I told work I would likely be out the rest of this week (I don't have a cushy office job in the A/C and usually have to take my BMs in public restrooms when I get a chance).

Has anyone else dealt with the painful aftermath of a drained anal abscess? What did you do to minimize the pain and to keep the area clean? Did you form a fistula (that's my next fear since it happens in about half of all cases and I have little luck staying out of the minority.).

Any suggestions would be much appreciated. Thanks!

p.s. the LIS did its job. I don't have the spasms anymore and the fissure is completely healed. Just never anticipated another dragon down below.

Old 12-19-2010, 08:45 PM   #11
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male2205 HB User
Re: My fissurectomy and lateral internal sphyncterotomy

My name is Mario and I suffered from an anal fissure for almost 7 weeks and though is been openly discussed in all the forums I've read over the past month and a half, I can not stress enough how painful, uncomfortable, and challenging this can be, I couldn't say that it is the worst pain anyone could have but I can certainly say that nothing I've been through before compares to it. My mother had one and she openly says that giving birth is a walk in the park compared to this. Two of my friends went to surgery because of fissures and they certainly don't regret having made that choice.
After a month and a half of trying everything and anything possible and after two visits to a board certified colon and rectal surgeon and his colleagues, my Dr. recommended surgery and it didn't take me more than two minutes to say yes.
Now, two days ago I had a fissurectomy and lateral sphincterotomy and even though the whole experience takes a big toll on you, I feel I made the right decision. I believe and have faith that things are going to finally get better. I felt pain once the anesthesia wore off but I got pain killers and the pain subsided a lot, in fact, on the second day after surgery (yesterday) I barely felt any discomfort. Of course, I didn't have any BM which by the way was my biggest concern. Needless to say, just the thought of having a bowel movement scared the crap out of me and today, less than 48 hours after surgery, I had my first BM.
I can't lie to you, it was painful but not nearly as painful as I thought it would be and it was a lot! Sorry for being so descriptive but some of you will surely appreciate me telling you this,
I've been in pain afterwards but is less intense that whatever I had before the surgery, at least better than in my worse days with the fissure.
I'm bleeding only a little and going to start with the warm sitz baths after done here.
I'll keep you all posted and pray that your pain will go away very soon. Will post again in a few days.
Blessings to all

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