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Old 08-03-2010, 01:38 AM   #1
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Exclamation Sharing my Lateral Internal Sphincterotomy experience

I decided to post my experience in case it can help someone else. The hemorrhoidectomy posts are more numerous and Iíve learned a lot from themÖesp Tacomaguy whose is excellentÖbut since the surgeries are different I really wanted to read more about others experience with LIS. Iím sure I wonít cover everything but this is a fair account.

Where to begin? With the slow loss of my grip on sanity? Just about every waking moment spent in pain? The strange raw flesh funky smell? The wet gas? Iíve had my fair share of surgeries, major life trajectory altering ones too, and this is beyond a doubt the worst.

Iíve had an anal fissure off and on for over a decade. It has caused me lots of pain and missed opportunities. It also caused me to have low grade fevers. Iíve had the nitro treatment twice, analpram, lidocaine, and hydrocortisone suppositories. Tried the daily fiber thing with Konsyl but could not stomach it. I also have IBS. And I had two internal hemorrhoids (removed by banding last year). Admittedly I have had the most ridiculous diet and take full responsibility for this mess that Iím in. Of course there were mitigating circumstances but what goes in your mouth affects what comes out the other end.

Basics about this experience. I am alone with no family. I chose to only share this experience with one friend who escorted me to surgery and first follow up. I used the sitz bath three times a day, occasionally with epsom salt, until it started to hurt for lack of support. Use squeeze bottle every time use bathroom. Use aloe+e toilet tissue with water on it as I found the Cottonell wipes to be irritating. Dry with blow dryer. I take colace, miralax, magnesium, multivitamins and vitamin c. Am not able to take anti-inflammatories. Chew food very, very well.

Day 0: Ate very little for dinner, liquids until 10p and did the enema bowel prep before bed.

Day 1: Surgery at 11a, general anesthesia, urinated on schedule, home by 4p. Pain not too bad but difficult to walk. Nurse went to pharmacy for me to get my pain meds. Vicodin every 4-6 hrs. Pain increase after local anesthetic wore off. Took vicodin every 4-5 hrs. Slept in 1.5 hr increments.

Day 2: Had follow up to remove bandages. In all the pain, had not realized that I had been urinating on the bandages and I was stinky. Burned like fire when packing removed. Asked for and got Valium script as I read that it helped with spasms and anxiety in the hemorrhoidectomy threads. Asked if I could use lidocaine but doc said it would hinder healing because too thick. Was told everything looked good so far. Was able to go to drugstore to get script though hard to walk.

Day 3: No bm yet. Anxiety level high. Pain relentless and only dampened somewhat by pain meds. Taking Colace, fiber, water, vitamins, and magnesium. Spacing meals into small portions. Mainly soft foods like oatmeal, brown rice, and crackers, and fruit. Small piece of chicken once. Pain was very bad from the pressure of having to go but not being able to. Was in agony. Spoke to surgeon on call who said I would feel better after bm and to use enema or come in to doc office in morning. Didnít have an enema and it was middle of night. I used a sitz bath to try to relax and something came out of me that I didnít really even feel! It was some mass of mucus and poop (?) I think but no real bm. Pressure let up some but that relief didnít last long.

Day 4: Went to see doc. I did not take my pain meds because I had to drive. It was painful. Drove leaning to side and almost standing up. Doc said looked like it was healing fine and offered an enema, which he said would be uncomfortable. I opted to go home and do my own enema. I have to note that when the doc looked at my backside, only after I told him it really hurt did he use lidocaine. So Iím thinkingÖwhy not just put lidocaine on first and save me some agony! Thanks to lidocaine was able to make it to drug store to buy enemas and other supplies. Enema was a little painful but it worked. Felt like I passed a tennis ball. Whole body kinda spasmed and pushed it out. Thankfully it was not dry and hard. I didnít feel fissure pain but felt searing pain at incision site. Did have throbbing pain afterward but felt much better overall. Tried ice pack on back side which felt ok for about five minutes.

Day 5: Morning bm ok but still throbbing and searing pain after. Followed by spasms so used heating pad on small of back which helped. Continued to follow diet of soft foods with very small piece of chicken added in. Added a dose of Miralax in the morning. Still taking 2 vicodin but now every six hours. Able to sleep ďwholeĒ night for first timeÖ12p-530a. Very uncomfortable. Warm sitz felt really good at first but starting to hurt...too much pressure/no supportÖso tried bath but couldnít sit in it. Use shower head and contorted positions as makeshift sitz.

Day 6: Morning bm diarrhea. Feels like passing acid. Sweated profusely. Decide to not take full dose of Miralax for a while. Return to doc for another follow up. Pain pills do not control all pain. Takes it from a 10 to a 7. Tell him about the pain pills and though he seems a little incredulous as he cannot believe Iím still having intense pain, he prescribes oxycodone and tells me I should only take one every six hours. He only provided 25. Was not able to get pills that day as I by passed the hospital pharm to go to the drugstore to pick up addl items but their computers were not working. Was in too much pain to try another store.

Day 7: Morning bm was ok but throbbing and stinging pain, mostly at incision site, afterwards. Good thing is I can finally wipe with less pain. Went to get the oxycodone. They worked better. The 10 went down to a 3 but with breakthrough pains of 8/9 at times. I messed up my pill schedule trying to avoid constipation and suffered some awful pain as a consequence. Reduced to tears actually. Iíve cried on more than one occasion, including in the docís office. I still canít stand up straight to walk and there is no comfortable position to lay downÖnot even in my recliner. If you could see me typing, youíd think I was a contortionist. Must use lots of pillows for support.

Day 8: Morning bm resulted in some bleeding. Same throbbing and stinging afterward. Needed to wear gauze, which caught a fair amount of blood. Felt some pressure was released after that though. Spent 20 minutes on my knees bent over the couch before I realized that I forgot to put my pjs back on. This pain is making me feel like Iím losing my mind. I read about the hemmeroidectomy experiences and I feel like I should not be in so much pain. These people have stitches up the ying yang and they seem to be doing much better than I am. I am frustrated, angry, disappointed and alone. Reading the HealthBoards is the only thing keeping me from screaming hysterically for hours on end.

Day 9: Morning bm ok. But same throbbing pain afterward and stinging at the incision site. Starting to have weird anal spasms when urinating. Also can feel a lump on the inside of cheek and some strange pain and weakness in my thigh all on the incision site side. No fever though. Have had an infection stemming from anal fissure before that put me in the hospital for three days so Iím now having anxiety about threat of infection. I am so stressed out I could scream. Pain is still relentless and valium does not help (maybe dose is too low). Was supposed to return to work tomorrow but that will not happen. So now I have the added stress of worrying about my pay.

Day 10: Morning bm started something awful. Even though no problem expelling bm, there was incomplete evacuation which caused horrible pressure and pain. Had three bms before noon. And the endless amount of gas that is passed decided to emit some sort of acid like substance as well as very small fecal specks. Everything I drink sends me to the bathroom after two or three sips, which of course comes with the anal spasms, gas and acid emission. Iíve been eating the same stuff the whole time so I donít know. Iím at a loss. Called doc to have the lump on cheek checked but have to wait until tomorrow. Pain is easing up, if I donít move much, as I have committed to taking every last pill prescribed, on schedule. Forget sleeping all nightÖIíve set the alarm. Forget constipationÖdrink more water and take miralax.

 
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Old 08-03-2010, 02:25 AM   #2
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Re: Sharing my Lateral Internal Sphincterotomy experience

Wow, I don't have the words to convey my sympathies for your ordeal. You are a strong person to endure so much without support and remain sane.
You are in my prayers for sure. I hope you find relief soon and heal quickly. Keep holdingon
~Missy

 
Old 08-05-2010, 05:35 PM   #3
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Re: Sharing my Lateral Internal Sphincterotomy experience

Thank you so much Missy. Much appreciated.

Went to the doctor to have the lump checked out but was in no condition to be examined. The pressure of driving and walking to the doc's office caused lots of pain. The doc was unable to touch me because the pain went all the way to the muscle. He admitted me to the hospital to be put under general anesthesia for exam and possible lance of abscess. Was given lots of fentanyl for pain but it did not really help. Anesthesiologist said that it would not help for the burning/searing pain nor the pain from spasms. It was difficult to urinate. I would have anal spasms from that. I started to have vaginal spasms and pain down my thigh. Spent from 10a to 8p, when I went in for procedure, in absolute agony. Woke up to pain. Now had a fentanyl/morphine drip with self-administered pump. It took more than a few hours to get the pain under control with this combo and many times pressing that button. I was allowed to push the button every twelve minutes at first, then every six minutes until I was comfortable.

There was no infection found and the wound looked to be healing well. However, given the full exam that doc conducted, wound had to be opened and restitched. Stayed in the hospital overnight. Was given a schedule to take pain medicine that I will not deviate from! I now take 2 percocet every six, 1 toradol every 4 and 1 valium every 8. I will continue with all of my dietary changes to keep the bowel moving. Use the gauze! It will help keep things dry back there and stop what I refer to as 'battery acid' from irritating the sensitive skin down there.

This was a hard lesson. My advice, as echoed by others I'm sure, is to keep on schedule with your medications...yes, I get up in the middle of the night a few times to take the meds but it's worth it. Give it some time before trying to ween off unless you are sure how your body will respond to the wound healing. Take measures to counteract the possibility of constipation instead of cutting off the meds. If you are able to take anti-inflammatories, please discuss with your doc how much you can take and do it. Since I normally cannot take them, I was at a disadvantage. But given my extreme reaction, I was prescribed Toradol. I believe that the Toradol is the main reason I don't have much of the pain anymore. This drug is not a narcotic but more like a mega dose of ibuprofen or something. Unfortunately it can only be taken for five days following the initial intravenous dose.

I know I may sound a bit melodramatic about the pain but honestly, I am not embellishing. I have had organs removed, blood clots in my lungs, torn ligaments, worked all day standing on my feet with a broken toe... and did not experience this level of pain. I was literally shaking from pain and the tears came uncontrollably...no matter who was present or where I was..."trying to be cute" was not an option...neither was caring who saw by bare backside...the nurses cared more than I did as they tried to close the gown to help me to the restroom. Since the pain I've experienced is unexplained, I'll chock it up as a fluke. And since we are all unique, I would neither encourage nor discourage anyone from having the procedure done based on what I went through.

I believe I'm on the road to recovery and all will be well. I can control gas now and I haven't had any accidents or feelings of immediacy. Hopefully I'll have a more positive follow up to add later.

Thanks all

Last edited by holdingon; 08-05-2010 at 05:54 PM. Reason: importance of gauze

 
Old 08-07-2010, 11:06 AM   #4
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Re: Sharing my Lateral Internal Sphincterotomy experience

holdingon- thanks for sharing your story. The details weren't pretty but at least it will help people who are having this surgery to prepare, and realize they won't be out riding a motorcycle in the few weeks afterwards! It's one of the great things I see on these Boards- people learning from the ones who have Been There, Done That.

I hope you continue to improve.

 
Old 08-10-2010, 11:44 PM   #5
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Re: Sharing my Lateral Internal Sphincterotomy experience

I had my "last" follow up with my surgeon yesterday and was told wound looked to be healing well and that I was obviously keeping everything clean I added hazel to the elaborate bathroom ritual and it's working out well.

Yesterday was also my last dose of the Toradol. It caused me quite a bit of apprehension as I was sure that drug was magic. I did feel like the area had some mild swelling the today but it seems to be calming down. BMs are not painful...just the area of incision stings. I'm starting to think the initial stitches must have been too tight or hit a nerve or something because the second time around feels totally different...no pain in the muscle.

I'm continuing with my bland diet of mostly soft foods. I've had one small serving of meat a couple days though (as in real chicken soup) and it did not cause any problems. The hospital stay (where I was on a liquid diet) did cause constipation for two days so I took three magnesium pills instead of the usual one/two, full dose of miralax and two colace which resulted in four bms in one day (not loose bowels though). That caused throbbing pain in addition to the stinging. All I could think was 'Where is all this crap coming from?!' Didn't think oatmeal, rice, fruit and a small piece of meat could do that. I must just be full of it! lol (gotta keep a sense of humor.)

Walking causes a little bit of bleeding and irritation. But at least I can stand straight up now. I don't have too much discharge anymore and a piece of a stitch came out. Urinating does not hurt anymore even though it still causes a spasm or two.

I stopped taking the Valium as it was so draining. My fear now is weaning off the Percocet. I don't want to have any uncontrollable pain again but I also don't want to keep taking these pills. I figure tomorrow I'll cut down to one pill every six, during waking hours only this time though.

Oh...added Metamucil wafers and prunes to the menu. The wafers are mighty tasty (both flavors) so if other high fiber options aren't appealing, give the wafers a try. I bought the prunes in the snack packs which helps me to get though eating them. They are actually pretty good. And as always, I am keeping up with the water. In fact, it's pretty much all I drink now a days.

 
Old 08-12-2010, 06:29 AM   #6
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Re: Sharing my Lateral Internal Sphincterotomy experience

One very good reason to wean yourself off the painkillers (although I understand they were vital for your sanity in the early days) is that painkillers can be constipating. DH has taken Oxycodone and percocet for back problems and they always leave him constipated. It's one of the reasons he tries to avoid them.

 
Old 08-12-2010, 05:40 PM   #7
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Re: Sharing my Lateral Internal Sphincterotomy experience

Back problems. I feel for your DH. The painkillers are like a cruel joke! Help with the pain but cause constipation which causes more pain.

Wish I could take ibuprofen. Oh well. But didn't take any pills yesterday or today so things are looking up. Still really uncomfortable though.

Now I think I'm taking too much fiber...the recommended 25 grams. Bulky, bulky bms but they are incomplete. Too many trips to the bathroom makes for a sore bottom. Didn't have this problem when I didn't eat so much fiber. Maybe it's a shock to my system. Healthier eating lol. I'm cutting back the fiber today. Can't find any other people post-sphincterotomy that have mentioned this problem...unless everything I'm reading is just blurring together. So now I'm left to just wondering if anyone else had this problem. Anyone?

 
Old 08-13-2010, 01:31 AM   #8
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Re: Sharing my Lateral Internal Sphincterotomy experience

Quote:
Originally Posted by holdingon View Post
Back problems. I feel for your DH. The painkillers are like a cruel joke! Help with the pain but cause constipation which causes more pain.

Wish I could take ibuprofen. Oh well. But didn't take any pills yesterday or today so things are looking up. Still really uncomfortable though.

Now I think I'm taking too much fiber...the recommended 25 grams. Bulky, bulky bms but they are incomplete. Too many trips to the bathroom makes for a sore bottom. Didn't have this problem when I didn't eat so much fiber. Maybe it's a shock to my system. Healthier eating lol. I'm cutting back the fiber today. Can't find any other people post-sphincterotomy that have mentioned this problem...unless everything I'm reading is just blurring together. So now I'm left to just wondering if anyone else had this problem. Anyone?
Dear Holdingon,

After my sphincterotomy I've also started with a fiber diet ( normally breakfast fiber cereals) but the result was also too many trips to the bathroom; after the 2nd surgery ( the abcess removal) I've stopped with the fiber; I think we should go to the toillete once a day, but more important (at this stage) is to have soft stool and for this I'm taking 10ml of Lactulose (Duphalac) and it's working fine

 
Old 08-20-2010, 10:05 PM   #9
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Re: Sharing my Lateral Internal Sphincterotomy experience

dcarvalho...you were right. Hope you are feeling much better now.

Four weeks since surgery and three weeks since re-opening of surgical site. I still have tenderness at surgical site. Really hurts when leakage (very small amount of fluid) gets on it. I can still feel the fissure. Oddly, I felt looser right after the surgery but now I feel more tight. I hope it's only my inability to relax fully during bm. What really concerns me though, aside from still have spasms, is that I still have to put gauze to keep dry... which is extremely uncomfortable, like a stick up your butt...and it makes the skin feel painfully dry. I was so happy to be off the narcotics and I thought the pain would be gone at this point.

Any one else have recovery drag on with these issues? Any ideas on how to treat the skin without irritating anything further? My doctor doesn't think there's a problem...as in this is something I should just deal with and wait out. And I know there's really no choice but to wait it out but does it have to be in such discomfort?

 
Old 08-21-2010, 01:18 AM   #10
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Re: Sharing my Lateral Internal Sphincterotomy experience

Quote:
Originally Posted by holdingon View Post
dcarvalho...you were right. Hope you are feeling much better now.

Four weeks since surgery and three weeks since re-opening of surgical site. I still have tenderness at surgical site. Really hurts when leakage (very small amount of fluid) gets on it. I can still feel the fissure. Oddly, I felt looser right after the surgery but now I feel more tight. I hope it's only my inability to relax fully during bm. What really concerns me though, aside from still have spasms, is that I still have to put gauze to keep dry... which is extremely uncomfortable, like a stick up your butt...and it makes the skin feel painfully dry. I was so happy to be off the narcotics and I thought the pain would be gone at this point.

Any one else have recovery drag on with these issues? Any ideas on how to treat the skin without irritating anything further? My doctor doesn't think there's a problem...as in this is something I should just deal with and wait out. And I know there's really no choice but to wait it out but does it have to be in such discomfort?

6 weeks after surgery and 3 weeks after abscess removal, I'm feeling better now; BM's are painless and lot easier; the 2nd surgery wound is still open and the smelly liquid leakage continues; It's important to keep the skin dry, but it's not necessary to "stick the gauze up our butt"; I use a thin gauze to cover the wound and absorve the leakage; Doctor says that the wound will continue to leak until it's totally closed but that will only happen when fully covered by skin which will take some more weeks.

PS: It's still difficult for me to sit down in a chair or in the car seat; I use a "donut" cushion to make it easier

 
Old 08-21-2010, 01:31 PM   #11
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Re: Sharing my Lateral Internal Sphincterotomy experience

I'm glad to hear that you are doing much better! Once that wound closes...no more doughnut pillows for you!

Quote:
Originally Posted by dcarvalho View Post
but it's not necessary to "stick the gauze up our butt";
I'm not! lol That would certainly be painful. I just meant covering the outside incision. Maybe it just feels so bad because of the wound site is still sore. I just hope this incontinence clears up soon.

I also wanted to say that I cut out the stool softeners (make sure to keep water intake high) and leveled out the fiber intake to around 20-25g per day (combo of foods, one pack Metamucil wafers, and one/two doses of Benefiber mixed in food) which is working out. I went from bulky bms to loose bms back to formed but "regular" size bms. I hope this is not the reason why I feel tighter though. Time will tell.

 
Old 08-24-2010, 11:48 PM   #12
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Re: Sharing my Lateral Internal Sphincterotomy experience

Still leaking small amounts of fluid and junk If this isn't permanent, how long does this type of incontinence last? Anyone still having this problem? Surgery site still kinda painful too.

I'm still using gauze because the leakage still burns. I had this really soft, thin gauze leftover from dental surgery and had been searching for an equally as soft one from the drugstore. Finally found one. If anyone else is searching for the same, it's an all purpose dressing for cleaning and dressing light draining wounds made of rayon/poly. I cut them to last longer...and because they are large.

I've come across studies that mention incontinence as a complication but they really don't mention how long it took for temporary incontinence to clear up. Well, they do by virtue of when the study was conducted.... but not really because the time frame for cessation of symptoms are not specified. Unless I'm missing something, which is entirely possible Seems glossed over...or catch all, like 'within 6 months' or 'within 12 months'. When your butt is leaking acid, you look for any milestone indication you can find to hold out hope for full recovery! Worse when they say stuff like, "participants who continue to have minor soiling say that it doesn't affect their quality of life".

 
Old 08-25-2010, 10:19 AM   #13
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Re: Sharing my Lateral Internal Sphincterotomy experience

Sorry to hear about you problems. The incontinence risk was a deal-breaker for me when my surgeon suggested LIS, even if it might just be temporary.

In terms of your leakage, are you using barrier creams and/or sprays?

When I had a temporary ileostomy the skin would often get sore if the bag seal let go and the contents leaked. The solution was to use barriers creams, powders and sprays.

It is many years since I had these issues so the type and variety of products has probably changed completely. However, I found Drapolene (nappy rash & barrier cream) worked best for me. Cavilon spray is still available in the UK.

I'd speak to the consultant/surgeon and get them to sort you out with some form of skin treatment/protection.

 
Old 08-31-2010, 10:46 PM   #14
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Re: Sharing my Lateral Internal Sphincterotomy experience

Barrier cream might be good but I haven't used any. My doc said not to use any type of ointments right after surgery to avoid getting it in the wound and I guess I never thought about it again.

I'm still having a small amount of discharge. I still have times when I feel swollen. I still have pains and some spasms when using the bathroom. I've thought about doing hyperbaric oxygen treatment but am not sure. Has anyone tried it before?

 
Old 09-07-2010, 11:00 PM   #15
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Re: Sharing my Lateral Internal Sphincterotomy experience

So no hyperbaric oxygen therapy for anyone?

I went for another follow up to see why I still have pain and leakage. I've also been feeling kinda sick...worn down. My doctor said that the incision is not healing correctly and prescribed me flagyl. It's been six weeks since initial surgery and five weeks since incision was reopened. Has anyone had such a slow healing incision?

 
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