My anal fissure experience and 3 procedures (Positive)

Digestive health
1

Yo what’s up! I just made an account to post on here. I originally posted this as a reply to one individual but wanted to make my own thread as i believe this may be of help to many people. apologies if this is not allowed.

This will be long so i apologise but try and make it through, it may be helpful.

I am a 28 year old male, UK with Ulcerative Colitis who has dealt with a chronic fissure for 6-7 years. i was diagnosed with bowel disease and due to this ended up with a bad tear that never healed. I started as a fit and healthy male who worked out daily and weighed about 14 1/2 stone before this nightmare, I now currently sit at 9 stone. I attribute the weight loss to anxiety over eating because as we all know whatever you eat has to come out the other end!

I also suffer from terrible anxiety which does not help our bottom situation at all. I have spent the last 5-7 years in my house doing nothing due to the pain and embarassment, spent so much time away from work and having no quality of life at all. I honestly believe the stress and anxiety comes hand in hand with the bottom pains as you wake up terrified to use the toilet and my whole world revolves around this. My spasms would last from first BM to 8-9:00pm at night. Horrendous pain.

The pain you feel is from the internal sphincter muscle spasm in response to the fissure. The muscle spasms preventing blood flow to the area and therefore healing.

This has been my experience with different procedures. My GP prescribed me the 2% Nitro Glycerin creams for 2 years which did not work, I tried 2 variations due to terrible headaches from the first cream eventually leading to an allergic reaction down there which made everything much worse.

Eventually after many years I got referred to a Colorectal Specialist who gave me Botox injections and a Fissurectomy (fissure scraping to remove scar tissue) last year. This procedure in my opinion was the worst pain I experienced with the whole ordeal, even worse than the fissure itself. Recovery was tough and I was taking max doses of Ibuprofen and Paracetamol just to get through the day and this lasts for 3-4 weeks. I would not recommend this as it did not solve my issue just provided relief for a few months.

My next visit with the specialist ended up with me being offered a LIS (Lateral Internal Sphincterotomy) or another round of Botox and examination under anaesthesia. I chose the Botox again for a second time as I was so terrified of a more major surgery - especially reading horror stories online about cutting into the Sphincter muscle, even in this forum lol. This round went a lot easier for me as there was no scraping of the fissure. I was walking within a week but still needed a lot of painkillers during and after BM’s. Again I had short relief as the botox slightly paralyses the spincter muscle to prevent the spasms i mentioned earlier, but ended up being referred back again due to re-opening the fissure.

This leads up to where i am now and after finally choosing to settle for the LIS surgery which I had 1 week ago on Monday 17th Feb 2020. I read hundreds of horror stories from people here so was prepared for the worst - incontinence, terrible pains which lasts for weeks or months etc.

My experience was honestly the opposite of everything I read online. I woke up that morning to toast at 6:45am as no food is allowed after 7:00, I also drank as much water as i could before 11:00 as no fluids are allowed past that time either. I arrived at the hospital very nervous at 12:30 and had all pre checks done. The surgeon talks you through the procedure of making a small slice to the left or right of the rectum, not actually inside it.

They then under the skin through the incision remove part of the internal sphincter muscle. In my case they removed the rear or posterior portion of my sphincter which was heavily damaged from years of tearing. I eventually went in for the surgery at about 3:30 and woke up completely out of it due to the painkillers and anaesthesia a few hours later. The pain isn’t bad at this point so once checked out you spend that night sleeping it off.

Now don’t get me wrong, the next 2 or 3 days are painful, especially when going to the bathroom. It hurt like a b***h but its more of a surgical pain than the fissure pain and spasms, I was and still am black and blue and swollen down there which is to be expected and the stitches are quite uncomfortable. But in my experience it is NOTHING compared to the pain of a fissure. you need to ensure you take the relevant laxatives they recommend, this is a huge point as you do NOT want to get constipated during recovery. I took 10ML of lactulose X4 times per day and X1 sachet of Fibregel on an evening. As I’m still in recovery I eat 4-5 tiny meals a day mostly greens and white meats, soft oats etc and a LOT of water to keep everything soft.

I am now just over one week in, stitches are still there, i’m still black and blue from bruising, but my experience in general is very positive. I have taken 0 and I mean no pain killers of any sort during my recovery so far going from the day after my surgery until this very second. No paracetamol no ibuprofen nothing. I currently go to the bathroom 2 or 3 times every day now and its easier to pass stool every time, i don’t get the spasms at all anymore. I still have a bit of anxiety regarding going but it gets easier with each day I experience less pain.

I honestly think after years of damage down there my sphincter just kept getting tighter and tighter, I felt like a grown man trying to poo from a babies sized bottom and it was ruining my life.

Although i am not fully recovered or sitting yet i have been on my feet walking since day 1 post surgery and each day is getting easier.

Anyone out there struggling with a chronic fissure get advice about a LIS, i am one week in and see a bright light at the end of my tunnel already and wouldn’t recommend it enough.

I will try and reply to any comments or questions when i get the time :).

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hi great to hear your story and glad to see you are recovering

I found the surgeon is reluctant to give LIS due to all possible side effects . I’m 38 year old male and was told whilst this op has a great success rate of 95 percent if I am one of those 5 percent then the surgery is irreversible. so I could suffer incpnoletence for life and may have to wear nappies . this is where I started stressing

never had the botox before but had my first 1 in december 2019 . consultant said there is a possibility I may need a second injection .

since my botox I would say its helped me 70 percent however I now have anxiety around counting down the days to 3 months post botox as apparently I was told that’s when the botox comes out of my system and then pain may come back

3

Thank you so much for the positive post. A good majority of people with positive outcomes I would imagine never come back to report, but I can understand. This thing literally takes over your life. Been dealing with mine now for 6+ months and will be having the LIS surgery in two days. I’m counting down the minutes. For months I was terrified at the idea of surgery, but it’s really the only option at this point. I want my life back. Hurts so much I can only poop with the help of a warm water enema. The anxiety of the next bowel movement is paralyzing. No surgery is 100% guaranteed, but 96% is about as good as it can get. Worst case scenario is incontinence, but even then there is surgery to fix that. Thanks again. It means a lot to those of us in this condition.

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Are you seeing a colorectal surgeon, or a general surgeon? I saw both, but decided against the general surgeon because he only does “a handful a year.” I wanted someone who’s done hundreds. :slight_smile: The surgeon I chose has 43 years of experience and I got a good feeling from him when discussing this issue. The thing with botox is it really doesn’t heal anything, and the success rate is 50-60%(?). Also, worst case scenario, there is a surgery that fixes the incontinence.

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hi which country are you in? as in the uk I have been told LIS surgery is not reversible hence if you are one of the small minority where the op isnt a success then you are screwed and may have to wear nappies

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The chance of incontinence seems quite small, like you say a 5% chance of side effects from the OP. To be honest I have suffered for so many years that i would take not being able to hold in wind over the agony I felt every day. If you use a Colorectal Specialist - mine has spent 20-25 odd years in this field, they decide how conservative to be with the sphincter cutting so i would imagine they know best. This was a concern of mine too as i am only 28 and want a life back but i decided it was well worth the risk.

I am 9 days in now and the only small issue is that if I need to empty my bowels i cant hold it in as well. l’d personally rather be running to the loo then waking up terrified of the pain and spasms after a BM every day.

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You are very welcome, I spent months researching about the different procedures and peoples experiences on here and the majority were very negative.

People need to start posting their positive accounts because mine has been a walk in the park compared to years of fissures, sitz baths and rolling around in agony from muscle spasms.

Good luck for your surgery and make sure you’re hydrated and taking enough laxatives / fibre to keep stool soft. that’s the most important part imo.

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Thanks again. Question–How long are you planning on taking the laxatives and stool softeners, and did your surgeon tell you to keep taking them? Seems everyone I read in recovery does the same, but everything else I have read indicates long term use is unsafe. I certainly don’t want to be taking them long term. I’d eventually like to get back to a “normal” life.

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Hi. Yes, I’m in the US. I guess it is going to all boil down to how much more pain you are willing to live with and how long you are willing to live with it. Six months of anxiety and severe pain with a wife and three kids is just not manageable for me. I recommend looking for a colorectal surgeon who is confident and has a lot of experience. I wish you the best.

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my surgeon is a colon specific surgeon very experienced.

I just hope I dony need the surgery

glad you have shared positive experience

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I plan on taking the Lactulose and Fibregel for 3-4 months at least. I had already been taking Lactulose for the fissures for a number of years anyway with no side effects at all.

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Thanks for sharing your experience! You’ve inspired me to share mine. On 2/17/20 I underwent 3 procedures – sphincterectomy, hemorrhoidectomy and fissurectomy with skin tag removal. I had been dealing with a chronic fissure for 3+ months and hemorrhoids on and off for years. The fissure put me at my breaking point physically and emotionally.

Prior to the surgery I did try home treatment with the compounded ointment, sitz baths, high fiber diet and stool softeners. Unfortunately it would not heal on its own.

My surgery was done by a colorectal surgeon and I was in the hospital overnight for pain and wound management. I will not sugarcoat it: the following 7 days were horrific. The pain and inflammation were nearly unbearable – raw, burning, stinging pain round the clock while on Gabapentin, 800 mg Ibuprofen, Tramadol, muscle relaxers, laxatives and stool softeners. I truly questioned if surgery was the right decision.

Fast forward to today, I am now 16 days out and really feeling pretty great! Pain during bowel movements is minimal, pain after is very short lived and I feel like I’m getting my life back!

I have been religious about self care since the surgery: tons of water for hydration, high fiber diet, Senna stool softeners (two pills once per day now, was twice per day at the beginning), healthy(ish) diet without much meat, not a lot of alcohol, no spicy food, sitz baths multiple times a day as hot as you can tolerate, baby wipes after BMs, gauze/cotton to pad wounds – I am totally committed to this recovery.

If you’re on the fence about surgery, I can now say I do believe it was the best decision even though it’s the most physically difficult thing I’ve ever been through (including childbirth). I am lucky enough to work from home; if not I would have needed a minimum 2 weeks off of work. Zero incontinence issues. I’m getting my life back … finally! Mad empathy to all of you suffering – sending wishes for recovery and well-being.

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Hey Jay I am so pleased for you
Thank you so much for posting your story.
I am having LIS on 21st march and I am so scared of the pain after.
Your story has made me feel more hopeful.
The fissure pain I’ve had for over a year. I’ve tried everything and am currently house bound off sick from work due to the pain.
Lots of people post horror stories so it was so comforting to read yours.

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No problem! I wish you the best of luck with your surgery I hope you find some relief as I have. Just hit 3 weeks post-OP yesterday and still recovering well!

15

Thank you Jay that’s very kind of you.

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i have fissures after delivery. really hoping to get surgery. is it really helpful?