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2013 Anal Fissure - Lateral Internal Sphintcerotomy

Its not really a question - more of an experience i want to share with you. I can't tell you how useful and guiding the comments from other users were - even if some were terrifying (i believe its better to be as prepared as possible). Doctors can tell you the procedure and the possible side effects, but only other sufferers can really empathise and understand what you might be going through emotionally and physically.

I'm 28 years old. A female. A Brit who is living in Sri Lanka (moved 2 years ago). I have had problems with hemorrhoids and anal fissures since i was 24. As a teenager i was prone to constipation, with a few episodes in my early twenties. The first fissure happened for no reason that i could gather, no constipation, no diarrhea nothing that would really explain it. But it happened. I have had injections for the internal H's in the UK, the fissures were left to heal on their own. They also did a flexi sig which showed nothing bad. The H's used to cause me pain, bleeding, and what was worse was the blockage feeling. I was a wreck, terrified of the pain and the bathroom. It made me very, very low – and it is something that you are usually too embarrassed to talk about to people or explain, and even if you do they can’t really understand. The closest I came was saying its like trying to push a brick through a straw filled with shards of glass.

For a year after i moved to SL no probs at all. Then the dreaded h came back with another anal fissure. i went to a surgeon here who recommended LIS and banding. I admit at the time i was scared and didnt want it (worried about side effects), so cancelled. I used to work in a hosp in the UK and had access to operation lists, and had never seen it listed there so was dubious. For some reason its not really encouraged in the UK. It eventually did go away. But it came back again in December 2012 and didnt go away at all, although it was sometimes better, sometimes worse.

Finally, the day before yesterday i had a BM which was no more painful than usual, but afterwards i was having difficulty walking, bending and going from kneeling to standing. Sitting down was not a possibility. I thought it would subside. It did a little during the day but after the next BM it was worse and did not subside. I went straight back to the surgeon (how I managed to get an appt I will never know). He said I had an internal hemorrhoid that had come outside and become oedematous  because it couldn’t go back in due to a spasming sphincter. He pushed it back in – possibly the worst pain ive ever had in my life. I nearly fainted three times afterwards. He said I had a chronic anal fissure too and recommended I have LIS and banding immediately. So I said yes – I was in so much pain it couldn’t get worse right?

Yesterday I had the LIS treatment plus banding of a large internal hemorrhoid that had come out, and excision and cauterisation of a piece of tissue associated with an anal fissure done under LA. I think I was more scared than in pain which is what made me such a bad patient lol. I am actually normally a very good patient, doing exactly what the doc says, but this time – yeah I shrieked and wriggled – and I really didn’t need to to be honest.The injection hurt like a ***** – if you are having it done under LA insist on a numbing cream before the injection. Didn’t really feel the banding, did feel the sphincterotomy – but no pain. Apparently the fissure had caused a large piece of tissue to form to it (helaed incorrectly) and normally this is left to shrink by itself. It was too big he said so he cut and cauterized it – which I literally felt every little bit of. Yuck. Then he shoved in a suppository and was done.

If you are having the surgery under LA, as I say insist on numbing cream first. Take painkillers beforehand, and if you are especially nervous have a sedative. This is a surg you have to relax for or you’ll make it difficult for yourself and the doc.

I felt tons better afterwards. No lie. Take it easy afterwards though. I waddle like a duck atm with the gauze there. I get occasional burning or stinging pain but its nothing I can’t cope with. No incontinence as far as i can tell so far in any way.

I have even had my first BM and it wasn’t as bad as I thought it would be either. Not a walk in the park, but not unbearable either. My main concern was actually the h coming out again and it getting stuck out but that didn’t happen so yay! No blood, bit of stinging during and afterwards, but the sitz bath and hot pack helps.

Most people are really terrified of the first BM. Believe me, i've been scared of that bathroom for many years now, and the fear of the pain and the unknown has caused me panic attacks in the past. But now i try to box it all in. At the end of the day you have to go through it so trying to be as positive and as can do as possible can change a lot of things. Ive had my downs too, but believe you will get through it - and somehow you will. So below i have a checklist of stuff to do beforehand so you are as prepared as possible for afterwards (reduce pain and swelling etc)

It’s important to make sure your stools are soft so take whatever laxatives are prescribed to you or which work for you. Eat a diet high in fibre and veg after the op – ive been eating boiled potatoes, carrots aand green veggies. No meat. Prunes are amazing,  they are your friend – but don’t eat too many if you are on laxatives. Eat anything that will make you go – esp if you are constipated.

Things to do BEFORE BM (as much as possible).
1. RELAX - it is scary for most people, and will probably painful, but tensing up is the worst thing you can do. Do breathing exercises. Sing songs to yourself. whatever takes your mind away from worry
2.Take painkillers if you can and if the doc has prescribed a topical painkiller apply that too.
3. Run a sitz bath (hotter than you can stand - you are after all gonna  probably take some time)
4. Have a heat pad ready to be warmed up straight away - or failing which a hot water bottle works just as well
5. Stand or squat. DO NOT SIT. I very rarely sit on a toilet for BM's and standing relieves a lot of the pressure, pain and you will need to strain less - it has helped me a lot in the past and helped today.

Now I’ll keep you updated when I can and tell you about my recovery, and if you have any questions just shoot them over to me :) Thanks for reading and hope you got something useful out of this. God bless you and I hope that your issues are resolved soon.
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Avatar universal
Hi I was just reading your thread & just wondered how you are getting on - as it is now 18 months later - as my daughter has had exactly the same problems and op ,Thanks
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Avatar universal
Hello Cazza504,
Thank you so much for your detailed post about your experience with AF. I too have been suffering from this for about a year now and have been putting off the surgery as much as possible. While I have it under control for the most part (water, fiber, lido cream), it still is very limiting in what I can eat or do. Your last comment left me very uneasy and just wanted to know how you are doing now. Hope you have healed completely.
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Avatar universal
So it is a day later and i am not comforted one iota.
I saw the doc today. The fissure has healed. Unfortunately the incision he made, and the excision wound has not healed. I am obviously very distressed and worried about this.
The only advice he gave me was to take sitz baths (which i was doing anyway) and put a swathe of cotton with benetine on it next to the site (also doing already).
Am terrified of the long term consequences if this doesnt heal.
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Avatar universal
Three more days later...
It hasnt really got better sad to say. In fact at times i think it is actually worse. This is day 9.
Ive rested as much as i can, stuck to a fruit veg and fiber diet with plenty of water. But this isnt really getting any better. The LIS site does not seem to be healing any further. The excision site is extremely painful, leaving me gasping just before, during and after a BM. If i felt this was improving id cope. But really it doesnt feel like it is. I've got my post op appt with the doc tomorrow. Dreading it. Dont want to be examned and told that there is something wrong or another op to be done. Dont want to be examined full stop as it is very sore.
So it seems that i may be in the 1 percent that doesnt heal. Goody for me.
Well i'll keep you updated and good luck with your surgery. I hope it works out better for you than it did for me.
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Avatar universal
So it is three days later.
On the 6th May - Day three post op - i was convinced that the hemorrhoid was coming out and was in pain so went back to the doc. I t was at this time he told me that he never did a banding. the massive h was in fact an anal tag that had become oedematous. No wonder it bloody hurt so much when he pushed it inside my anus! This is the tag he removed. So i actually had an LIS and excision of anal tag. I was not best pleased. He did an exam (pain pain pain alert) and said it was healing and any swelling/pain was to do with this. somewhat reassured i went home.
I have kept with a fruit and veg and bean diet only. No rice, pasta, bread or meat, which has made things easier.
In general feel fine, couple of twinges here and there though. Only BM's are causing pain. The site of LIS is sharp, but feels like a normal fissure, and like its healing. As mentioned before the excision site is more painful but this goes away over time.

Day 4
Morning BM was extremely painful on site of LIS and then that switched with the pain of the excision site. this went down during the day. I thought it was supposed to be gettign better, not worse. Sigh.
The evening BM was much better, barely any pain, just discomfort.
Still eating a veg and fruit diet. Taking painkillers and lactulose.

Day 5
Most painful BM yet. Stools are soft. But it feels like passageway does not want any visitors. The LIS site is actually mostly painfree. The excision site on the other hand feels like there is a piece of tissue blocking the inside which is extremely painful when anything comes close to it, gas or faeces. It also feels swollen and literally made me shriek in pain. I never had spasming before, or if i did i never really noticed - today i had my first dose of that. I wanted to die, no lie. Almost worse than the pain that made me go to the doc in the first place. Surely by now it should be starting to heal and be less swollen?
Even after a sitz bath it feels like there is pressure there and swelling, almost like something is jutting out.
The LIS is fine i think its trying to heal normally. But this excision site - well i just dont know what to do with it. Making me feel very low, and my initial optimism has just drained away.
At this point i would say have the LIS. Nothing else. Its making my life a misery.
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Avatar universal
So an update – a day later and there have been a few changes – to my optimism at least.
As I  said before, the first BM was not painful.
The second wasn’t too painful, but there was a lot of flowing fresh blood (I feel thin was actually from the banded hemorrhoid – not the LIS)
Since then there have been two more – with no blood but more painful – esp at the LIS site. The antibiotics are giving me diarrhea so I cant help but go, but I feel it is hindering my healing. Sigh.  
It also feels like the pressure from the banded hemorrhoid is pushing against the opening at all times which is a bit of an issue for me. BTW my doc told me to put a gauze against the anus with iodine solution for the first few days – forgot to mention that earlier.
I’ll see how it goes throughout today, then maybe wll see the doc about getting prescribed different antibiotics. Will keep you updated
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