Recovery Time After Lateral Internal Sphincterotomy Surgery

Recovery time after anal fissure surgery?

Hello, Doctor.
In mid-February of this year, I underwent a lateral internal sphincterotomy (LIS) and had an internal hemorrhoid treated using Hemorrhoid Energy Therapy (HET).
I have the following questions:
1.
It has been one month post-surgery.
I experienced some bleeding a few days ago when applying medication internally, which I assume is normal.
The bleeding had mostly stopped prior to that, could it be due to the scab coming off?
2.
In the past few days, there has been no bleeding, but I noticed a slight greenish discharge on the toilet paper, which is minimal.
After using the restroom and soaking in a sitz bath, I observed a little yellowish residue when wiping.
Is this normal?
3.
I still feel some pain at the anal opening (on the left side, the same side where the surgery was performed).
There is no noticeable swelling upon palpation, but there is some discomfort when pressing or stretching the area.
Could this pain be due to the surgical division of part of the internal sphincter muscle? How long is the typical recovery time?
4.
Does wound healing mean that I am fully recovered, or should I wait until all symptoms have resolved to consider myself healed? I found that in foreign literature, it typically takes about six weeks for the wound to heal after LIS, while some local sources mention 3 to 6 weeks, or even as quick as 2 weeks.
Which timeframe should I use as a reference? What is the usual recovery time for anal fissure surgery? Am I recovering slower than average?
5.
I have had follow-up appointments for three consecutive weeks.
Last week, the surgeon said the wound had scabbed over and that I didn't need to return.
The examination was done via digital rectal exam.
Is it sufficient to assess the healing progress through this method, or is an anoscopy necessary? The doctor has only performed digital exams during my visits.

6.
In the first week, the doctor prescribed a topical ointment, but in the second week, due to slower swelling reduction, I was switched to a different medication.
By the third week, I developed an infection, and the treatment was changed back to the original ointment plus antibiotics.
By the fourth week, the infection had resolved, and I was switched back to the second medication, which the doctor said would be more comfortable.
However, I find the second medication causes a tingling sensation, and I’m not sure if it’s because I’m applying too much.
The doctor recommended inserting about 1 to 2 finger-breadths of the medication.

7.
The anal issues have caused me anxiety and worry about poor recovery or complications, such as anal abscess or fistula, especially since I experienced an infection post-surgery.
Would you recommend seeing a psychiatrist or a counselor for this?
Thank you for addressing my questions.

Niming, 30~39 year old female. Ask Date: 2022/03/17

Dr. Ke Fangxu reply Surgery

1.
Mild bleeding after surgery is not a concern; if possible, it is best to avoid applying medication inside the anus to prevent further injury to the wound.

2.
This is normal.

3.
Mild pain after surgery is inevitable; the internal anal sphincter does not have surface nerve innervation, so it will not be painful.
Do not worry excessively.

4.
Lateral Internal Sphincterotomy (LIS) typically requires a longer healing time than traditional surgery; a recovery period of about 6 weeks is a reasonable expectation, while the recovery time for anal fissure surgery is shorter, approximately 2-4 weeks.

5.
An anoscope is much thicker than a finger, and using an anoscope after surgery may cause tearing of the wound.

6.
The medication for hemorrhoids contains local anesthetics, which may cause a tingling sensation; if you have questions about the medication, please discuss them with your surgeon.

7.
Yes, you are overthinking it.

Reply Date: 2022/03/17

More Info

Recovery after a lateral internal sphincterotomy (LIS) surgery, which is often performed to treat anal fissures and sometimes involves addressing hemorrhoids, can vary significantly from person to person. Here’s a detailed response to your questions based on medical knowledge and common practices.

1. Post-Surgery Bleeding: It is not uncommon to experience some bleeding after LIS, especially if you inadvertently irritate the surgical site while applying medication. The bleeding you observed could indeed be related to the scab coming off as the wound heals. As long as the bleeding is minimal and resolves quickly, it is generally not a cause for concern. However, if you experience significant bleeding or it persists, it’s advisable to consult your surgeon.

2. Discharge and Color: The presence of a small amount of greenish discharge is not unusual, particularly if it is minimal and not accompanied by a foul odor or significant pain. The yellowish traces you notice after bowel movements could be related to normal healing processes. However, any unusual or strong odor, increased pain, or changes in the discharge should prompt a visit to your healthcare provider.

3. Pain and Recovery: Experiencing some pain at the surgical site, especially on the side where the procedure was performed, is common. This discomfort can be attributed to the healing process and the fact that part of the internal sphincter muscle was cut. Recovery can take several weeks, and while some people may feel significantly better within a few weeks, complete healing can take up to six weeks or longer. Pain that persists beyond this timeframe or worsens should be evaluated by your doctor.

4. Healing vs. Recovery: Healing of the surgical site does not necessarily mean that you are fully recovered. While the wound may close and appear healed, you might still experience discomfort or other symptoms as your body continues to recover. It’s essential to monitor your symptoms and communicate with your healthcare provider about any ongoing issues.

5. Follow-Up Exams: The method of examination (digital rectal exam vs. anoscopy) can vary based on the surgeon's preference and the specific circumstances of your case. A digital exam can provide valuable information about the healing process, but if there are concerns about the depth or nature of the healing, an anoscopy may be warranted for a more thorough evaluation. If you feel uncertain about the adequacy of the follow-up, don’t hesitate to seek a second opinion.

6. Medication Application: The sensation of tingling or discomfort when applying medication like "喜癒痔" (a topical treatment for hemorrhoids) could be due to the formulation or the amount applied. It’s crucial to follow your doctor’s instructions regarding the quantity and method of application. If the sensation is bothersome, discuss this with your doctor, as they may recommend adjusting the amount or switching to a different product.

7. Anxiety and Mental Health: It’s entirely normal to feel anxious after surgery, especially concerning recovery and potential complications. If your anxiety is affecting your daily life or causing significant distress, it may be beneficial to speak with a mental health professional. They can provide coping strategies and support to help you manage your concerns effectively.

In summary, recovery from LIS surgery can take time, and it is essential to listen to your body and communicate with your healthcare provider about any concerns. Monitoring your symptoms, adhering to post-operative care instructions, and addressing any psychological distress are all vital components of a successful recovery. If you have any doubts or feel that your recovery is not progressing as expected, don’t hesitate to reach out to your surgeon for guidance.

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