What this experience covers
This experience addresses the question that dominates many people’s decision-making about LIS surgery: what is the real risk of incontinence? It draws on what people describe experiencing, the conversations they have with surgeons, and how they navigated the decision. This is a composite from many anonymised accounts.
The pattern
The fear
Incontinence risk is the primary reason people hesitate about LIS. The surgery deliberately cuts a small portion of the internal sphincter muscle to reduce spasm and allow the fissure to heal. The fear is logical: if you cut a muscle that controls continence, might you lose some of that control?
People describe this fear as paralysing. They research obsessively. They read every account they can find. They look for certainty and find statistics instead.
What the evidence shows
The published evidence on LIS and continence shows:
- Major incontinence (loss of control of solid stool) is rare — most studies report rates below 1 percent
- Minor continence changes (difficulty controlling gas, occasional minor soiling) are more common — reported in roughly 5 to 15 percent of people, depending on the study and how the question is asked
- Most minor changes improve over time — the sphincter adapts, and symptoms that are present in the first weeks often resolve within months
- Long-term persistent incontinence is uncommon but does occur in a small number of people
How people experience it
People who have had LIS describe the continence picture in practical terms:
- Most notice nothing different — the surgery heals the fissure with no apparent change in continence
- Some notice temporary gas control changes in the first weeks — difficulty distinguishing between gas and stool, or occasional unexpected gas passage
- A smaller number notice minor changes that persist longer — needing to be more attentive to gas, occasional urgency
- A very small number describe persistent changes that affect daily life — this is the outcome people fear most, and while it is real, it is uncommon
The decision process
People describe weighing the incontinence risk against the reality of living with a chronic fissure:
- Months or years of daily pain
- The impact on work, relationships, mental health
- Failed conservative treatments
- The understanding that LIS has the highest success rate of any fissure surgery
For most people who ultimately choose LIS, the calculation comes down to: the certain, ongoing suffering of the fissure vs a small risk of a continence change that may be temporary.
What people wish they had known
- That the risk, while real, is lower than the anxiety makes it feel
- That most changes in gas control improve over weeks to months
- That their surgeon could give them a personalised risk assessment based on their anatomy and medical history
- That asking directly about the surgeon’s personal complication rate was appropriate and informative
When to contact your doctor
Seek medical attention if you experience:
- Heavy or persistent bleeding that does not settle
- Severe pain that is getting worse rather than better
- Difficulty controlling gas or bowel movements after surgery
- Any symptoms that concern you