there's been a lot of discussion on here lately about botox. I never considered it for myself and my dr never mentioned it as an option before my LIS. But I saw him again yesterday (at my 13 week mark after LIS) and he did offer it this time. He was very hesitant in bringing it up and after i expressed my own concerns (fistulas, infection, etc) he confessed that he very rarely does it and prefers not to, as he's found that the permanent success rate is not very high but the chance of recurrence is. I'm curious to hear from people that had the botox treatment and have never had anymore problems. Most of the people on the site now have just had it so there's no long-term follow-up. Has anyone had long-term success?
When he examined me, the dr did still see the fissure. Unbelievable!! How could something just NOT heal, even when i'm doing everything to help it? i'm not having spasms. Maybe i'm still having small ones and that's what's keeping it from healing. But i barely feel spasm pain now. I just feel raw down there, and sitting is still really uncomfortable for hours after a bm.
We decided to schedule the 2nd surgery - at the end of sept. I guess it's still possible for it to heal after all this time, some of you here have done it, so i haven't lost hope yet that it'll be over one day!! i've reached my year anniversary of pain and problems from this :(

Hi,
I thought this study was very interesting and might help.
http://faculty.washington.edu/momus/PB/analfiss.htm
Jennie

that study is interesting, but not really new info. i know botox is better (at least in the short term) than the ointment. Unfortunately that study didn't compare botox to the LIS surgery, and only one of the studies followed the patients for longer than 2 months. Everything i've heard about botox says that it works for a few months, but recurrences typically occur after 2-3 months.
personally, i'm not considering botox...although if the second LIS doesn't help the healing, i'll try anything.

I'm not saying you should consider Botox, but I'll tell you why I did. True, the success rates are lower than LIS 60-something% after the first treatment 70-85% after the second, as opposed to 95% for LIS, but I figured I pooed problem free for all my life before this episode, so I really wouldn't need the LIS after this. Plus, the Botox was virtually pain free even without a numbing shot, and the recovery time was 5 mins if that, and I could always get an LIS afterward if this didn't work.

About the success rate of Botox: I have access to a university's database of journals, including full rights to pub med, because of my job and have read several studies on fissure treatments, especially botox since I got it myself. The reccurance rates for botox do vary--i can't remember the exact range of numbers, but somewhere between 20% and 50%. However, the recurrance rate drastically decreases with a second round of injections and those who didn't heal with the first round often do with the second, brinigng the overall success rate up to +- 80%.

Juney, just an idea--if your healing has stagnated, I'm wondering if that might be because there is an infection. My fissure last year was hardly healing at all because there was an abscess in the underlying tissue. It was so small for a year that the drs. wouldn't believe I had one until it finally erupted. When it did they had to reopen a portion of the fissure that had healed and cut from there to the outside to drain the infection. After the infection cleared, the healing was pretty rapid except for that last little part the botox helped with. So perhaps next time you go in you could have the dr investigate the area with an imaging device (the one they use to find fistula tracts) to see if there is an infection somewhere.

yikes! that abcess stuff is really scary. i HOPE that's not my case. I have no other symptoms, the pain is exactly the same as it was before....although it's much less intense and doesn't last for as long now. it's more just annoying! I won't see the Dr again until the 1st week of sept, for a pre-op exam. i will mention this to him then, although from what i know of him, he'll reassure me that that is very unlikely. he said everything was fine inside when he did the first LIS, just a normal fissure nothing out of the ordinary...
did you have other symptoms of the abcess? what was your pain like? had you had surgery or anything done to help heal the fissure or were you treating it conservatively at that time? how did you know you had an abcess when even the dr's didn't believe you??

I didn't really have the "classic" symptoms of an abscess until it was ready to erupt. I knew I had an infection however. One sign was an odd, painful skin tag that would grow and shrink erratically. But even before that popped up, I knew that there was an infection because of a distinct soreness--you know the soreness you get when you don't properly clean a paper cut on your finger and it become red and sore to the touch, that's what it felt like, only in my butt. It was different than the sharp and stinging soreness of a fresh cut. For the first 10 mos. my drs. were treating it conservatively and didn't believe I had an infection becaue they couldn't see anything (duh! it's under the skin). One dr. did note some inflammation which he promptly attributed the Crohn's, even though I had no other symptoms and told him it felt like an infection. It took me 8 mos to get something other than nitro, which gave me pounding headaches and heart palpitations, and didn't help relax my sphincter very much. The dr only gave me nifedipine at that point, and that was only a little better--I wasn't getting the headaches.

Once the abscess erupted a couple days before last Xmas, the dr. put me on amoxicillin, which is absolutely the wrong thing for an abscess because e-coli, which was what my infection was from, becomes tolerant to that really quickly. After that didn't work, the drs. put me on mega-doses of cipro and flagyl--I was immune to the plague and anthrax for the next mo and a half until the drainage surgery. Those drugs also gave me the runs until the middle of March.

After the surgery, the treatment became again sitz baths, nitro if tolerated or nifedipine, and advil. I had nothing else until my late June botox treatment.

well if nothing else i've read has scared the absolute shit out of me, this definitely has. i'm completely freaking out now, worrying that this might be my case. the only thing that makes me think it's not is that the dr was IN there in may for the LIS and he did not see anything out of the ordinary. but maybe that's because he wasn't looking. I'm not red and swollen down there at all, and the removed skin tag healed just fine and has not returned.
when did you feel that odd soreness? constantly throughout the day or only after bms or only when sitting/standing, etc???
i've never thought not healing could be attributed to an infection since i have no other symptoms. jeez, i'm freaking out now.

Sorry, sorry. Didn't mean to freak you out. I more wanted to offer a possible solution based on my own experience of working with drs who swore they had no idea why I wasn't healing. I also mentioned because it should be a relatively easy thing to check for via whatever that device is that they use to find fistula tracts. It's also on my mind with the recent fistulomy on the board and the other seeping wound.

The soreness was erratic. It was always worse after bm, but the relative pain of the tag would be unrelated to the size and softness of the bm. Until it got really bad, it would usually feel better around dinner time (i'm a morning bm-er).

I'm really sorry. I really didn't mean to make you worry. just wanted to make sure you got a thorough check up before going under the knife again. If you ask me the LIS is a far scarrier thing and you got through one of those already.

no it's okay. i'm more worried now than i was before, but i think it's best to at least know what i might be dealing with. this way i can ask my dr to take a more thorough look and consider all possibilities when i have my pre-op in early sept. i definitely don't want an unneccesary LIS done.
the first sphincterotomy did relieve some of the pain and the intensity is definitely not as great anymore, so that makes me think it is still just a fissure. as well as the fact that the dr said it all looked normal inside. i even asked him about a fistula (since i'd heard of them associated with fissures) and he said there was definitely not one. the fact that the pain isn't getting worse makes me worry less, even with all the potentially horrible stuff to worry about.
when your abcess erupted, what did it feel like? what happened? was the pain building for weeks or just days before?

Basically, I got a cold jstu before Xmas, so my immunities were down, and a couple of days after that the tag grew to be huge (about the size of a blueberry). Since the drs hadn't helped me before and swore it wasn't an infection, I pushed on the tag and about a teaspoon full of puss gushed out of the area where my fissure was. After that the abscess was in full force, filling every day with puss and sanguinous fluid (gross, I know).