So, good news bad news on the chronic AF. Good news -- Botox WORKS! It's nice to have relief. While on the Botox, what are typically year long chronic fissures heal quickly with little to no pain, but after a few months go by the Botox wears off, and it's back to square one. As long as I keep up the Botox it's OK.

After a few rounds of this, it too is starting to get old. It's also not a fun procedure at all. Even the CRS is like -- are you ready for LIS? I sensed it was unusual for patients to take the Botox for life path.

I'm on the fence again with LIS. I'd imagine the LIS would last much longer than Botox, but I've got that old mantra of surgery as the last resort. Luckily my insurance covers 4 Botox scrips a year so it's not costing much to stay on the Botox path, but it's not convenient at all.

Any thoughts on this dilemma?

Personally, I would opt for the LIS.

I went through 3 two month courses of Diltiazem. (After finally getting to a consultant after 6 months of useless visits to a GP) After the first course of Diltiazem (each one lasting 2 months) I thought it was sorted. Relapsed within a week of stopping it. Second course was not quite so effective. Relapsed during and after. Third course, even less effective still.

Spoke to my CRS (a very good one). Said I didn't see the point in botox. It doesn't change things, just freezes them for a while. Maybe a good cure for those with a one-off fissure. But if it keeps recurring (as yours seems to be) then it's not likely to fix it long term. Same as the diltiazem. Keeps it at bay for while. Then wears off ...

I only had my LIS surgery yesterday. But can put your mind at rest that it's really not that bad. When my fissure was at it worst, it was FAR more painful. The surgeon did say it re-opened slightly while they were in there (had surgery yesterday - Monday - and it had flared up slightly on Saturday). But I've pooped today and it wasn't too bad. A little uncomfortable, but not like pooping broken glass like a bad fissure can be.

I'm in my 40's. Had on-off problems with fissures and piles since my late teens. But the last year and a bit the fissure got out of hand. Non-invasive simply wasn't getting rid of it permanently. I could heal it, but as soon as I stopped the meds, it just came back again. Fingers crossed the LIS has done the trick.

I would seriously consider the LIS, Botox brought me great pain relief but my fissure was never healed by it too long and deep. I'm 16 post LIS and I can now have pain free BMs.
When my IBS and crohns flares then my spasms can return but that's my particular medical history.
The LIS itself wasn't that different to the Botox in terms of recovery and I'm 95% healed already and I never got past 30% with Botox. Yes it is an op but in some countries they can do it with a spinal or local anaesthetic, so it's not "proper" surgery. If you keep having to have Botox then at least if you give LIS a try that could save you 4 hospital visits a year.
All in all I would recommend LIS but I only had the one fissure that wouldn't heal due to my other issues.
Good luck

Thanks all for the feedback. The most interesting thing about Botox for me is I do heal 100% and have no fissure but then I get the fissure again when it wears off.

This is the odd part, as I typically read LIS is meant to treat fissures, not prevent them.

My CRS said I'm prone to tearing there, maybe from worn down tissue or a weakness in the area, so I want to make sure LIS will prevent me from tearing going forward, but my understanding is LIS prevents spasms in the muscle, so maybe I will continue to go through these tearing processes but heal faster?

If the outcome is still tearing + healing I may not want to take any risks with surgery, I obviously want to get rid of the tearing completely.

Jaggededge how are you going now what did you end up doing?