Hello,
I've been helped by reading other's stories for a little while, but I would really like the members insights.

Had an anterior fissure 6 years ago. Didn't know what it was and developed chronic tightness. Fissure healed and tightness about 80-90% better, but then I got a posterior fissure 2 years ago. Up and down since. Got really bad in Feb 2020. Finally found a local CRS who did botox. Seemed like he got everywhere (external and internal sphincter) except for the tip of the internal...You know...right where it was needed! So, that area was in great spasm for 3 months. Is that even possible?

I was in soooo much more pain. It took me to a low point I had never been in my life. CRS said never heard of worse with botox before. Made me think something more was going on (e.g., abscess, cancer). Recently, had an MRI and the colonoscopy, both clear for anything more insidious. Plus, a few days ago started bleeding again. it was a downer, but also a good sign...Just a fissure.

Next step is exploratory under anesthetic with possible fissurectomy to remove scar tissue to aid healing. However, it will be 1-3 months (ala covid). So, I would really appreciate any comment on whether botox can miss one portion of the Int sphincter and, if so, make things worse. If true, then I would consider botox again (with a stern look at the CRS to aim more carefully).

Thanks!

Sorry that the botox made you worse off. I'm not sure why it happens but I have read several accounts on this board of people who are worse after botox. Personally I don't think it's possible for the botox to be missing in one part of the sphincter because it migrates over time. So your surgeon did everything right I think, but it didn't have the intended effect. Take care and let us know how things go with you.

I wonder if it was just not enough instruction from CRS. Here's my two bits based on reading a lot of published research and guidelines (nothing like pain to motivate). I will star * what I failed to do and why I think botox worsened my pain.

2-3 days prior to botox though to 2 weeks after:
1. Softeners: continue and even increase (a bit, you don't want diarrhea)*
2. Drink lots of water (min about 3 litres per day)*
3. Avoid foods that bulk up the stool, including fibre that you know leads to dryer bulk (This is where the water is so important)*

Expect and initially after:
1. Go straight home.*
2. Careful not to push on the area. Pelvic physio teaches great trigger point relief, but doing so initially after botox may migrate some away from where wanted and to the external.*
2. Expect initial increase/change of pain. Botox causes significant trauma to the area. You are poisoning your Int and maybe ext sphincter.
3. Move around and keep blood flow to the area, but don't do anything too rigorous for at least a week.*
4. Expect it to take 2-4 weeks to fully kick in.*
5. Plan your life for 2-3 months around healing. "Hey family, want me back? Well then, you get me even less for 2-3 months."*

As you can see from my stars * I may have been the cause of the increased pain, but I did my research after the pain increased and my CRS said none of this.

I understand that optimum conditions are required for healing after botox, or even surgery, so perhaps that's why your pain was worse. But even so, it should have settled down eventually, which makes me wonder if repeat botox will really help you.

Hi hope you are feeling better posertiermadness. Had a question about colonoscopy. I had an anterior fissure for about a year or so and at my last appointment in September, the doctor did a digital exam and said it was healed. It was sensitive for quite a while and the past couple months has been just fine. I go every three years for colonoscopy, family history of pre-cancerous polyps, and had a polyp removed three years ago. I postponed my Fall appointment to early March, in about a week, and thinking of postponing again due to fear of re-opening the fissure, but also don't want to wait too much longer because of the issue with polyps. Anyone have any experience with getting a colonoscopy after the fissure has healed? Very fearful of it opening up again but then need to have the procedure done. Was thinking to postpone for another two or so months, but then we're coming closer to an additional year so was thinking to just go and tell the doc and hoping he'll be careful. I've been seeing this gastroenterologist for over twenty years and he's been very good. Not sure whether I should postpone further or not.

The only thing painful was his digital just before the scope, with the latter not painful. Of note the pre-clean out (colyte) can be a bit traumatic (raw), but not overly worse for the fissure, particularly if healed and you don’t push. (Not a prescription due to liability, but) you could prepare post-scope for a nutrient rich liquid fast (bone broth, vitamins, sorbet, juice, gelatin, jello, etc.). You’d be mostly empty (maybe a couple more small watery expulsions) and have several anal days off (e.g., 2-3 day fast and 1-2 days post fast before something more comes out) if you initially stick with a low residue diet. Please educate yourself on fasting (so much out there on intermittent fasting, but we require more than a day’s break to heal that otherwise tiny cut). Don’t overdo any liquids (they’re all liquids in the stomach) at one time to curb hunger or you’ll get more watery waste. I wish you all the best with your scope.

Thank you very much for your kind response, appreciate it and your prep advice, too! I believe the risks of cancerous polyps outweighs fears of what can happen with a healed fissure area. I wish you the best and hope you are healing.