I am wondering how the two treatments compare as far as how you feel and function as well as painwise.

I have had botox into the internal sphincter 3 times now and each time it seems to give me very urgent BMs with the result being increased anismus. Like I just can't open the bottom of my butt without having to push and even then it barely opens and this is so hard on my fissures! All 3 times this happened. I had very small doses too because I have a weak pelvic floor from years of botox there but I don't think a larger dose would have been better...

Anyhow, I am wondering if anyone experienced this with either botox or LIS.

1) My understanding is that botox would affect the entire internal sphincter (as do the ointments) as it would spread but LIS should only affect the bottom part that is cut?

2) Or does LIS somehow weaken the whole sphincter?

3) Do you get more urgency or risk of incontinence from one or the other?

4) Does LIS relieve the pain and spasm much more than botox?

5) What about the part of the muscle that is not cut, can it still spasm?

6) I also found that I felt rather weak back there like things are going to fall out (from the botox). Would LIS do this too? Or not because it's just the bottom part of the muscle.

7) Do you find that after LIS you have a loose bum at the opening but then tight as you move up to where the muscle is intact.

Sorry for the multitude of questions. Any info would be appreciated. I am doing horribly right now and will not be getting any more botox back there but am terrified that LIS would leave me with the same horrible effects only they will be forever...

Hi msimon. I am very sorry you are not doing well right now. I never had any Botox but I had an LIS over a year ago. It helped with the spasms. I still get them but they are not as bad. Unfortunately the LIS was not a success due to scar tissue causing stenosis. I never felt weak in the rectal area after the LIS. I did not have much urgency or leakage to speak of. I thought the LIS was pretty easy to recover from. I cannot feel any difference where the sphincter was cut and where it wasn't. Due to the stenosis I always have to push a certain amount. I know that is not a whole lot of information but I thought I would share some of my experience. Hope you are feeling better soon.:)

Msimon, I too have never had botox, but I have had two LIS procedures. The first was by a general surgeon and the surgical cut was too conservative. The second was done by a CRS and seems to have healed the fissure. After the second procedure, I felt very loose down there. I was running to the bathroom for every bm. That lasted for just a few days and I have had no incontinence or control issues. I also have not have spasm pain since the second procedure. I have not noticed anything like you've described with feeling loose in some areas and tight in others. My CRS did tell me he did not think the fissure would return because of the permanent reduction in pressure created by the procedure. I know this doesn't address all of your questions, but I hope it helps somewhat. I hope you feel better soon.

1) My understanding is that botox would affect the entire internal sphincter (as do the ointments) as it would spread but LIS should only affect the bottom part that is cut? Botox does a spread a bit, but if scar tissue is in the way it will not.

2) Or does LIS somehow weaken the whole sphincter?

3) Do you get more urgency or risk of incontinence from one or the other? With botox I got an urgency and needed to get to the bathroom ASAP or it would come out. Passed gas unintentionally sometimes. Should wear of with the botox.

4) Does LIS relieve the pain and spasm much more than botox?

5) What about the part of the muscle that is not cut, can it still spasm?

6) I also found that I felt rather weak back there like things are going to fall out (from the botox). Would LIS do this too? Or not because it's just the bottom part of the muscle. Felt the same with Botox

All my research lead me to the larger amount of botox, placed it the right spot yielded the greatest success. I had a total of 3 injections at one time. 30 units on each side of the fissure and 16 units in the fissure, total 76 units.