I am having my Botox and fistulotomy on Thursday and getting very nervous. It will be done in my CRS's office with just local anesthesia. The nurse said he would use an anoscope to do the Botox. I have been reading about how painful the Botox is if you are awake and am now terrified of it. I have a few questions:
Did your doctor use an anoscope when doing the injections?
Was it extremely painful getting the injections?
How many units of Botox did you get? (My CRS is going to use 10 units on me, I am concerned this is a low amount)
Thanks for any information you can share.

I had it done awake unsedated 4 years ago. It will hurt like hell but only for a brief 2 seconds at the point of injection. You'll be fine, it's quick and you'll be over it. I was given 2 shots one on each side. 20 units total - 10 units each side. Ask your CRS maybe he meant 10 units each side so total 20 units.
My CRS used an anoscope to check me out first but don't recall if he used it while injecting the botox. He had me in a different position kinda bending over with my knees bent. The exam bed in the office can be converted for just that purpose.
Again, you'll be fine.

Hi Itpainsme-
I had two different sets of Botox injections without sedation. I was also very nervous about it and I am in general an anxious and nervous person. I have to confess I never asked about the units so I can't answer that part. FishBoi's comments sound like a good possibility- that your Dr meant each side. I also had one injection on each side. And the description above is pretty accurate- it hurt pretty intensely but only for a couple seconds tops. My Dr had me meet him at the ER at the hospital across from his office. He explained that for insurance purposes ( I think for them to cover it) it had to be in the hospital setting. But he just had me on the table on my side with my legs pulled up. He definitely did not use the anuscope. I like to be prepared and go to accupuncture a lot and they always say something like "ok- needle is on the skin- breath in" and have you expell your breath as the needle goes in. That helped me to have a tool. My CRS said he would be telling me what he was doing every step so I was waiting for some kind of a cue like that and all of a sudden he just did it. That scared me because I did not want to move or jump! So I commented that I thought he was going to say something like my accupuncturist to prepare me- my CRS had great skills but bedside manner was not particularly one of them. His comment back was "well that was your mistake- I'm a surgeon, not an accupuncturist". I could never tell if he was kidding or truly that arrogant. Anyway, he did prepare me by letting me know on the second side and he remembered this and did it as well two months later when we repeated it. So I have to give him that credit.
Basically my point is:
- yes it hurts, but it is not that bad and over in a second.
- I had little to no pain the rest of the day, but I did baby myself even though you can supposedly just "go on with your day".
-I would specifically ask next time- "what are you going to say before you inject- how will you prepare me?" and I would try the breathing in and out technique. Sometimes forcefully breathing out in a stream with lips pursed helps me.
-If you are not driving yourself and are a drinking person, I would suggest a glass or two of wine or beer beforehand- I don't think there would be any reason not to do so unless you are driving.
-Reward yourself afterwards at home (even if you are not going home right away) with something you like. A favorite TV show or movie, curl up with your pet, use the heating pad if it helps (be careful). My daughter had picked up a lemon scone for me and some lemon curd and came by to see me after we got home. Nothing has ever tasted so good to me, even though it isn't a very healthy thing to eat!
I'll keep you in my prayers- looking back, I am glad to have had it done without sedation because I ended up having surgery a couple of months later and my body gets pretty clobbered when I'm sedated. So I didn't have to deal with that part. Love the sedation though and would never, ever let someone do the LIS without it ( as in HopetoHeal's experience!)
Hope this helps-
Bambi

I had botox a little over a month ago and a skin tag removed at the same time. My CRS used two needs to freeze the area and then 3 shots of botox. Not sure how many units each one was, but it's the freezing that hurts the worst. But like mentioned above, it only lasts for a few seconds. The botox burns a little bit going in, but once you're done, then it doesn't hurt anymore. It's quick!!

I meant to say blow the air out gently through slightly pursed lips. I think forcefully might tense things up.
Bambi

I had Botox without sedation. 30 units total (just checked my records to be sure), 15 units in each side, two shots total. I had some topical numbing agent (5% lidocaine) in the area and that was it.
It wasn't that bad IMO. The pain for me was only moderate and very momentary. The needles do look big and the position I had it done in was rather awkward, but as far as medical procedures go, this one was a breeze. Your mileage may vary, obviously, but people generally tolerate it well.
BTW I asked the same question years ago when I had it done. In case you're interested, my old thread is here:
http://anal-fissure.org/t1980-has-anyone-ever-gotten-botox-without-sedation

Wow a lot of people who had botox, didn't know. I'm one of the ones that got it under sedation, so can't really chime in. But I would like to ask all the botoxees, without any intention of stealing the thread, did it work for you? Or did you end up doing the LIS in the end?

Thank you all for sharing your experiences! I am so glad to have found this board. I no none of us are happy to be a member of the AF club, but I am glad to have some good support to get me through :D

Dexterdude,
Good question, I would like to know the answers too.

Botox was awesome and healed my ass completely for a couple of months. It was great. The sun was shining, birds were chirping, soft turds were softly and effortlessly gliding down the porcelain slide into oblivion. But ... and there's always a BUTT ... I re-tore the fissure a few months in and eventually opted for LIS. I did get careless with my diet during that time, though, so I guess my message wouldn't be "don't try Botox" but more "even if Botox works take it easy and keep up a fissure diet for a looooooong time afterward".