My AF was diagnosed four months ago after EUA, although I'd had it for over a year on and off. I chose not to have LIS at that time as my surgeon didn't recommend it for me - she said as a woman who'd had children, and with an anterior AF (90% of AFs are posterior) I was at higher risk of incontinence. It was healing anyway at that point so I was happy to just see what happened.
So it healed, and I had several months completely pain free, and was starting to think that it had finally gone away. I carried on being careful what I ate though, with lots of fibre and fluid, and I was never constipated even slightly. But in the last couple of weeks, it has returned with a vengeance. I'm feeling pretty down about it as it was so phenomenally painful and disruptive of my life.
My question, then, is should I risk LIS, or would the issue of it healing and breaking down again still be there? It seems to me that after it's healed, there'll always be a weak spot there, so anyone who's had an AF must be at permanent risk of recurrence. I absolutely don't want to risk incontinence but I'm not sure I can keep going through this.
My surgeon said that her choice would be botox - but my health authority won't fund it (it's funded by some health authorities in the UK but not others - it's completely random) so I'd have to pay several thousand pounds to have it privately, so that's not an option.
Any advice? Should I try LIS? Is it likely to heal more permanently after that or will I still have the possibility of breakdown again (and now with the possible added pleasure of incontinence)?

The Botox might be a good idea if you feel you can treat the AF on your own and hopefully it will fully heal before the Botox wears off in 8-9 months. I normally tell people not to waste time on Botox but if you have legitimate concerns with incontinence then you should start with Botox. If it doesn't work, then you can move on to considering an LIS. You may also ask to have an anal manometry test to see how strong your sphincter is. I had the test and knew I was strong enough to have the LIS.

Unfortunately you can still/will have AF after an LIS, but it doesn't need to end up being chronic. I have a had a few minor AF in the last 2 1/2 years since my LIS. But I treated them with sitz baths the day I had the AF and they were gone the same day.