I'm fairly new to this forum, but I have a long-standing history of recurring anal fissures. The first several times that I had an anal fissure, the fissure healed with very conservative treatment within about 6 to 8 weeks. The last fissure I had about 2 years ago would not heal and I eventually had Botox injections. I have underlying chronic pelvic floor dysfunction and although my fissure did eventually heal at some point after having Botox, my underlying muscle pain/spasm seemed to worsen.

About 6 weeks ago I developed another fissure and again the fissure will not heal and is getting worse each week. The pain is severe and is constant; not just for a period of time after a BM. My CRS recommended LIS but she has basically stopped doing LIS because she says that she has about a 90% success rate with Botox. I asked if we could try Botox again and she agreed, but warned that it might not work and could make my underlying condition worse as it did the last time. I chose Botox because my CRS said that she has only done about 5 LIS procedures in the past few years and that concerns me. I live in an area where we only have about 4 or 5 CRS' and I believe there is only 1 other CRS who is covered under my insurance.

Would like some feedback on what you all think about my doing another round of Botox as opposed to doing LIS with a surgeon who doesn't perform many LIS but does Botox very routinely with good a results.

Hi, that's quite a dilemma
I'm not sure what to advise I guess if you have tried Botox and it didn't help and made an underlying condition worse then is it worth trying again.
On the other hand it's always best to get the LIS done by a CRS who performs them regularly.
Will LIS solve everything or will you still have to have further treatment for your pelvic issues.
I wish I could say which one would be best but you know your body best and only you can decide
Have you had your resting tone tested because if it is normal then LIS may not be the magic solution and Botox maybe worth the risk
Good luck deciding though

Mypoorbutt,

Thank you for your reply. It is a difficult dilemma that I find myself in. I completely agree with you that I would feel much more comfortable and confident if my CRS performed LIS regularly with good results, but ever since she started using Botox, she rarely has to go to surgery as most of her patients respond favorably to the Botox. The LIS would most likely not have an impact on my underlying condition and I have had an anal manometry test done back in 2012 and I was found to have a normal resting pressure, but I do have significant dyssynergia of the pelvic floor.

All of the studies would support LIS as the best option, but since my CRS is more experienced with Botox, maybe LIS isn't the best option at this point. I guess I could just go for the Botox and pray that the result will be more positive this time around.

Ah yes quite a dilemma if the research for your individual condition says that LIS has good results then maybe go for that.
I would worry that just cutting the sphincter in the LIS wouldn't change the underlying issue and if your resting pressure is normal then that's not having an impact on why you are getting a fissure.
Could you get a second opinion as you wouldn't want to have an op that may not be the answer
I have read on here that people have had Botox multiple times and had different effects each time so perhaps this time may not be as bad as the first

Have you tried niphedipine ointment? It has helped with my fissure that I got post fistulotomy.

Zinnia,

Yes, I have actually been using nifedipine ointment for several years as a treatment for my chronic levator spasm and general pelvic floor hypertonicity. The nifedipine doesn't really do much, unfortunately. I hated the way that Botox affected my muscles the last time I had it, but I don't know what other non-surgical options are out there.

Hi how do you find out if you have the pelvic floor issue I have a prolapsed uterus my baby is 10weeks old it feels like i retear my fissure when I snease could I have a pelvic floor issue?