Ok. Need some advice.

My current med regimen: I am taking a dose of miralax upon waking. 100mg docusate at 11am. 150mg mag citrate at 7pm and another dose of miralax at 9pm.

This has worked for me for a while now (after a lot of trial and error) to keep the pain at bay while awaiting approval for Botox. My first stool of the day is usually soft and then I have a fairly loose stool early afternoon and that’s it for the day.

Here’s my problem now. Even with my stool so soft it’s the consistency of toothpaste i still need to strain. Then every couple weeks I either have a day where I have a harder stool and retear or a day where my stools are nothing but watery and I basically can’t be more than 10ft from a bathroom.

Question 1: Any suggestions to change my regimen? I wanted to add fiber to bulk up my stools so they are more formed but am afraid I will start tearing all the time. again.

Question 2: even when I am not having pain for weeks at a time I still have trouble passing stool. My CRS says its spasm from the fissure but I don’t understand how the sphincter is spasming when there’s no fissure pain. I am so afraid I will have the Botox and it won’t help the tightness.

I don't have any suggestions for your regimen, but the reason you could be having retears is that the muscle has become used to being tight. Like any other muscle, it can continue to remain in this state unless somehow relaxed through manual therapy, surgery or Botox. Botox however, only affects the voluntary muscles, but it can help heal the fissure anyway.

Thanks for the input.

I already had a fissurectomy and lords dilation procedure done back in June 2017. It was a complete failure. If anything, things were worse after. I just don’t want to go through the hope and everything only to have another useless procedure and find out I need the LIS anyway. I have another appt with my CRS next week to express my concern. Hopefully we will be able to have some meaningful dialogue on it.

From being on this forum for more than a year now, these are the top 3 concerns I've noticed about getting Botox done: 1) What if it makes things worse? 2) What if it doesn't work at all and I have to get LIS anyway? 3) What if it works, but only temporarily, and then I need more Botox or end up having surgery in the end?

I guess you need to decide what's the worst thing that could happen if you do get the botox and whether you could deal with that. If you don't think you could handle it, or don't want to deal with it, then ask you doctor for your other options.