Hello!
So I typed up a whole big thing and when I hit submit everything went away and I have to start all over. So I will be a lot more brief than my first post.

37 year old female with 3 kids (youngest 16 months). Problem first began in May 2016. Was misdiagnosed until September 2016 when I saw CRS who confirmed AF. Did dialtzem (so?) for 4 weeks until it irritated my skin. Stopped cream and AF came back. Had Botox and worked great until 3 weeks in I got an abscess at fissure site which turned into fistula. Had fistula surgery and took forever to heal (about a year). Felt pretty good but would have off and on burning inside but pain was manageable and not nearly as bad as before. I considered it a win.

Fast forward to 2 weeks ago. I finally had enough of not ever feeling “normal” in that area and knew I needed to go back to CRS. She confirmed that I have a AF inside just above where the old fissure was. I was also red until the anal area and told me to eliminate dairy, coffee, sofa and spicy foods. I go back to CRS in 2 weeks to see if any healing has taken place. If not, CRS wants to be Botox again.

Here’s the thing. I’m nervous about Botox due to my history of last time. I believe I have a tight sphincter muscle and suspect this is what is causing my issues the last 3 years. I was misdiagnosed 3 years ago and had a lot of trauma to my butt before I finally got the help I needed. I think I need LIS to finally kick this thing once and for all. I’m going to talk to my CRS about this in 2 weeks.

I will be starting a diary from here on out in hopes to help someone who is experiencing the same thing. Or, if anything, to let you know you are not alone.

Welcome to the forum. It's often a long and painful journey trying to fix our butts. It might be worthwhile to try Botox again, it's probably not what caused the fistula to occur.

Your CRS may be reluctant to do an LIS because you've had multiple children. Some research papers advise an anal ultrasound to make sure there are no hidden defects that could result in incontinence after LIS in women who've given birth. And don't hesitate to get a second opinion if you feel you're not getting the right care.

Thank you! I will discuss Botox again and possibly LIS when I meet with my CRS on the 18th. More to come....

I had my follow up today and CRS recommended I see a more specialized CRS who works with a lot of women. I am waiting to get an appointment with the new CRS for a second opinion on LIS.

Hi I'm going to follow your story an see what the crs says, good luck we're all here for support

Thanks! I have an apt Dec 18th with new CRS.

Update 12/18/19:
I met with the new CRS today and she did a very thorough examination, including a finger up the butt and felt my muscles and then a very thin scope after that. She can feel that my internal muscle is tight. She said not super tight because she was able to stick her finger up there, but tight nonetheless. She also confirmed that I have a couple hems (not bad at all she said) and scar tissue were I had my fistula surgery, and she can see it’s a little red where my fissure is.

She recommended LIS and a fissurectomy to clean out the scar tissue and cauterize it. The only way I’m going to get better is with LIS though since my muscle is tight and there is literally nothing I can do about that except loosen it with a scalpel. So, now I’m just waiting to schedule the surgery.

I should also mention that my CRS said that incontinence occurs in approx 1% of patients. She also followed it with saying that she’s don’t thousands of LIS and only one patient has had full incontinence and this person ended up having LIS twice and has other health factor as well. She said the greatest risk is injection at the incision site and still that’s pretty rare. Just thought I’d mention this to anyone needing another CRS opinion.

Sounds like you had a productive visit. Will she only do a partial LIS since it's not a very tight muscle?

She didn’t mention anything about doing a partial.