Update: I saw my CRS today. Last week I had the manometry test done. The results show that I do have a very high anal tone. This is where it gets tricky and confusing. With these tests, it can actually show exactly where the high pressure is. I have the increased pressure quite high up. The LIS cannot be performed there due to high risk of incontinence. So while I’m happy that I now know the reason for not healing and recurrence, it sucks that I’m not a good candidate for LIS. She offered Botox but targeted using ultrasound so it is essentially like cutting exactly where the high tone is. The dr says this will be more effective. Then she will repeat this every three months for a while so the Botox doesn’t have a chance to wear off. My old reports show that my previous surgeon put in 100 units last time but all over, not targeted.
Anyone reading this and curious about manometry test, it was fairly painless. Just a thin tubing, I could feel some water dripping out. I had to cough and squeeze. The ultrasound couldn’t be performed due to pain. I also had a digital (finger) exam and that was excruciating!

Sounds like your seeing the right person but if after a year or once the botox wears off later on I would try lis some people just need the lid to heal their current fissure which it should do since your muscles don't get back to normal till around the 12 + month mark maybe you won't need lis to prevent future fissures especially if you haven't had fissures your whole life. Then maybe your pressure is just high because of this fissure an maybe even the pressure will reduce after 12 of lis an a healed fissure. Anyhow I'm happy for you it sounds like this surgeon is on to it. My surgeon did 50 mils then 100 mils 50 each side an it has helped alot. I also recall my surgeon saying the pressure / problem could be high up which would only be slightly helped by either lis or botox due to its position he said some people get the pressure high up but I can't remember him saying how it's fixed he said he'll try get some botox close to that area. This must be what you have aswel although I didn't have a tone test he just said this could be the case an I think he said its only in woman were this high pressure can happen he also mentioned stress in woman would make it hard to be fixed an that we need to learn to relax especially on the toilet. I'm a pretty stressed person with anxiety most days so that wouldn't help in my case.

So when is your botox booked for? It's so easy don't be scared I freaked out both times an both times was completely fine it's just like a few days of bad fissure days then it slowly calms down an you'll notice the relaxed muscles which is nice not to have that sore tight feeling. Keep us posted.

Hey missy, yep we sound very similar as I have anxiety as well. It comes and goes but I’m almost positive that it contributed to the fissure. I have read some of your older posts and they could’ve been written by me, very similar experiences.
Interesting what your doctor said about high tone. If this all doesn’t work, I’ll be begging for the LIS. I’m willing to give this Botox a go because my surgeon is on the ball so I trust her. Only time will tell and chronic fissures are tricky things to heal. I’m wondering how I can strengthen the scar after Botox. I’ve got the diet and water sorted , stool is mostly soft but formed. It’s the damn scar that opens back up sometimes!
I don’t have a date yet. She wants me to go through the public hospital as the ultrasound machine is there and it will be free for the Botox. I’m just waiting for a call. I’ll keep plugging along, some days are ok pain wise and I’ve been dealing with this so long, what’s another few weeks x

Yes that's true I hope they don't muck you around like they did with me they dropped the ball an I wasn't seen for a year when it's ment to be within 3months I think it is so if you don't hear from them for a few weeks make sure you ring around an stay on top of it. I think your in good hands with this surgeon you've got a plan. I was never offered botox every 3months I would of taken that offer I'm sure once you get botox you'll love it most people do until it wears off but every 3 months is a great idea