Hi Rachael, I ve been reading your posts and I see you are in troubles too
Here we have two small clinics dealing with anorectal disorders and performing outpatient procedures. One of them offers botox for fissure but I think it is not very common and is not covered by general insurance. The usual treatment when spinchter is tight is nitro in a form of 0,1% ointment made in Austria and named Percutol (I think diltilazem or nifed. are not in use here as I was not offered alternative for my nitro sensitivity). Self dilatation is usually prescribed in combination with nitro ointment or xylocaine or olive oil. Besides the self dilatation, it is advised to massage the anal canal with your finger (if it is possible) to increase the blood flow and use only natural oils or gel with hialuronic acid (I tried it but the pain was much worse). They try to avoid LIS especially with women from well known reason (smaller spinchter and risk of incontinence).
A clinic in neighbor country Croatia makes dilatation (with some device I think) and advertises good healing rate, but here, it is not performed.
At my first visit in may I was prescribed hydrocortisone suppositories because my spinchter was not tight then, but on the other visit I was told that it was a bad idea, was useless and never to use it again and was offered self dilatation with nitro (but I got huge inflammation from that). then I went to the other clinic to see a nice CRS who made the examination without any pain (using pediatric anoscope). He is considered the best CRS (he is the one who does botox, but he did not offer it to me). He said he would stitch my fissure together, make a small cut in spinchter and remove a skin tag. He is a proctologist and cosmetic surgeon so I decided to trust him when it comes to that, but I will ask about botox too.
Disabling burning, drilling pain in anal area for almost a year, started after UT infection. Small anal fissure diagnosed, turned out it is probably not the cause of pain, MRI shows no inflammation or fistula. Grateful to forum members for support.