Lloyd, I cannot believe you have had LIS 3 times! How awful! And botox each time? That doesn't make sense to me, isn't that overkill? I was asking about whether you have had a pressure test/manometry because some fissures are not caused by/perpetuated by high resting pressure. I these cases, botox and LIS are unlikely to help.
In your picture it looks like you have an anterior/front fissure....am i right?
Do you have incontinence?

I had 3 fissures one at the front (12 o'clock) a small one and then one at 6 o'clock a big one internal with lump behind it and another internal 9 o'clock

First op was back in 2003 second 2007 and most recent February

No tests that I'm aware of for pressure.

Yes incontinence is really bad since the operation I'm hoping that it's just temporary with Botox. I've had serious bouts of diharria since the operation making me have to take codine regularly to constipated me so I can function in work. As soon as I stop then the diharria returns!

HIV test came back negative thankfully

So on steroids for 2 more weeks then back to hospital but I feel like a lab rat and have found this forum to learn what others have done!

I have a lot of symptoms of Chrones but it mainly effects my mouth, esophagus and anus so I think it's likely to be perianal chrones but the Dr's don't seem to think this and I don't want to suggest it as I feel they should be the experts. I'm not skinny though (not overweight either)

Frustrated is an understatement

So do you still have 3 fissures? Do you think you are healing at all?

I'm sorry you have been suffering so long, and been through so much.
Is that photo after an LIS op or just what's going on now??
I must agree with msimon... You really need a manomentry pressure test to see the real resting pressure of your sphincter. It may be worth having an anal ultrasound too to see the muscle, and if there is anything else going on up there that could be causing the fissures and bleeding.
I have been trying to get to the bottom( no pun intended ) of why my chronic fissure wasn't healing. I had all the tests and was told my resting pressure is low. I have now been diagnosed with HMS with Elders Danlos syndrome.... Which basically means I have very fragile skin. Google it and see if you recognise the symptoms in yourself.

OMB x

Pic was at 5 weeks now the bleeding has completely stopped. Still open dry wounds x 3 but not healing

I know I'm just one of many! I'll google it

Update - it was a fistula!! I had an apple size abscess removed!! Life is so good now!!! It's amazing what an MRI shows up!! 4th CRS actually knows what he is doing!!

What amazing news! I'm so terribly happy for you!

And thanks so much for coming back to let us know.