I wouldn't do Kegels right now if someone paid me. They just wind up making the crazy sphincter even stronger and that isn't a good thing! That's got to be hard when you need to do Kegels to fix one problem, but they might be aggravating the other; I suppose it might be possible to learn to isolate the muscles when you contract them, so that you're not contracting the sphincter muscle at the same time. When your PC muscles get achy, does sitting on a heating pad or in the bath help?
I know what you mean about feeling like something is jammed up there when you sit down. I get that feeling occasionally, I used to get it more when the fissures were worse. It's painful to sit down, like I'm sitting on an orange or something--it's probably just because of tight rectal muscles and/or swelling, I'm guessing, since there's not actually an orange up there. When I get like this, sitting on a heating pad does help.
I can manage to get ointment in without hurting myself...the nitro has helped me SOME, my original fissure site stays healed now 99% of the time, and it's starting to look more healed, but I've developed another that seems more superficial. The only reason it's not torn open is because of taking Miralax....and I have days of wondering whether if I just took Miralax for a couple of years and let everything heal really nice, would the sphincter eventually relax on it's own? But no way am I backing out of the surgery.
It does sound like you might be healing the fissure...it is a VERY slow process, and there are other members here whose rule of thumb is that you should wait one year between LIS's to let the tissues get back to normal. My CRS did say that when he's had to do two surgeries on someone, it's usually on the order of several years later.
I'm not sure why your CRS says no to botox? To me that doesn't make sense, since it does what the surgery does, only more temporary. It seems like an easier alternative than committing to the surgery too.
But try not to worry about the incontinence thing too much. I know it's hard when they say that women who've given birth are at the most risk for it--I'm right in that boat with you. But there are plenty of women here (or were here at one time) who had the surgery more than once and didn't wind up incontinent.
Let us know what you decide! We'll be thinking of you--