I have had about 4 or 5 fissures since 2006. With the exception of my current flare up, all of the previous ones healed with little or no treatment within about 2 months. My CRS told me that he would not do LIS because of incontinence and because my fissures were small and superficial. This CRS has since decided that he will not treat me any further because I went to another surgeon for a second opinion. My question is this, I have two different issues going on...one is the recurrent anal fissures that are most likely the result of the failure of my rectal muscles to relax during a bowel movement causing strain. The 2nd issue is that I have chronic levator spasm a/k/a puborectalis dysfunction a/k/a pelvic floor dysfunction a/k/a pelvic floor dyssynergia. Basically what this means is that the muscles above the sphincter in my rectum do not relax properly during defacation and therefore my rectum does not open enough for me to completely empty and for me to have a bm without straining. I consulted with an out of town CRS who said that these two issues are independant of one another, but this is my biggest fear....if I have LIS with the other issue unresolved, will LIS still be effective. Anyone have any experience with this...I need help. Thank you.

Well, I don't have the pelvic floor problem, but I did just have LIS. I know exactly how you feel with the sphinter and BM's. Those are the spasms and yes, LIS will take care of that. Are you taking Miralax/Movicol? It is a miracle worker, you don't have to strain at all with BM's. I can't believe the CRS you were seeing won't see you anymore, but it is probably for the best if he said you would be incontinent with LIS. I have not had any problems at all. Good luck!!

Sue, I wish that Miralax had been the miracle cure for me as it has been for so many, but even though I take it twice a day and it does keep my stool soft, I still have a difficult time with bm's. Even soft stool is difficult to pass because my muscles don't cooperate and function as they are supposed to. That is why I am afraid that LIS might not work with me.....because I would still have the dysfunctional muscles.

Hi mm,
You should try for a CRS who also deals with PFDs. I know that there are a couple at the Cleveland Clinic and Mayo Clinic. Cherylk saw someone at Mayo, for a similar problem, I believe, though she did not have surgery. If you already have a complete diagnosis, ignore what I'm saying, but if you went to two different CRSs, it does not seem as if you do. 
Val76, who lives in Germany, also has pelvic floor problems, and she had Standardized Anal Dilation (SAD), which helped with the anal problems, but she still has the pelvic floor problems.  You might look for some of her posts too. 
When it comes to BMs, I seem to suffer in a similar way to you. I eat all my food soft. I take MoM as Miralax did not work for me. I use a Sitz bath at the end of a BM to help with 'ending'. 
I also get vulva pain, coccyx pain, and sometimes difficulty in urinating, but will say that it was all a follow-on from my anal/rectal problems. 
About the first CRS not wanting to see you again, just go further with what YOU want for your health. Don't even worry. I am hoping to have an SAD, but I am also investigating my pelvic problems too.
Stay in touch.

savaici, I have received a formal diagnosis from my former CRS (chronic levator spasm), my GI doctor (pelvic floor dyssynergia) and a urologist in San Francisco that I visited for 3 weeks who specializes in treating pelvic floor dysfunction. I have actually corresponded with Cheryl about the treatment she received at Mayo Clinic. She went through a bowel retraining program that consists primarily of biofeedback therapy and this is something that has been recommended for me, but I have not been successful in locating a therapist who can do this close to where I live and at the present time, I cannot afford the time off work and the expense (about $8,000) for the program at Mayo Clinic. If I could get the fissure issue resolved, then it might make it easier to tackle the pelvic floor issues, but I also know that they are very connected, which is why I am concerned about having LIS. I'm trying to figure out whether LIS would be as effective in my situation given that I have this underlying problem that will still be present even after LIS.