From what I read, Im sure you have a fissure. If botox helped there is still hope. Whats important is to keep stools soft, and give the area a chance to heal. I also apply nitro/dilt right after shower when the muscle is most relaxed, and before the spasms starts. Im not sure how important it is to get it all the way up there, but I do my best.
Im taking olive oil, husk and magnesia. 9 out of 10 BMs are perfect consistency, and the last one isnt that bad. I have learned to control my stolls by diet, but the price is that I eat just about the same day in and day out. Rather that than the endless hours of burning pain right!?
Anyway, stick around, educate yourself, and hopefully heal in time. Its a long slow process, so dont expect changes overnight!