I had botox done 5 weeks a go after 12 weeks on diltiazem and rectogesic wich didn't do much.
Im still having unbearable pain 24/7 (knife sharp/burning/broken glass like pain). Its not only after a bm - but all the time no matter what i do.

Ive had some horrible side effects from botox (serious incontinence, crazy pain, hems and multiple retears) so i really dont feel like another round of that nor a dilation, which my doctor seems to think is next step.
I dont really have a spasm like pain - but my doctor dosen't believe me on that one and therefore says that since the creams didn't work, botox or dilation is my 2 other options... Since i got the fissure 6 months ago ive had 5 really bad retears and a week ago i got a painful(!) new one + a retear - so to me it seems like the botox didnt do shit...
and im so confused on what to do next.. Since im dealing with incontinence issues now after botox, im not feeling like having the dilation done, since im really worried that would make it 10 times worse and maybe a more permanent issue, and i really dont feel like another round botox + all the side affects again..
do you have any tips or methods which helped you that i can try? i cant handle this 24/7 pain anymore

I can't comment on the Botox but you need to get more pain management. Talk to the doctor and if you don't get something to relieve the pain, find another doctor. Don't suffer.