Lars-is there any reason that you think the surgery might not be helpful for you? Sorry to hear you are still suffering.

I wonder if it matters so much where the pain is coming from. Pain can be referred when there is a complex neural network like in the anus.

I thought I was getting better right before my syrgery and wanted to chicken out bad.
I am so glad I didn't.
Why not tell yourself you need to bring this thing to an end, and the surgery will most likely do that. I am now fissure free for a year and a half! I would do it again in a heartbeat, no hesitation!

my "spasms" were basically what you described, just a constant clench and tightness. I thought they should not be called spasms, more like an anal charlie horse. The spasms themselves never really felt like a cramp, unless, Like Lecia, I was on my period. Otherwise, there was just tension and smallness in the area.

Lecia - I am so afraid that I have developed levator ani while I have had the fissure and that LIS will not help that.... I have now been on diltazem for 3 weeks and nothing have improved...It seems that nothing helps me and therefore I am having trouble seeing that LIS does...Nitro, Botox *3 and now diltazem... Sorry but I am just so upset...

You should know, though, if you are just too tight down there.
If you an barely stand to put your finger up your but, then you are in all likelihood too tight, and that in and os itself will keep healing from occurring. Cutting the sphincter and relieving the tightness an be all it takes.
Botox can be a very iffy proposition, while LIS generally is not.

Lars-I figure at this point you have nothng to lose. Like I said to Jen, there is no real negative outcome if for some reason it doesn't work. And even if it doesn't fix it 100%, it can still improve it.

If you have levator ani syndrome can you get a referral to a physical therapist?

You should seek a diagnosis for levitator ani. Then go from there.

Sorry the creams dont seem to be helping Lars
LIS is reserved for when everything else doesnt work ?? Right !
Heres a big hug for you

Lars - I agree with everyone that you should look into LIS. The main reason I am afraid to get it is because I DON'T have the spasms, and you do! When is your next appointment?
Kim - I am so afriad to get LIS because it does not hurt to put a finger in my bum most the time (like what you were saying to Lars). I feel like I am normal tightness already. When I first got my fissure like a year ago my bum hurt with a digital exam, but not too much now. I am on nitro and that loosens it a little, but do you think it sounds like I am already loose enough??? I plan on bringing all this stuff up to my doctor prior to my surgery - it is just nice to hear what you have to think as well.

That does not surprise me, Jen. You seem to heal from retears. That tells me, in my very limited knowledge, that you get at least more blood flow than perhaps many other AF folks do. But you have relapses. You just may not be loose enough.
As for Tabby's question, surgery should be a last resort, but it's not like some kind of horrible, nightmare scenario last-resort!!! It's just not the conservative approach. Many people jump right into it when they find out it has the best success rate.
Many people wait, and wait, out of fear of incontinence or pain, or GA, or $$$, or many other reasons. They keep going through the ups and downs that chronic AF entails.
I chose a somewhat middle ground, I waited to see if I could heal it but seven months was long enough. Surgery is a quality of life issue. How long can you, or do you want to, carry on?
That's how I see it.