Thank you for the information. The reason I ended up in SF for treatment is because that is the area where many of the top notch clinics for pelvic floor dysfunction are located. There are others around the country, but after searching extensively, I discovered the northern california was at the forefront of treatment for the disorder. I actually had the Mayo clinic in Phoenix suggest that my best bet would be to try one of the clinics in SF. I spent 3 weeks there in December and I've been back twice since. They are not treating me for fissures, but the underlying cause, which this particular dr. believes is both pudendal neuralgia and chronic muscle spasm. I've received nerve blocks and internal physical therapy. obviously it has not helped. i could probably find a dr. to do botox closer to home, but i am really tired of spending countless hours online searching. did you end up getting LIS? if so, who did your surgery and do you feel that it helped with the fissure issues? have you seen a permanent decrease in your rectal tightness? I guess what I'm wondering is whether you find it much easier to have a bm than before.

Hrm were you going to UCSF? I could see UCSF being at the forefront of pelvic floor dysfunction disorders. They're known for being really good at treating lots of poorly understood problems, particularly nerve related ones.
Anyway yeah I ended up having LIS about 3.5 months ago. I still get rectal pain so I'm not sure how effective it was. I think it did help because I can now pass bigger stools now at least. So I'd say that yes, it has helped me have easier BMs, although it hasn't fully eliminated the pain just yet. Since it's just 3.5 months out for me, it's too early to say if it's permanently decreased my tightness or if it was worthwhile in the long run. Most people that do it have excellent results on a much shorter timeline though. But of course their cases are likely also very uncomplicated compared to yours, so your mileage may vary.

No it was at a private practice clinic near Hyde and Sutter across from a hospital. The doctors name is Jerome Weiss and he is a urologist. There are several other clinics in the area that specialize in pelvic floor dysfunction, including a 6 day clinic offered by David Wise and another clinic run by a physical therapist by the name of Stephanie Prendergast.
So, not to be too nosey, but is the pain that you have now a new pain as the result of surgery or pain that existed prior to surgery that has not resolved? Were your fissures chronic in the sense that they wouldn't heal or did they heal, but recurred easily? And, when you say that it has helped with bm's, do you find that your muscles are much more relaxed during bm's so that you do not need to use much effort? Thanks for all your feedback.

It's actually tough to put my finger on the type of pain I have now. I would say that it's from the same area where I used to get fissure pain, but the type/quality is a bit different. For example: before surgery, running was painful (it would cause pain in the left side of my groin). After surgery, running no longer hurts, but sometimes I get a sore stinging sensation from the same area when just sitting down. I know it's a vague description but the discomfort is fleeting and inconsistent in and of itself.
My fissure was chronic in that it healed twice -- the first time with me doing nothing but taking stool softeners, and the second time after Botox -- but retore. After it retore the second time, it didn't heal again. But I also didn't try Botox again. Some people have only reported healing after several rounds of Botox, and I stopped at just one.
When I say that LIS did help with BMs, what I mostly mean is that I've been able to expand the range of foods that I can eat without causing painful BMs (although I still take Miralax religiously). I'm not sure my observations have anything to do with less effort required during a BM. If anything, I'd say that it has actually allowed me to use *more* effort during a BM (whereas in the past the same amount of effort would hurt).

That's exactly how it is for me NG, I can eat a variety of things knowing that a decent sized BM can pass easily, plus I can definitely use more effort during BM without pain,
That stinging you talk about, I have that occasionally, it's just like a sharp pricking feeling and there's no real time when it comes on, I also get the feeling that I'm gonna pass some kind of liquid from my anus, like a moist feeling, sometimes after passing gas.

I had that moist feeling for *months* after LIS. In my case there really was some kind of discharge. It wouldn't stain my underwear or anything, but when I'd give the area a good wipe, I'd definitely find it on the toilet paper. Some light liquid along with ummm "specks" Gross, I know. Lately it seems to have finally stopped being noticeable, though (knock on wood).
And yeah it felt like nerves were having a frat party in my anus for a long time after surgery. All kinds of bizarre and random sensations ranging from stinging to aches. Definitely not nearly as bad as acute fissure pain, but certainly not pleasant either.