First of all, let me say that I’ve been reading these posts for the last six months and tonight is my first time posting.

You all have been a source of strength and courage for me over the last six months while I’ve been battling this anal fissure.

It’s hard to explain to people the pain that I’m in on a regular basis or the anxiety I have every day over how this AF is going to dictate what kind of day I’m going to have. The unpredictability of it from day to day is the worst part.

I am so grateful that I found this forum - just knowing their are others out there who suffer with me made it better for me and allowed me to open up to my friends and family about this embarrassing but completely debilitating condition.

Today, I had Botox. It was done in a surgical theater setting under general anesthesia by a kind and caring Colorectal Surgeon in Winston Salem, NC.

Along with the Botox injection, the doctor took the opportunity to also cauterize the edges of the wound to try to stimulate healing.

I am post op for Botox now for six hours and resting at home comfortably. I will maintain this post moving forward in the hopes that my story might help someone else in the way others posts have helped me.

My AF came from a time in my life when I wasn’t being good to myself l. Poor diet and no exercise led to me gaining around 50 pounds and my fissure was the result of chronic constipation.

I self treated what I thought was a hemorrhoid for five months with suppositories and hemorrhoid cream. This made my fissure worse.

The pain became so bad that I went to see my GP who diagnosed my fissure with a visual and digital exam.

My GP prescribed nitroglycerin and recommended a follow up with a GI doctor for a colonoscopy as I have a history of polyps and was overdue for a colonoscopy. Following the colonoscopy I was referred to my CRS.

To sum up a long story:
Nitroglycerin is a miracle drug for me. I apply before and after a bowel movement and most days it will kill all pain immediately. When it doesn’t, I couple with a warm shower after bowel movement - I bought a removable shower head and spray warm water directly on my anus for five-ten mins.

Some days I have to apply nitroglycerin multiple times but all pain subsides typically around lunchtime.

Significant bowel prep, diet and exercise is key for me.

I have lost 50 pounds, completely changed my diet and exercise vigorously every day. Most days I prioritize exercise over everything else. Exercise allows me to exert all my frustration, stress and anxiety into physical effort and it relieves my fissure pain. It’s not uncommon for me to lift weights for hours for the simple fact that I am 100% completely pain free when I am working out.

Diet-wise, I am about 80% lacto-Ovo vegetarian now; meaning I eat veggies, eggs and dairy but very little meat. I do not consume cheese.

I consume as much fiber as possible - both soluble supplements and all natural fiber directly through food. I consume two tbsps of soluble (acacia fiber) twice daily to keep my stools nice and soft.

I eat copious amounts of lentils, beans, split peas, flax, quinoa and brown rice. I love Indian food - and as long as you watch the spice level, it is an anal fissure sufferer’s best friend.

I also eat a cup cooked of steel cut oats every single day.

Diet is the most important aspect - if something is not loaded with fiber, I don’t eat it. This means absolutely no junk food or fast food. It also means avoiding white junk brad and anything it’s used in -like pizza. Whole wheat and whole grains are super important.

At night before bedtime, I take two stool softeners.

This insane dedication to bowel prep has paid off - I’ve lost 50 pounds and am the healthiest I’ve ever been.

At the same time though, my fissure just won’t heal - and my day is ruled by bowel prep. It’s no way to live. I decided finally after six months to take the next step and have Botox.

I hope it works.

Thank you for reading and being part of this helpful community that has helped me through some really rough days with a debilitating condition that is pretty unexplainable to someone who hasn’t also suffered through it.

Next post tomorrow; post Botox day 1.

Day 2: Thanksgiving 2019. This morning was rough. It all started out fine, no pain at all.

Per doctor’s instructions I’ve been alternating ibuprofen and acetaminophen every three hours.

Whatever they used to numb me in surgery was incredibly strong stuff. I passed gas all evening and all night last night and couldn’t feel it happening.

That numbness wore off this morning.

I began my morning routine in the same order I do every day. Wake, apply nitroglycerin, have coffee and go for a bowel movement.

Unfortunately, due to my fasting yesterday, it didn’t happen that way. I didn’t have to go. Immediately the anxiety hit me and I began worrying about what was going to happen.

I had another cup of coffee and a yogurt and went back to try for a BM again. This time I could feel the pressure of the bowel movement but I just couldn’t get it to move. I applied nitroglycerin again and felt my anus - it was very loose and no pressure, usually means that I’m ready to have a BM.

Long story short, my internal sphincter was crazy swollen from the Botox injection. I finally managed to have a bowel movement after about an hour and a half of alternating gently rubbing a Coconut Oil and E-vitamin suppository on my internal sphincter and sitting in my sitz bath. I could not get the suppository into my rectum and it was extremely painful.

Finally, I managed to have a bowel movement and it was very soft but slightly formed. These always give me issues- I only manage to have little to no pain when my BMs I’ve the consistency of a cow patty and that’s what I normally go for through careful diet and stool softeners. Alas it was not to be today.

The stool was a little bloody streaked on a few pieces but there was no blood on the wipes (I use Cottonelle flushable wipes).

I didn’t experience any fissure pain at all today - but my sphincter hurt tremendously after the bowel movement. I sat in the sitz bath a couple of times and it calmed down but my entire rear end has had a dull ache all day today.

I have had to change my gauze a few times today and have had bloody discharge on it. The doctor said it would go away tomorrow likely.

It’s Thanksgiving in the US today so my diet is shot to hell. I’ve taken more fiber to compensate and ate extra lentils and oatmeal. I’ll probably take three stool softeners tonight just to make sure I have a nice cow patty stool in the morning.

All in all, a decent day all things considered. It could have been much worse.

Day 3: Excruciatingly painful BM this morning. Consistency was very soft but still slightly formed. I suspect a bit dehydrated from all the pain meds still in my system.

I do not believe the pain was from my fissure but again from my internal sphincter. The pain lasted for five hours through 800mg of ibuprofen and 500mg of acetaminophen. I finally was able to get it to subside and forget about it with a few vape hits of THC oil and sitz baths. I might just self medicate again with THC before my BM tomorrow AM, I just hate to do it so early in a day and then be mentally altered all day, but if it means avoiding the pain I had today, it might be worth it.

On the Botox front, it seems to be doing its job. Usually, within ten five mins of applying nitroglycérin, my anus dilates. This morning, my anus felt like it does after using nitroglycerin without actually using the nitro. Instead of being tight as a button upon waking, it was soft and fleshy.

I will again take three stool softeners tonight before bed in an attempt to achieve my vaunted “cow patty” consistency poo in the AM.

Pain level this morning much better; still higher than normal post BM but easily remedied with post morning BM sitz bath.

Only took pain meds twice this morning and was completely pain free after 11am for the entire day.

Worked out this afternoon, felt great. Resting anal pressure still greatly reduced from normal.

Looking forward to tomorrow - hopefully swelling will be gone completely.

Fingers crossed.

Day 7: The day before Yesterday’s (Day 5) bowel movement was the most painful I’ve ever experienced. I literally crawled on the floor from my toilet to the shower after the BM. After rinsing myself with the shower wand (I couldn’t wipe, it hurt too badly), I used a sitz bath for 30 minutes to relieve the swelling and pain.

For the remainder of the day, I had a sore but not hurting butt. It was a full soreness all day, but no fissure pain.

Yesterday, Day 6, the same as the day before - only the swelling seemed to have gone down greatly and the pain was nowhere near as bad as Day 5. By lunchtime, all dull pain was gone.

This morning, Day 7, I had quite a decent bowel movement, and the consistency was back to my desired “Cow Patty.”

I had moderate pain from the swelling today during the BM, but a short sitz bath afterwards solved it.

I am still applying nitroglycerin before BMs but otherwise, do not need it for the rest of the day - and am experiencing zero fissure pain.

I understand from other posts that the post Botox and cautery recovery can be up to two weeks, so I’m trying to stay focused on weeks, not days.

Cautiously optimistic.

Yesterday (Day

I just wanted to thank you for sharing. I'm seeing my surgeon tomorrow for a follow-up and will be asking about botox vs. surgery. Your detailed notes are helping. When you got the botox done, how were you put under? I've never had surgery before - was there intubation or did you wear a mask and breath that way? Did they give you an option to be awake? How long did it take (the procedure) and have you been working during the day or at home during your recovery?

Hey keep_breathing. I’m glad my notes helped a bit. It’s hard for me to find anyone to talk to about this condition - and I’ve gotten so much help as well just reading others’ posts here.

I underwent general anesthesia for my procedure. My surgeon said he prefers just in case something out of the ordinary is found and it also helps ensure everything is completely relaxed.

As for the anesthesia, it was full intubation but I don’t remember anything at all beyond the anesthesiologist telling me she was about to administer it. I woke up in a bed about an hour later.

The procedure took about two hours total from the time they wheeled me away to the time I woke up in recovery. I was able to walk to the car afterwards.

As for recovery, I was pretty good through the next day but totally numb in my whole groin/rear area.

The second day after surgery was the Friday after Thanksgiving and there is no way I could have worked due to the pain.

By day three after surgery I was able to work again with no issues beyond the 30 mins or so following morning BM.

Keep in mind that I not only had Botox but also had my fissure cauterized to promote healing; so if you’re only having Botox, your procedure may be different.

My doctor told me that Botox doesn’t work for everyone and I went into this with eyes wide open knowing that there’s a chance I still might have to have LIS surgery - but I wanted to exhaust all non surgical options first.

Good luck tomorrow and I wish you a pain free day!

Thank you, this is so helpful. It really is reassuring to be able to communicate openly and frankly about something so private.

I've always had a phobia about surgery and anesthesia. I even tried nitrous oxide at the dentist's once and took the mask off because I hated the sensation of fading out of control. I don't drink alcohol partly for this reason, too - I'm just afraid not to have control over my body. This is a huge irony since this fissure is the same thing. It's like a betrayal of the body.

Did you have a sore throat after the intubation? What is the gauze situation like? Have you felt supported by your doctor or their office following the procedure? Do you have a follow-up visit scheduled?

I had never had general anesthesia either before this, but enough is enough. Anything to get rid of this pain, I’m willing to do.

I did not have a sore throat afterwards and I also was concerned with this as I have a very small airway opening (have obstructive sleep apnea despite being in great health otherwise)

I did wear gauze and a pad afterwards but the bleeding was minimal; a non issue for me. It only lasted one day.

Day 9: Morning BM pain levels continue to improve and I am able to go all day without nitroglycerin and mostly pain free.

For the first time ever, I am aware of the fissure’s presence without being in pain. If I love a certain way, I can feel it pulling but don’t experience spasms. This is a glorious feeling.

Today, the fissure began itching very badly. For hours tonight I’ve experienced intense itching with no relief; sitz baths don’t help, scratching it doesn’t help. Shower doesn’t help. The only partial relief I’ve found was application of 100% pure aloe Vera gel.

My wife believes the itchiness to be related to the healing occurring in my cauterized fissure.

I have KEY-E Coconut Oil suppositories but I’m truly afraid to use them now for fear that I might accidentally tear myself.

So for now, I’m going to bed with an itchy butt.

Hopefully will be home tomorrow.