Not sure where to start as I am feeling quite depressed right now. I stumbled upon this forum while googling about my condition, so here goes. I’ll try and keep this note brief, but please bear with me as it’s 25 years of history I am trying to condense here.

I am a 59-year-old male from Singapore. In 1997 when I was 36 years old I was diagnosed with anal fissure, triggered after a really bad bout of constipation. If I recall correctly, LIS was one of the first treatment options offered to me, and because I was in so much pain at the time, I decided to take a chance on it.

The surgery solved my problem but about 5 years later I began experiencing anal fissures again. This must have been around 2002 or so. That's when my CRS prescribed Rectogesic 0.2 percent (I think it’s the same as nitroglycerine?). Over the next 15 years or so, this was my go to remedy, along with Lactulose to soften my stools. And of course plenty of fruits and veggies in my diet, and at least 3-4 liters of water every day.

As the years went by, I realised that it didn't take a hard BM to cause a fissure in my butt. All I needed was a slightly harder stool than usual for me (what in fact would be considered perfectly normal for most people!) to result in a fissure. The healing time also seemed to take longer between each incidence of fissure. I got so sick and tired of the situation that I consulted a new CRS, and in Jan 2018 underwent LIS again. The recovery took a couple of weeks but the surgery helped and I was free of pain for the first time in 16 years.

I continued to eat a fibre-rich diet, drank 3-4 liters of water every day and discovered the wonder of magnesium supplements, taking one or sometimes two capsules a day. Life was good until Aug 2020 when I underwent surgery for another (unrelated) problem. Unbeknown to me, I was given an opioid-based painkiller called Tramadol to take and within 3 days I was severely constipated, triggering yet again another fissure. You can imagine how depressed I became, and I blamed myself for not researching about the side effects of Tramadol.

Whatever the case, the damage had been done. I went back to the same CRS who performed the LIS but he said there was nothing much he could do, and referred me to another (lady) CRS who treats women who suffer from pregnancy-induced fissures with Botox. She examined my butt but said the tear wasn’t visible. Unlike most other fissure sufferers, my tear isn’t at the rim of the anus but a little deeper. The CRS had to insert a scope to discover the source of the fissure.

Anyway the lady CRS decided against using Botox and suggested I give Rectogesic another chance. And so I did, thrice daily for 3 weeks, then when it was slightly better, twice daily for another two weeks. Since Nov 2020 I had been fine, but two weeks ago the fissure was triggered again. The funny thing is that this time around I don’t recall being constipated. If at all, perhaps the stool was ever so slightly larger and harder than usual. Or maybe it was because I ate some really spicy food the night before? Whatever the case, my fissure is back. There was some bleeding the first few days, and although it seems to have stopped, the pain I experience during my daily BM hasn’t let up. I’ve been applying Rectogesic faithfully 3 times a day since 15 June and today is day 14. Usually, I would see a marked improvement after 2 weeks, but this time the fissure doesn’t seem to be getting any better. My stools are very soft because of my diet, water intake and probiotic and magnesium supplements plus a once daily sachet of Forlax, so I just cannot understand why the pain isn’t getting any better.

I am really down in the dumps and my wife thinks I am becoming clinically depressed. At this point, I just don’t know what else to do...

Hello, I also have a fissure which is located maybe 1-2cm from anus, precisely at 6 o'clock in gynecological (lithotomy) position. However, the issue is the same in my opinion, because even at this location, the wound still reaches internal sphincter. It can be harder to treat though, as fissures located directly at the rim of anus are easier to reach.

My question is, why did the lady CRS decide against using Botox in your case, what was the reason for that? Because Botox is recommended for most chronic fissures, not only those which are pregnancy-induced. And fissures which are little bit deeper still reach internal sphincter and therefore Botox is viable

Hicks wrote:Hello, I also have a fissure which is located maybe 1-2cm from anus, precisely at 6 o'clock in gynecological (lithotomy) position. However, the issue is the same in my opinion, because even at this location, the wound still reaches internal sphincter. It can be harder to treat though, as fissures located directly at the rim of anus are easier to reach. My question is, why did the lady CRS decide against using Botox in your case, what was the reason for that? Because Botox is recommended for most chronic fissures, not only those which are pregnancy-induced. And fissures which are little bit deeper still reach internal sphincter and therefore Botox is viable

Dear Hicks. First, many thanks for replying to my post! Grateful to know that I am not the ONLY person in this world who has a fissure that's located deeper in than usual. I guess my CRS decided against Botox the last time as she wanted to see if I would heal with Rectogesic (nitro). Which I did eventually, and was blissfully free of pain for 6 months. This time around, however, the nitro doesn't seem to be doing its job after 2 weeks. Think I will see my CRS next week to discuss the possibility of a botox injection.

Hicks, have you ever been botoxed before? What was your experience like? I have to say I am kinda freaked out by the negative experiences some people on this forum have reported with botox.

I am also worried that having undergone not one but two LIS surgeries before will complicate my situation. I have to say that I am totally confounded and frustrated (and depressed) that I still suffer from fissures after undergoing 2 LIS procedures (albeit with a 20-year gap between each). Is there anyone out there who has done LIS three times? I honestly cannot imagine subjecting myself to surgery again, but I am more open to botox if nitro cannot help anymore.

I haven't been botoxed yet, but I'm going to be next week, so I could describe my experience later. I have my fissure for over 6 years though. Botox is one of really few recommended conservative treatments, so I think everyone should try it before undergoing surgery. I also know about some negative experiences regarding botox, but I'm not really sure how those could have happened, because it really shouldn't do anything else besides relaxing sphincter. Anyway, it is temporary so I wouldn't worry, there aren't really a lot of other options.

If you don't mind me asking, I'm curious, where were your previous fissures located - which healed after undergoing LIS - did you have an "internal" fissure before?

For some reason, on both occasions botox was never offered to me as an option. And rather naively I accepted LIS as the only recourse. I know better now, but it's a little too late to be regretting this. In answer to your question, my fissures always occur in the posterior region. I wouldn't say dead center the 6 o' clock position if you imagine that part of the anatomy as an analog (sorry, bad pun) clock, it's located a bit more to the left, either 7 o'clock or maybe between the 7 and 8 o'clock position. As far as I can recall, my fissures have always been located fairly deep in. This time round I am also quite certain that the fissure I am experiencing is the same one that healed after my last LIS. Anyway, I saw my lady CRS today and she's offered me botox as an option if I want it. She did warn me, however, that she's never used botox on someone who has had LIS before, never mind twice before. She did say that it should not make a difference to the way I respond to Botox, but I just wonder...

Hicks, when you see your doctor next week, can you pls ask if he has ever botoxed someone who has had a failed LIS procedure? And if the answer is yes, whether botoxing an LIS-ed patient has any impact on the results. I'd be very interested to know. In the meantime I've told my CRS that I am going to give nitro another 2 weeks to work its magic before I give up and try botox. Which brings me to my next question. Didn't you try nitro before you decided on botox?

If anyone out there reading this thread has experienced a failed LIS procedure and then tried Botox (with either good or bad results), I'd really like to hear from you. Right now I feel like I am the only unlucky sod in this entire world who has had two failed LIS surgeries...

Here for this. My LIS failed and I need some help…seeing surgeon tomorrow and wondering if Botox would help..