FishBoi,
I had my Botox yesterday and I was given 30 units of Botox, split between all four sides of my internal sphincter muscle. I guess the 10 units the nurse mentioned to me before was incorrect.

BusyBrooke3,
The pain of the fissure went away instantly after having the botox, however I had a relapse about a week after the botox. Bleeding, scraping, swelling. Since then, my muscle does feel more relaxed, and the fissure has began to heal. It's really important to eat right and keep your BM's soft. I drink a glass of prune juice everyday and a teaspoon of Metamucil and drink lots of water. So, just keep up with babying your fissure even after botox. I didn't have any side effects, but was a little tender at the injection site for a few days. Really nothing to be scared about. I really recommend botox before jumping into surgery. Just my opinion.

Thanks for sharing. I've been pretty apprehensive about this, but your words are reassuring! I will take your advise. Thanks!

I had 30 units total, 15 in each side. Insurance covered it fully in my case, but only after other conservative treatments like the various ointments had failed. Some insurance companies consider the procedure experimental and won't cover it though. And yep, the billing code for both the procedure and the Botox can make a difference (ask your doctor about how they handle this if you're not sure).
As far as how much Botox to use and where to inject it: somewhat surprisingly, there actually isn't any "standard" consensus in the medical literature. Botox is a newer treatment for fissures so you will find numerous differences of opinion on the exact protocol, both in the literature and from doctor to doctor. IMO where the Botox is placed is probably more important than the number of units used. Botox is an extremely strong neurotoxin and it takes very little to cause paralysis. But not all doctors inject it in the same spot, which is likely what leads to some of the differences people experience in efficacy, pain during and after the shots, and so forth.
Long story short: 30 units total is within the normal range. That's what I got and it worked for me. I had it done without sedation in the doctor's office (but bear in mind that I ONLY had Botox and nothing else at the same time). My fissure was gone for months afterward. Eventually I re-tore it, however. Most people that I've seen succeed long term with Botox (and to be honest I haven't seen that many ... although many get short term relief) had several rounds in close succession (a couple months apart). If they're spaced too far apart, my opinion is that the muscle than has time to tighten up again and tear. It's all about keeping that sphincter muscle slack for as long and as continuously as possible.

P.S.
Should add that I didn't have any incontinence after Botox. I wouldn't read too much into whether the Botox was effective or not based on that.
Also, I personally like being knocked out for most medical procedures. I'm a huge chicken and do not have a very high pain threshold. But for Botox -- assuming you're not getting anything else at the same time -- I actually prefer to not be sedated. The procedure itself is so fast, and the pain so momentary, that I don't feel like it's necessary. If anything, I'd say maybe a benzo (Valium, Klonopin, Xanax, Ativan) to relax would be good, or perhaps an opiate painkiller before the procedure to mask the pain. Either one ought to take the edge off and leave you in much clearer state of mind afterward. It's all personal preference, obviously, but this chicken says to go for it unsedated so long as you're not getting any other procedure at the same time.

Reading through this I feel a bit better! I have been told that botox would be the next step for me, but got to wait for my appointment to discuss it. Kind of felt a bit nervous about it, but also hoping for it to hopefully sort this out! :)

Sue, I am with you there! I too am waiting for my next consultation. As you already know lol... I am a chicken though and am getting my botox whilst knocked out. OOoo a younger looking ass hole hee hee
Wheh is your next appointment?

Well my NHS appointment is 13th September. They diagnosed the fissure at the end of May but I got sick of waiting and went for a private consultation last week(which i couldn't really afford!). He recommended botox as I am still struggling (he said if the cream hasn't worked after a month that it's unlikely to), so at my next NHS appointment I am pushing for that. Just hope it's the consultant I see, and not the registrar like last time. When's your appointment? :)

Yep you're right, no wrinkles in our bums!!

Oh I hope u get the consultant Sue! Like I said in another post about you today, we are at the same stage and blinkin progress with the NHS. My scan is in about 10 days time and then my review with crs is the same week as yours. My fissures are just a month earlier than yours so we can keep eachother posted on what the crs are advising. I do feel disappointed to read that ur doc said if the cream aint working after a month then it probably won't. Oh holy s..t it botox and then LIS. I just want the LIS after reading frm our boardies here. I think we are wasting our time ??? How are you now though? Are you still having major probs in bathroom? Any spasms etc...? I have been stuck in for yet another week apart fm seeing the G.P from hell lol...Don't this suck!!!!