I have an appointment tomorrow with my GP, and I know he's going to strongly suggest Botox and I'm going to strongly ask for a referral.
I don't know what to think about Botox--- hospitals, doctors and nurses scare me, I'll have to pay out of pocket, and much of what I've read on this forum hasn't been the greatest support for Botox.
I had previously been on my way to healing just over a month ago, using only Diltiazem occasionally and prune juice. One bad BM put me back at the beginning line, only this time with two fissures.
I've spent 3 weeks on Miralax (two full doses a day) and using Diltiazem when I can bear the burn. My pain levels top at 4 out of 10 (10 being I break down and cry and hyperventilate when I feel the urge to poo).
It doesn't seem like healing is progressing at this point. I'm doing everything I can for myself.
Do I need to give myself more time? Or would it be better to go ahead and look at other options???
I'm afraid of trying anything that risks making this worse!

If it were me, I would skip the Botox unless you just need some short-term relief. My CRS will only perform Botox on those looking for temporary relief. There is a recent published study that compared Botox to saline injections. Half of the participants were given Botox; the other half were given saline injections (the placebo). After a year, the fissure healing rates among the two groups were almost exactly the same. My CRS said by the time most people get Botox, it is too late for it to be effective in healing the fissure and LIS is usually a better option. He said Botox can be effective for short-term relief, but the pain generally returns after a couple of months. Each additional Botox injection becomes less effective, so Botox usually just results in a delay of the inevitable. However, Botox may be worth a shot (pun intended!), especially if you need short-term relief, but keep in mind that there are potential side effects, such as injection site inflammation, infection, etc. There are lots of cases of people on the forum getting a thrombosed external hemorrhoid following Botox injections, or increased pain and discomfort.
The bottom line: fissures suck!

Hi AF friends,
I am so sorry to hear that you have had such a terrible set back especially when it sounds like you were on the road to recovery, nmfa. And the decision between getting botox and LIS continues to be a tough one as well as a personal and individual one. If possible, I would hold off making any decision until you see a CRS as they are really the qualified specialist in dealing with these things.
Any risk of inflammation and infection is true for any procedure that involves cutting into tissue including LIS and botox.
In my case, I was recommended Botox and was certainly more interested in giving it a go before going a more invasive, permanent route. I'm not going to lie, it hasn't been an easy road (I had fissurectomy as well which left me feeling pretty beat up as I had a lot of infected scar tissue removed). The 1st 2 weeks were the worst, had a retear and things VERY SLOWLY have continued healing since then - now i have very minimal pain (surgery was 10 weeks ago). But, I, too, am not out of the woods - because as my CRS told me "one false poop can put you back at square one".
The way I see it, Botox helps augment the body's natural healing process by temporarily paralyzing the muscles so that blood can flow down there and heal. For me, it was worth the shot before going to the next line of defense.