I've had an anal fissure for about 12 weeks now and I've been using nifedipine for 10 weeks.  Before that, I may have had a small chronic anal fissure for several years that was misdiagnosed as hemorrhoids.
The nifedipine has been helping but I've had some set-backs.  This week has been one of my better weeks.  I don't have that burning pain for hours.  Instead I feel some irritation and pulling and pressure in the area.  My CRS says the sphincter is still tight and thinks I should have botox.  I did talk the CRS into letting me try nitro for a few weeks.   
How long should I give the nitro or nifedipine before having botox?  I'm afraid of having botox.  I know it's rare to have temporary incontinence with it but that's a side effect that would make my work very difficult.  If nitro or nifedipine hasn't worked enough in 10 weeks, is it possible it could work in 6 months?
Thanks!

Hi Darkeyes,
My CRS prescribed me Diltiazem cream but recommended use for 6 weeks (although I used it for 7)
Generally, it's believed that a fissure needs about 6-8 weeks to heal/ start healing whilst using these medications, although some take shorter, others much longer, depending on the severity of the fissure itself. Some people continue to use them on & off for months.
I think at 10 weeks, if the fissure is healing well with the use of the cream then it would be about time to stop using it but if the fissure is still continuing to cause you issues, then I can see why your CRS would consider Botox to aid further healing (the fact that your pain has reduced and you are experiencing some different sensations makes me feel that you ARE healing but it is slow - but that's totally my opinion!) It's hard to say whether if you continued to use the cream for 6 months that it would further improve your situation or not but the question is whether you SHOULD be using it for this long.......I would check that with your CRS. Mine was quite convinced that you shouldn't overuse it. Botox is just another alternative to assist the healing, so if your CRS recommends you try it, I'd go with it for sure.
It could be that although you are still having some spasms, that you are actually healing, albeit slowly, and all those sensations are still completely natural even at your stage with a healing fissure. (I also went through this too) Ultimately, it's up to you, but I think Botox might be definitely worth a shot, especially if you want to try to heal naturally. All the very best to you :)

Hi Darkeyes,
Overall I'd talk to your CRS. Unfortunately there seems to be a lot of different opinions. I've heard some people say 8 weeks and others say use it for an additional 2 weeks even after you feel better. I think it all depends on the nature of the fissure and the doctor you're talking to.
I know for me set backs seem to be part of the healing process. So hang in there, and don't lose hope :)I'm glad you're having a better week!!!

Thanks ever the optimist and keepingthehope.  I'll see how the nitro goes and think about Botox if it hasn't healed.  I think I may be healing but very slowly.  It's interesting how set backs seem to be part of the healing process.  Thanks!