What do I do now?
Here's my story:
Jan 2012 I got my first fissure, found I am allergic to Diltiazem, tore another one in Feb 2012, pushed to see a specialist, waited over a year to see a CRS. In the meantime I managed my fissure with triple dose Miralax and strict diet. FINALLY get to see the CRS and his only advice? Taper down the Miralax cause it'll make your bowels lazy. Tried that, experienced pain & blood (duh!).
Been taking a triple dose of Miralax daily for over a year now, with no spasming, and still haven't healed. CRS says he won't do surgery without trying botox first. He thinks I'll heal on my own. I'm wondering if botox is worth it at all, since it just relaxes your muscles?
I'm so discouraged-- why haven't I healed? (And why are doctors such douchebags?!)
Anyone have a similar story and figure it out?

CRS can't be wrong.  Did you say three Miralax doses?  Are you sure?  One possible reason for such extreme hardness of stools can be imbalanced hormones.
PS.. Please check your blood pressure too.

Every doctor I've talked to about Miralax has said that it just draws water into the stool but that it doesn't make the bowel lazy the way that laxatives that stimulate nerves do. So, I don't know what to say about that part that you heard from your doctor.
Have you been able to get more than one opinion about appraches to take for your individual treatment? Some doctors are more likely to want to try Botox first than others, but there have been some members on the board who have had some good success with Botox with or without fissurectomy. You might want to check out a couple of threads in the surgery section about experiences with Botox. 
Healing fissures is so complicated, and no two fissures heal the same way. Sometimes they heal really fast with conventional treatments and sometimes they become chronic, and no one really knows why. I'm still on my own fissure odyssey, this last bout of fissures cropped up in 2011 and became intermittently chronic, but I've been getting fissures on and off for 20 or 25 years.
I hope you make some headway soon.
p.s. i say a Hail Mary when i poo too (and before i poo, and  i poo , and any time i'm losing my mind over fissures, which is frequently)

Pre-fissure I've never had any issues with constipation or hard stools. Not too sure what sparked my fissure in the first place.
My first doctor said that Miralax is fine to go on and off of no problem. CRS told me no, it will make your bowels dependent. The light research I've done on Polyethylene Glycol suggests that the CRS is right.
I've experiment with different foods & doses of Miralax, but just can't seem to bring the dose down.
My blood pressure is low, and has always been low. How does blood pressure affect it? My thyroid is fine too, but my hormones are always shifting due to pregnancy & breastfeeding.
Just hard to know which way to go, and I don't understand why botox would help me any further by stopping spasms that I haven't had lately. Also, I'm not covered for either Miralax or botox, so its getting to be pretty pricey!
Thanks, I'll have to read up on the other threads when I have some time!

The thing here is not only in spasm, but in resting pressure.
Simple example tomorrow morning, no spasm, no pain, look in window, and I cannot find my fissure as it is glued between folds. You can ever think it is healed.
5 mins after put nitro, went to window check up and found my nasty ulcer. 
So botox is equal to constant nitro effect.
Hope this explains.

Sorry, mirror not window

So it is your hormones !  This is also a point where none of the conventional methods  of dealing with fissure (except surgery) will work.  If surgery is expensive, then you may have to use a holistic medicine approach.  For example; acupuncture, chiropractics, homeopathy and so on...   You may have to research and read reviews to find a good one in your vicinity, whose focus would be mainly on digestive and endocrine imbalances.
A great substitute for Miralax would have been Magnesium supplements.  However, it is not recommended for people with low blood pressure.  Low blood pressure may also be the reason for you to experience hindrance, rather than help, on the use of Diltiazem.
Like I said, your approach here for cure should be different.  Diet and supplements do help, but will not assure a normal bowel movement, only because your tummy is dominated by a different force.  So the food that works today will not work tomorrow.  The hormone fluctuation makes everything unpredictable.
Having said that, I pray that you find a perfect method for treating this ailment.  Yes, not just a "Hail Mary", but a rosary should help :)which I think, I will say one for you.  Have faith and stay blessed !

As Igrik says, my problem is not spasms (rarely had em!), but instead I had/have an abnormally high internal sphincter resting pressure. That means that... basically, and don't hate me for this cause I say it jokingly... you are a tightass! Try all the options you can to relax, also see a CRS about the issue. Botox will help with that by relaxing your muscles = lessening resting pressure. But my CRS said it's not so recommendable and that LIS is the way to go. I just wanted to get it over with so I was like 'kay, surgery it is!

Yes tornihell, seems that is the deal high resting pressure.
And botox seems to be not helping much, for instance JHH didn't feel any effect from botox and still is tight. 
Now I wonder what are resting pressure measurement units, and what is normal, not normal. Also question is, will manometry test be relevant and doable at all with active fissure and trauma in channel?
Also if we check Davo posts, his CRS told that Botox is not the relevant thing to use.

Hi Igrik, I think anal resting pressure would depend on a case to case basis... Though I guess it is measurable by tests. But then again you are right--it might not be so effective to use tests when there are active fissures and trauma in the canal. Examination under anesthesia is possible but the problem is when using anesthesia, usually the body will relax, so then the resting pressure is not the same anymore. :/ Hard to say.
That is why my doctor didn't do any tests on me, to test resting pressure. he just took a look and already knew immediately the problem. :)