Hi all,

I need to make a decision regarding surgeries and botox, and I am looking for guidance.

My situation is this: I began getting anal fissures 5 years ago. The first few times they healed on their own. Three years ago, one appeared and didn’t go away. Things got worse, and I went through many of the typical treatments: Nitro/nifedipine, fiber, stool softeners, etc, etc. Unfortunately, I also had a doctor give me an unlimited prescription for hydrocortisone suppositories, which I used for a protracted period of time before realizing they can thin the skin, so it is possible that I am just prone to refissuring now because of that.

Since I began trying to heal, I had several hemorrhoids reduced via direct current, one major refissuring, and then a lot of sensations that are not clear. Even with stools soft and small, I still experience sensations that cause me anxiety.

I was told that I have a ‘functional stricture’ (non-anatomical narrowing of the anal cavity due to muscular overtension), and I began daily dilation in December 2014, and it seemed to work really well. When done in front of a biofeedback machine, it reduced the resting pressure very effectively. I continued this for several months, but started to feel pinching sensations. I started seeing blood every now and then, often not accompanied by pain, or just very mild sensations. It is unclear whether this was coming from a fissure or a hemorrhoid.

I am actually not in any pain right now, although I sometimes feel ‘pinching’ sensations upon defecation. The only reason I am doing this good, though, is because I am relying on Miralax, magnesium, prune juice, and coffee (to stimulate a second bowel movement every day). In truth, I have no idea what is happening down there now, because I am ‘un-examinable.’ With things as tight as they are, any anoscopy would cause re-injury.

I don’t consider my current situation an acceptable ‘solution’ because:
a) I would rather not be on Miralax for the duration of my life (but I could accept this)
b) the limitations of my diet and lifestyle cause significant professional/social setbacks
c) I expect that if my resting pressure is left unaddressed, my hemorrhoids will return
d) it is too anxiety inducing, especially since I can never know what is wrong with me in my state (since I can’t be examined)

At this point, I want to proceed with further treatment. The fact that dilation worked so well is hopeful, and suggestive. But does it mean I should go for botox or LIS? Botox would address pelvic floor issues more directly, but it doesn’t seem like people are often that pleased with the results. I don’t see how LIS would address pelvic floor issues, but it seems like people are happier with it in general. Perhaps my CRS will suggest other procedures too, but reduction of anal pressure seems to be top priority.

That this has gone on so long has created so much psychological trauma at this point, I don’t know what to do. I don’t know if I could handle a surgery-gone-wrong, nor do I think I can continue to handle the status-quo indefinitely. I have a hard time believing that I will be pleased with any results because my mind is in such a constant state of anxiety. I need to end this, mostly for peace of mind, and I just don’t know how to do it...

If anyone has words of wisdom, they would be much appreciated.

Hi ut_outdoorsman, and sorry for your troubles I don't know if this will help or not, but I am one of those who wasn't having the classic "spasms" people sometimes describe on here, at least not regular. I struggled with my fissure for about 9 months--it would be painful at that time of day for a few weeks, then heal up, during which I would have some irritation and general "tightness" (like sitting on softball). I would sometimes have a random stabbing pain here and there, but not the debilitating spasms people describe. I was on nitro for 4 months. As soon as I started weaning off it, however, I kept getting retears over and over. After a lot of anxiety I finally decided to get LIS, because I just couldn't handle, physically but also mentally, the constant setbacks and flare-ups anymore. I too was really nervous about it going wrong. It has now been a little over 3 months since my surgery and I am so happy with it. I won't sugar coat it--the first week after surgery sucked for me, but one healing took off it went surprisingly quick. I'm back to doing all my normal activities now--I just got home from a jog actually and sit as much as I want without really thinking about it. In terms of surgery side-effects, mine have been mild and are gradually disappearing. I did have a bit of incontinence to gas (though pretty much all silent, ha), which is almost gone now. I also did have a tiny, tiny bit of other incontinence 3 times I think, but honestly so small I didn't realize it and it didn't effect my quality of life at all (and trust me, I am skeptical of that phrase in general, ha). That also hasn't happened in a while now. As pleased as I am with my results, back when it was first recommended to me almost a year ago, I wasn't mentally ready to do surgery then. I think everyone has to follow their own path balancing doctor advice, research, and gut feelings. I suppose this isn’t really an answer for you, but I hope it helps!