First time long time on AF, not sure what do do at this point...

I'm the usual suspect of progressive chronic AF, have had AF on and off for the last 10 years or so, usually they would heal on their own after a few weeks, but the last bouts have since taken many many months (6+) to heal and I'm left in horrible pain, to the point where I'm taking 2 ibuprofen after every BM. I'm on another long stretch battling another AF.

Tried the usual first tier of remedies, baths, diet, exercise, diltiazem, oils, softeners no real success there. Was ready to jump into LIS on this last one when doc suggested Botox, said he tends to be conservative, would rather not do surgery unless a total last resort.

So I got a prescription for 100U of Botox at the pharmacy and brought it to the CS office, a couple of pin pricks on each side of the area and done. He used just about all of it.

Within a matter a weeks the Botox has been incredible. It's like the AF is not even there. I have to check for it and see it's still there which is odd. It's been a couple of months and it still hasn't healed, but I wouldn't say it's bothering me. The only meds I'm on is an occasional half dose of Miralax to keep things soft, especially on a pizza day.

So, what to do at this point? I obviously want it to go away. Doc said the LIS is essentially doing the same thing as the Botox by stopping the spasms, and since I'm not in pain and don't feel it, the LIS would be redundant.

He did manage to share a little gem of a story about one of his patients that had chronic fissure so bad over 20+ years that he doesn't even feel it anymore, as if he just accepted it. Really don't want to become that guy...

So, what to do from here... continue down the Botox path? Consider LIS? It's an odd position to be in that I have it but I'm managing it OK now, so is this something I just "live" with? Or still consider the path of surgery?

-JE

Hi there, how long has it been since the Botox? The fissure continues to heal for about 3 months after I am told. Also the second round of botox was recommended by my CRS if I did not fully heal. But for me it's different - I had two prior LIS surgeries both several years ago and I am convinced they really helped me for decades before I relapsed. I am going through Botox post recovery( 3 weeks out now) and am finding it takes so much longer to help one heal. I was not offered a third LIS because of my two prior even though my first one 20 years ago when I was 18 and the second one was 12 years ago after pregnancy. (But in those days there was no Botox offered just LIS.). If it's not quite 3 months probably giving it the full time to recover . Since it worked well maybe another round ? If I am not fully healed I plan another attempt at Botox -I guess my concern for me is always what if the Botox wears off and the spasms return?