I have an 18+ year history of chronic pelvic floor dysfunction, and more specifically, chronic levator spasm and pudendal neuralgia. As a result of this chronic pelvic floor tension, I developed recurrent fissures. For the first several years, the fissures would heal with conservative treatment. About two years ago, the fissure failed to heal with conservative treatment and I opted to have botox injections. The injections flared up my underlying pelvic floor tension, but did eventually result in the healing of the fissure. About six months ago, I developed another fissure and was offered LIS by by CRS. I asked to repeat the botox again rather than doing surgery, which my CRS agreed to. The botox seemed to be less effective in treating the fissure this time around, but did reduce the severe pain symptoms that I was having with the fissure. About three weeks ago, I had another major fissure flare up and the pain is unbearable (and I have a very high tolerance for pain). I contacted my CRS, but her next available appointment isn't until May. There is no way I can wait this long so I am currently trying to get a sooner appointment to discuss treatment options.
My questions is, given that my recurrent fissures are most likely being caused by my underlying pelvic floor tension and not necessarily due to tension in the sphincter or constipation, etc., should I push for another botox injection or ask for LIS surgery instead. On one hand, the botox does seem to help reduce pain, but it is not solving the issue. However, if a spastic sphincter isn't my main issue causing fissures, then LIS could be risky and could have irreversible consequences. Also, my CRS does not perform many LIS surgeries in her practice as she typically has good results with botox. She only does a handful of LIS surgeries per year, at most. This concerns me. If anyone has any advice, it would be greatly appreciated.