Hey fedup....I have had every symptom you've described exactly! So I know exactly what you're going through. Mine started with the birth of my (third) daughter as well.
Botox tends to be a temporary measure, once it wears off it's really common for people to have a reoccurrence. I know it's harder in the UK, just from what I've seen on this board it seems that across the pond you are sort of pushed to do the botox before getting the surgery. That seems unfair, when the botox results are iffy and the surgery has a high success rate.
I absolutely believe that you're correct about having a new tear, all your symptoms would point to that. I hope you can manage a referral. I really think you need a new doctor to help you get through this. I remember feeling like I was trapped in my body, because it wasn't something I had the power to heal on my own. I needed help, and yet I really didn't want to deal with it, I just wanted it to go away on its own. But it wouldn't!
Finding a doctor to perform the surgery was honestly the best thing I ever did for myself. I was lucky to find a wonderful doctor who was sympathetic and intuitive--he didn't push me to do botox or ointments but agreed to do the surgery right away. I'd been struggling for five years at that point so I was ready.
I wish everyone could see a doctor like that. It makes me so sad to see stories like yours, where the doctor blows the patient off because he thinks all butt problems must be hemorrhoids, or he doesn't think it could possibly be a big deal. It is a huge deal, the emotional and physical toll it takes is overwhelming.
We're all with you here, don't worry about ranting. This board was the reason I kept my sanity through this ordeal. I didn't have many people I could talk to face-to-face. My husband only wanted me to GET IT FIXED. He didn't understand that sometimes it takes time and that what I really needed was a shoulder to cry on.
Take care of yourself, fedup! Do whatever you need to do, I promise it CAN and WILL get better. But it takes effort on your part, to seek out a better doctor who can give you the treatment you need. Hang in there!