What this experience covers
This experience describes what happens when the first round of botox for an anal fissure does not fully work — the emotional weight of that moment, the decision between trying again and moving to surgery, and what people report about second (and sometimes third) injections. It is a composite drawn from many anonymised accounts and represents common patterns, not any single person’s story.
This is different from our experience on when botox does not work at all, which covers the broader picture of botox failure. This piece focuses specifically on the decision point: your first round gave partial or no results, and now you are weighing your options.
The pattern
The moment of realisation
For most people, the realisation does not come all at once. It creeps in. The botox was supposed to create a healing window, and somewhere in weeks three to six, it becomes clear that the window is closing and the fissure has not fully healed. Pain levels may have improved somewhat, but they are creeping back. Or they never improved enough.
People describe this as one of the more demoralising moments in the whole fissure journey. They had invested hope in the botox — endured a procedure, waited through weeks of uncertainty, maintained their routine — and it was not enough. The emotional weight of “it did not work” sits heavily.
The conversation with the surgeon
What happens next usually depends on the surgeon’s assessment. People describe a range of approaches:
- Some surgeons recommend a second injection promptly, particularly if the first round produced partial improvement
- Others suggest waiting longer — the fissure may still be healing, just slowly
- Some move the conversation directly toward surgery, particularly if there was no response at all
- A smaller number recommend continuing conservative care alongside discussing further options
The quality of this conversation matters enormously. People who felt their surgeon listened, explained the realistic chances of a second round working, and gave them genuine choice describe the experience very differently from those who felt rushed into a decision.
Deciding between round two and surgery
This is the core decision people wrestle with. The considerations are practical and emotional in roughly equal measure.
Arguments people describe for trying botox again:
- The first round produced some improvement, suggesting the approach works but the dose or duration was insufficient
- Avoiding the permanence of sphincterotomy and its small risk to continence
- The recovery from botox is easier than from surgery
- Wanting to exhaust less invasive options before escalating
Arguments people describe for moving to surgery:
- Botox did not produce meaningful improvement — trying again feels like delaying the inevitable
- Fatigue with the cycle of hope, waiting, and disappointment
- The high success rate of LIS surgery compared to repeat botox
- Wanting a more definitive resolution rather than a temporary measure
There is no universally right answer. The accounts make clear that both paths lead to resolution for many people, through different routes and at different speeds.
What a second round is like
People who opt for a second injection describe it as procedurally identical to the first — same brief procedure, same recovery period, same waiting game. But emotionally, it is very different.
The hope is more guarded. The self-monitoring is more cynical. People know what to watch for, which removes some uncertainty but adds a new kind of pressure: this time, they can recognise the signs of it not working earlier, which makes the waiting harder rather than easier.
If you are weighing up whether to try botox again or move to surgery, our chat can help you think through your specific situation.
When to contact your doctor
Seek medical attention if you experience:
- Pain that is significantly worsening
- Heavy or increasing bleeding
- Difficulty controlling gas or bowel movements
- Fever or signs of infection
- Any symptoms that concern you — there is no minimum threshold for reaching out