What this experience covers
This experience describes what people go through when they have fissurectomy performed on two fissures — anterior and posterior, or two posterior — combined with botox injection, in a single procedure. It is a composite drawn from many anonymised accounts, capturing common patterns rather than any single person’s story.
Having two fissurectomy wounds healing at the same time is a different experience from having one. The recovery is more involved. The wound management is more demanding. And the emotional experience — navigating two healing sites in a sensitive area — is something people wish they had been better prepared for.
How people arrive at this procedure
Double fissurectomy with botox is typically recommended when someone has two chronic fissures that have not responded to conservative treatment. Having fissures at two locations — most commonly anterior and posterior — is less common than a single posterior fissure, but it is not rare.
By the time this procedure is recommended, people have usually been through months of topical treatments, stool management, and sometimes previous botox injections. The recommendation for a double procedure can feel like an escalation. But people also describe it as practical — addressing both problems at once rather than two separate procedures and two separate recoveries.
The procedure
The surgery is typically a day case under general anaesthesia, lasting 30 to 50 minutes. Both fissure sites are excised — removing the chronic scar tissue that cannot heal on its own. Sentinel skin tags, if present, are removed at the same time. The botox is injected into the internal sphincter during the procedure.
Both wounds are left open to heal from the bottom up. This is intentional — secondary intention healing allows the tissue to fill in gradually.
People go home the same day. The immediate sensation is different from the fissure pain they are used to. The sharp, spasm-driven pain is replaced by the broader ache of two surgical wounds.
Two wounds: what that means
The single biggest difference between a double fissurectomy and a single one is managing two healing sites simultaneously. This affects everything:
- Pain is present at two locations. Some people find one wound more painful than the other. Some describe the anterior wound as more uncomfortable due to its position.
- Sitz baths matter even more. Both wounds need the same careful attention. People describe sitz baths as the anchor of every day during the first two weeks.
- Sitting is harder. Two wound sites means less comfortable positioning options. Cushions, lying down, and frequent position changes become essential.
- The healing timeline is not doubled, but it is often longer. The body is managing two repair processes simultaneously.
The recovery timeline
Days 1 to 3. The most difficult period. Both wounds are sore. The botox has not yet reached full effect. Pain medication is needed. The first bowel movement is anxious and uncomfortable — manageable with soft stools, significantly harder without them. Sitz baths three to four times daily.
Weeks 1 to 2. The botox takes effect and the sphincter relaxes. Pain begins to decrease. The wounds are at their most sensitive for care but are settling. Most people are still spending significant time resting. The turning point often comes late in week one or early in week two, when people notice the old spasm-driven pain is gone.
Weeks 2 to 6. Gradual improvement. The wounds fill in from the bottom. Pain becomes intermittent rather than constant. Activity increases. Bowel movements become routine. Most people return to work during this period — desk workers with a cushion, physical roles needing longer.
Beyond week 6. Both wounds typically close between weeks four and eight. The botox wears off and sphincter tone returns to normal. Follow-up confirms healing.
When to contact your doctor
Reach out to your surgical team if you experience any of the following:
- Pain that is escalating rather than gradually improving after the first week
- Bleeding that is heavy or increasing beyond what was described as expected
- Signs of infection at either wound site — increasing redness, swelling, unusual discharge, or fever
- Concerns about how either wound looks or feels
- Difficulty with bowel or gas control beyond minor temporary changes
If you experience significant bleeding that will not stop, fever with abdominal pain, or sudden severe pain, seek urgent medical attention.