What this experience covers
This experience describes what happens when botox for an anal fissure does not work — the signs, the emotional weight, and how people move forward. It is a composite drawn from many anonymised accounts and represents common patterns, not any single person’s story.
Botox for fissures does not work for everyone. A significant number of people find that their fissure does not heal during the botox window. This is not a failure on anyone’s part. It is a known limitation of the treatment. Understanding what it looks like — and what comes after — helps people move through it with less self-blame and more clarity.
The pattern
The first weeks: waiting and watching
The first two weeks after injection are a period of intense self-monitoring. People track every bowel movement, every sensation, every shift in pain. For those where botox is working, there are usually early signs by days seven to fourteen — reduced spasm, less burning, shorter pain episodes.
For people where botox is not going to work, this period is characterised by an absence of those signs. The pain stays the same. The tightness does not ease. Bowel movements remain as difficult as before. The hardest part is not knowing which group you fall into — botox can take up to two weeks to reach full effect, so even when nothing has changed by day ten, there is still a reason to wait.
When it becomes clear
There is rarely a single moment of realisation. By weeks two to three, if there has been no reduction in pain, no easing of spasm, no change in the quality of bowel movements — the picture becomes clearer.
Some people describe a partial response: the spasm reduced somewhat, but not enough for the fissure to heal. Others describe no change at all. A smaller group report initial improvement that fades — the fissure begins to heal but then stalls or re-tears.
The emotional weight
Treatment failure is emotionally significant. People describe feeling deflated, frustrated, and sometimes ashamed — as though they did something wrong. Common responses include:
- Feeling like a failure, even though treatment response is not within anyone’s control
- Fear that if botox did not work, nothing will
- Frustration with the ongoing impact on daily life
- A sense of being back at square one after weeks of hope
These feelings are normal and widely shared. They are also temporary. Most people who experience botox failure do eventually find resolution through other treatments.
What comes next
Repeat botox
Some surgeons offer a second injection. The first dose may not have been sufficient, or the fissure may need a longer window of reduced spasm to heal. People describe mixed outcomes — some heal on the second attempt, while others find that a second injection makes no meaningful difference. The decision is one to discuss with your surgeon, weighing realistic chances of success against the cost, time, and emotional investment.
Fissurectomy
Some surgeons recommend fissurectomy — removing the chronic fissure tissue — sometimes combined with another round of botox. This addresses the damaged tissue directly while still avoiding permanent changes to the sphincter muscle.
Lateral internal sphincterotomy (LIS)
For people where botox has definitively not worked, LIS is often the next conversation. This surgical procedure permanently reduces sphincter tone by cutting a small portion of the internal sphincter muscle. It has high success rates for chronic fissures but carries a small risk of long-term changes to continence.
People describe the decision to move from botox to LIS as significant but often easier than expected — especially once they speak with others who have been through it.
Continued conservative care
Some people choose to continue with dietary management, topical treatments, and sitz baths rather than pursuing further procedures. This is a valid choice, particularly when symptoms are manageable even if the fissure has not fully healed.
The important thing is that the decision is made with good information and in partnership with a clinician. Botox not working does not mean nothing will work. It means one option has been tried, the result is known, and the next step can be chosen with more clarity than before.