What this experience covers
This experience is about the decision between botox and lateral internal sphincterotomy (LIS) for a chronic anal fissure. It is not a recommendation. It is a composite drawn from many anonymised accounts of people who faced this choice — what they considered, what they tried, what happened, and how they made sense of it afterward.
For many people with a chronic fissure, this decision is one of the hardest parts of the entire experience. Not the pain. Not the procedures themselves. The choosing. Both options carry real trade-offs. Neither is guaranteed. And the decision often has to be made while someone is exhausted, anxious, and in daily pain.
Understanding how other people navigated this choice does not make it easier. But it can make it less lonely.
The pattern
Why this decision is so difficult
The difficulty is not about information. Most people can find the success rates and risk profiles. The difficulty is about what those numbers mean for one specific person, one specific body, and one specific life.
Botox is less invasive. No permanent changes. But it is temporary, and it does not work for everyone. LIS has a higher success rate. It is a more definitive solution. But it is surgery, and it carries a small risk of continence change that feels enormous when it is your body being discussed.
People describe going back and forth for weeks or months. They read everything. They ask their surgeon the same questions in different ways. They search for someone whose situation matches theirs exactly, hoping the answer will become obvious.
It rarely does.
The case for trying botox first
Many people — and many surgeons — favour trying botox before considering surgery. The reasoning is straightforward. Botox is less invasive. It involves no permanent alteration to the sphincter muscle. If it works, the fissure heals and surgery is avoided entirely. If it does not work, the option of LIS remains available.
People who chose this path describe it as a way to buy information. They learned how their body responded. They gave themselves time. And for the subset of people whose fissures healed with botox, the decision to try it first was clearly the right one.
The trade-off is time. Botox takes weeks to show its full effect. If it does not work, those weeks may feel wasted — especially for someone who has already been suffering for months.
The case for going straight to LIS
A smaller but significant number of people describe wishing they had skipped botox and gone directly to surgery. Their reasoning: by the time botox is being discussed, the fissure is clearly chronic. Conservative measures have failed. The success rate of LIS is meaningfully higher than botox. Why add another step with a lower chance of working?
People who feel this way tend to emphasise the cumulative cost of the fissure — the months of pain, the restricted diet, the anxiety around every bowel movement. Each additional treatment that does not resolve it extends that suffering.
Some surgeons share this view. Others strongly prefer a stepwise approach. The medical community itself does not fully agree, which makes the decision harder for the person living with it.
When botox did not work
For people who tried botox and did not get a lasting result, the emotional setback is significant. They went through the procedure, the waiting, the hoping — and the fissure persisted or returned.
What happens next varies. Some people try a second botox injection. Others pivot to discussing surgery. The transition from failed botox to considering LIS is often described as a turning point. The fear of surgery is still there, but it is now weighed against the known reality that a less invasive approach did not work.
One thing people consistently note: botox failure does not predict LIS failure. The mechanisms are different. Botox temporarily relaxes the muscle; LIS permanently reduces its tone. Many people who did not respond to botox went on to heal completely with LIS.
What people describe about LIS after failed botox
The most common description is contrast. People who endured months of chronic fissure pain, tried botox without success, and then had LIS describe the relief as striking. Not instant — the surgical recovery has its own discomfort. But the absence of the chronic fissure pain is noticed early and it deepens as healing progresses.
The regret, where it exists, is almost always about timing. Not about having tried botox — most people do not regret giving it a chance. The regret is about the months spent deliberating before and after botox, while the fissure continued.
What comes next
The full version of this experience covers the decision framework people describe — the specific questions they asked, the factors they weighed, and the practical steps they took to prepare for the conversation with their surgeon. It also addresses the contradictions: the ways in which people’s experiences genuinely differ, and why there is no single right answer to this decision.
If you are currently weighing this choice, reading about how others navigated it may help you organise your own thinking. It is not a substitute for the conversation with your surgeon — but it can help you arrive at that conversation with clearer questions and a better sense of what matters to you.