What this experience covers
This experience describes what people go through when their surgeon combines botox injection with fissurectomy — and sometimes sentinel skin tag removal — for a chronic anal fissure. It is a composite drawn from many anonymised accounts, capturing common patterns rather than any single person’s story.
The combined approach addresses two problems at once. The fissurectomy removes damaged, non-healing tissue. The botox relaxes the internal sphincter so the new wound has the best conditions to heal. When a sentinel skin tag is also removed, the same recovery principles apply.
Understanding what the combined recovery involves — particularly how it differs from botox alone — helps set realistic expectations.
Why combined procedures are sometimes recommended
A chronic fissure often involves two things working against healing. The tissue itself has become scarred and fibrotic. It has lost its capacity to heal through conservative measures. At the same time, the internal sphincter is in chronic spasm, restricting blood flow to the area.
Fissurectomy addresses the tissue problem. Botox addresses the spasm. Done together, they give the fresh wound both a clean starting point and the relaxed, well-perfused environment it needs.
People describe this logic as reassuring. Two causes, two targeted treatments, one procedure. And unlike lateral internal sphincterotomy, the sphincter muscle is not permanently cut.
What the procedure involves
The combined procedure is typically a day case under general or spinal anaesthesia. It takes 20 to 40 minutes. The fissurectomy removes the chronic fissure tissue, sentinel skin tag if present, and any hypertrophied papilla. The wound is left open to heal from the bottom up. The botox is injected into the internal sphincter during the same session.
Most people go home the same day. The sharp fissure pain they have been living with is often already different — replaced by the duller ache of a surgical wound.
How recovery differs from botox alone
This is where expectations matter most. Botox alone involves no wound. Recovery is measured in days. The combined procedure involves an open surgical wound that takes weeks to heal.
People who expected a botox-like recovery describe feeling unprepared for the wound care, the soreness, and the longer timeline. Those who understood the difference beforehand navigated it with less anxiety.
The key difference: botox alone means waiting for the injection to take effect. The combined procedure means managing a healing wound while the botox supports that healing.
The recovery timeline
Days 1 to 3. The wound is sore and raw. Pain medication is typically needed. The botox has been injected but has not reached full effect yet. Sitz baths provide significant relief. The first bowel movement is uncomfortable but usually manageable with soft stools.
Weeks 1 to 2. The botox reaches full effect. The sphincter relaxes noticeably. Pain decreases as the muscle stops fighting the wound. This is the most intensive period for wound care — sitz baths three to four times daily, careful attention to stool softness.
Weeks 2 to 6. The wound gradually fills in from the bottom. Pain continues to decrease. Activity levels increase. Bowel movements become routine rather than dreaded. The wound looks better each week. Most people return to normal daily activities during this period.
Beyond week 6. The wound closes fully for most people. The botox effect begins to wear off and the sphincter returns to normal tone. Gas control normalises. The chronic fissure pain does not return.
When to contact your doctor
Reach out to your surgical team if you experience any of the following after a combined fissurectomy and botox procedure:
- Bleeding that is heavy or increasing beyond what was described as expected
- Pain that is escalating rather than gradually improving after the first week
- Signs of infection at the wound site — increasing redness, swelling, unusual discharge, or fever
- Concerns about how the wound looks or feels — anything that does not match what you were told to expect
- Difficulty with bowel or gas control beyond minor temporary changes
If you experience significant bleeding that will not stop, fever, or sudden severe pain, seek urgent medical attention.