my third relapse of anal fissure

Hello all,

At two different times - in 2014 and 2020 - I had LIS and the fissures got healed with success. Until two weeks ago everything was wonderful but one day I stupidly decided to quit smoking and that decision led to me having constipation, which has in the end caused a completely new fissure to develop yet again.

Through first week I tried to do everything that I know are helpful but after seeing I ended up with no success in getting the fissure to heal, I directly went to see the doc who performed my last op and he told me he cannot let me have a third surgery, instead he could do botox injections to paralyze my internal sphincter muscle. More than a week has passed since I got botox injected but the injection does still not seem to have started doing its job as my sphincter muscle has been in spasm contantly for days. After BMs in the mornings I apply GTN ointment in my bottom following sitz baths but what kind of muscle is that ? It does not even show any sign of relaxation. This is so frustrating to see because I know if that muscle is in spasm the fissure cannot heal and so long as it can't heal it will get a bit more torn in every single bm.

I don't want to be left with no other option but to wait around by hoping the botox will prevent the muscle from going into spasm. That is why, I would like to ask all of you please tell me what I should do to relax my muscle.

Thanks.

Umut

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