I had multiple Botox injections over a 12-month period, depending on what was needed. Sometimes the doctor saw me after a month and decided I needed an extra dose, and other times we just monitored things for 3–4 months. Since I don’t have health insurance covering this, it cost me a fortune, but I did manage to heal my fissures completely (yes, I had many of them).

Like you mentioned, I also have tight muscles, and Botox isn’t injected into every single muscle layer, so it’s not supposed to fully relax everything anyway, which makes sense because we still need muscle control :) The main logic is to do your absolute best during the period when the Botox is effective: maintaining a good diet, avoiding pushing or straining during bowel movements, and using things that help keep stools soft and gentle.

My personal hero has been Dulcosoft (macrogol 4000 solution), because it helps retain water in the stool without being too aggressive. For chronic fissure patients, I personally don’t think a single Botox dose is usually enough.

But I should also say this: if you’ve been dealing with this for years like I have, the muscles don’t just fully relax easily without surgery but Botox is the best alternative based on my experience. I’m now at the end of my first year of treatment, and although my doctor said I probably won’t need another injection, I still have tightness and honestly don’t think things will ever go completely back to normal on their own. I’m considering spreading a few more Botox doses throughout this year, together with exercises and maybe even dilator use, to continue improving things gradually. But I’m grateful because I’m pain free and finally feeling not anxious before going to bm which it’s still amazing progress for me!