I was diagnosed with an anal fissure. I was prescribed nitroglycerine 0.02%, with stool softeners and fiber Meta-mucil. After two months I was pain free and cured. It was very scary living in pain. As for botox injections they would have to be repeated, not to promising, and as for surgery, it would be worse, because your muscle would be weak and you would soil your underwear. I was extremely lucky that nitroglycerine cured. Now I have to take Meta-Mucil twice a day to stay regular. For those of you who haven't tried nitroglycerine talk to your doctor.