Doctor blamed me for surgery after a month of agony

Hi, I (23M) had an open external hemorrhoidectomy on Dec 10, 2025. I need help deciding my next step.

Background: My recovery was going well until a large stool Dec 24, 2025. Since then my life has been hell, with debilitating pain for hours after a bowel movement. My doctor (CRS specialist) who performed the surgery prescribed me Diltiazem, which I have been applying 3x a day since Dec 31, 2025. I have been religious with my psyllium husk and miralax, producing soft stools every day. Despite this, BMs are hell, and the past ten days post-BM hours have gotten worse, leading multi-hour episode of 10/10 pain that I almost went to the ER for a few days ago.

I finally saw my doctor today for the pre-schedule surgery follow up. He examined me externally and said I have an anterior midline fissure, and posterolateral wound that hasn't healed from the surgery. He said something along the lines of 'this is why I said we should work on your internal hemorrhoids instead of doing external'. I was taken aback because I did not remember this recommendation to begin with, and I remember him recommending the external hemorrhoidectomy based on my profile (gay male who engages in receptive anal intercourse, internal hems not as bothersome as the external hems). He also seemed to be somewhat uncomfortable and almost condescending talking about my sexual practices.

Going back in time, I obviously would have never had the surgery if I knew it lead to this. Regardless, he laid out the 3 options I have since diltiazem doesn't seem to be working: switch to Nitroglycerin 0.4% for 4-6 weeks, Botox, or LIS. He offered no recommendation which I should choose besides outlining the success rates and risk.

What he outlined seemed different than the impression I got from the subreddit. (This is supposed to be the most prestigious medical group in a top 10 pop. USA city btw, so do tend to trust his expertise).

According to him:

Nitroglycerin 0.4%: 60% chance success (essentially a more potent diltiazem, possible headache and dizziness)
Botox: 60% chance success, 10% temporary incontinence, 6 months wait if it fails and I want to escalate to LIS
LIS: 90% chance success, 10-20% chance lifelong incontinence even for a 23M. (Says he rarely has had to preform this. And I thought the incontinence risk was more for women and older people?)

For now I chose the nitroglycerin. I asked about compounding it with other ingredients but he seemed to think it wouldn't help. I am wondering if this was the right decision, if nitroglycerin will work when diltiazem hasn't. But, I am also more put off by Botox and LIS than I was going into the appointment due to the chances of side effects he mentioned, especially given my hopes to return to my sexual practices eventually and as soon as is safe. I am thinking about seeking a second opinion from a different doctor.

I would really appreciate advice on what I should do.

TL;DR: External hemorrhoidectomy recovery went wrong, in agonizing pain for 4.5 weeks so far. Tried diltiazem and will probably switch to nitroglycerin for the next 4-6wk. Concerned about Botox and LIS due to side effects and receptive anal sexual practices. Seeking advice.