I've posted bits and pieces of this in other topics, but I thought I'd put it all in one place.
I started this journey in May (on my 50th birthday!) with a nice fat hemorrhoid. It was uncomfortable, but within a few days had transitioned to an internal pain. I saw a doctor who told me I had an anal fissure, and prescribed nifedipine and lidocaine. Neither drug seemed to do anything for me, and I quickly gave up the lidocaine. I continued the nifedipine though, since I hoped that eventually it would contribute to healing.
The pain got worse and worse. I don't have to tell you about my painful shuffling around, squirming in my chair, desperate nights.
I saw a colorectal nurse in June, who gave me lots of info about diet and keeping hydrated. She prescribed lidocaine + prilocaine, and told me to keep going with nifedipine. Again the topical pain ointment made no difference, and I gave it up. I spent a lot of time working out what to eat, what fibre supplements to use, and I discovered kondremul, a mineral oil stool softener which helped me a lot. I also sat on a hot water bottle when ever I could. I was having one or two really awful nights per week, and every morning, desperate pain when I walked.
I saw her again in July, and she said I had made no progress. She prescribed diltiazem. The diltiazem seemed to help the pain. Either that, or the results of several weeks of soft BMs, had reduced the pain considerably. I was drinking vast amounts of water, and eating lots of healthy food, taking fibre and mineral oil. However, after about 3 weeks I developed a sensitivity to diltiazem which started with a wet itchy anus which spread to a rash over almost my whole body in the course of 4 days, and which took nearly a week to clear up.
I saw the CR nurse again in August. She said I still had the fissure. She prescribed nitro, warning me about headaches. I have taken the nitro very carefully indeed. Tiny amounts, gradually increasing to see where my tolerance lies. I use more at night, since I can deal with the head effects better then. Either the nitro or the now >2 months of soft BMs have really reduced the pain. I am no longer swallowing handfuls of ibuprofen. In fact, I have not taken ibuprofen for several days. I still have pain in the mornings when I walk, but instead of feeling like a stick poked up my bottom, it just feels like a very external pain. Stingy, a bit burny, but nowhere near the pain it used to be, and was, even with lots of ibuprofen. Life is loads better. I've been on the nitro for a week, and I'm pretty happy. The relief started before the nitro though, so no doubt there are several factors at work.
I see a CRS on Sept 26th, to decide about LIS or botox. I'm hopeful at the moment that I'll be healed by then. Wish me luck!

Indeed we wish you good luck Scientist2516
We sure do hope that you will not have to go the botox or LIS route come 9/26.
You sound a bit unsure as to if the Dilt or Nitro or the soft bm lessened your early morning "stick poked up your bottom" feeling.
That feeling may be due to your high resting pressure of your sphincter muscles or that you are in spasm. Either way perhaps the Dilt and Nitro did play a role in decreasing those feelings.
Have you ever noticed these feeling of tightness and or spasming before Dilt or Nitro even with a soft bm?
Anyways, looks like your in good hands with your current regime and practices, keep it going.
Again on your upcoming visit with CRS.

You are right, Buttastic (great name). I don't know what has helped most, drugs or learning how to manage diet and get soft BMs. Probably both.
I had the worst spasms while still on Nifedipine. Once I switched to Dilt, I only had spasms a few times. Really, I've only had about 2 or 3 bad nights since starting the dilt. One was probably from making my hot water bottle TOO hot, stupid me.
I just started using the finger support method when I poop, after reading about it here: http://anal-fissure.org/t6671-new-toilet-seat-heals-posterior-fissures
We sill see if that helps.
Things are better. I still have pain walking in the mornings, but by the afternoon, no more pain. I even ran upstairs taking the steps two-at-a-time yesterday. I wasn't thinking. Afterwards I thought "did I really just do that?". But nothing bad happened!

I did my usual 1 mile walk to work today - NO PAIN!
I can still feel a little something "not quite right", but no pain, no spasms, not even discomfort.
The regimen at the moment is nitro twice a day, soft BMs and using my hand to support my anus during a poo. Sometimes I'll sit on a hot water bottle for half an hour. I used to do that for pain, but now I'm only doing it for heat therapy to increase blood flow to the area.

Hay Scientist2516, your story sounds so familiar,, because you are sooo healling..yay!

For my own satisfaction, wanting to have the whole story here, I'm copying my lost posts back into this thread.

2013-09-09, 03:22
The pain has been on-and-off. Sometimes I have to take ibuprofen, sometimes I'm fine.

I read a scientific article that showed that heat applied to the buttocks measurably reduces anal pressure. It also showed that anal pressure is much higher in people with hemms and fissures than healthy people.
So I've gone back to sitting on a hot water bottle as much as I can.

Today I didn't have enough time for my BM, so didn't evacuate it all. By the evening it was big and somewhat hard. The first hard BM I've had for weeks and weeks, and it did not want to come out! So I tried squatting! And it really works! I did not have to strain at all - just wait.
It still hurt a bit, and I'm a little worried that the spasms might start up (they usually take an hour to get going). So - ibuprofen and hot water bottle for me this evening.

2013-09-09, 16:44
I'm feeling a bit sore today. I'm trying to look on it as positive. The big BM stretched my anus, but I'm not getting spasms, so that means my anus is healing, but is getting too narrow, and it's good that it stretched. Right? Right!

2013-09-11, 05:12
I put another chunk of coconut oil in this = morning, but this time it didn't seem to help at all. Maybe the chunk was too big and hurt a bit.
Sigh. There is so much learning to do with this condition. What works, what doesn't.

2013-09-10, 17:12
Still a lot of pain. Quite sore all the time, and walking is painful again.
Used coconut oil last night and this morning, but this morning it didn't seem to help at all.
Feeling a bit low.

2013-09-14, 06:33
Today I was bustling around, making dinner, throwing balls for the dog etc, and suddenly I said to my husband "I feel so well. I feel like my old self." It's true.

2013-09-16, 20:58
Slight set-back on Sunday, probably from doing too much. I went dancing on Friday night, which felt WONDERFUL. Sunday I decided to do some housework. Sweeping, laundry, tidying up. Some bending over, some squatting down. Oops, after a while I noticed that nasty little feeling in the bum, and had to retreat to the sofa with my hot water bottle YET AGAIN.
Then on Sunday night I thought I had to poo, but nothing happened so I squatted on the toilet, thinking "this will do it" but instead, nothing but stretching and stinging. I went to bed with the hot water bottle, my bum feeling sore and stinging, terrified the spasms would start (they didn't) and really worried about my morning BM being big and hard.
However, although the morning BM was rather dry and hard, it wasn't too big, and didn't hurt much. I was using my fingers to support the anus, which probably helped. Also, I swear it helps to get all the poo out, I don't know why.
I feel fine now.
So much fear and worry. It's almost worse than the pain these days.

I feel so well now. I have had no pain today, none at all. My family went for a hike in the woods, and I enjoyed every minute. I did some laundry, we washed the cars, I was as active as I've always been, and feel totally fine.

I have my appointment with the CRS on Thursday, and really think he will say I'm healed. The one thing I still have is a little lump that feels tender when I put the nitro on. I think it's a little hemorrhoid, and it does bother me occasionally.

Words cannot express the relief and joy I feel. I know I'll have to be careful, perhaps for the rest of my life. I could get a re-tear. I could be prone to hemmies for ever. But for now, it's just so wonderful to feel like my old self, to "get my life back" as so many people here have wished for, that I can leave the future to take care of itself.

Thanks SO MUCH to everyone here that's been supportive, helpful and generally wonderful. I'll be around, I'm not leaving. I'll update you on what the CRS says. I just want to say thank you while I'm feeling thankful. Also, if anyone wants help reading papers, interpreting clinical trials, whatever, I'm very willing to help out as best I can. I'm keen to give back to this wonderful forum, and hope my scientific training can be of use to you.

I saw the CRS today, and YAY, it's good news! He said I'm nearly healed. That I will be able to heal completely, on my own and that there is no need for surgery. He said, keep using the nitro until I've had no pain for 4 weeks. So I'll have to keep a record, otherwise I won't remember when I last had pain. He said a big BM or too many BMs will make me sore for a while (which they do), but not to worry, healing progresses and regresses, but as long as I'm moving forward it's OK.

He confirmed that I have got a hemmie that must be the source of the burning pain I have sometimes when walking. I really don't care that much. If the fissure is healing, I can live with the hemmie.

So time to celebrate! Once again, I am so thankful to have found this forum and the wonderful people here.

Yay good news!!!! I am so happy for you!!!

Awesome news, Scientist! I'm so happy to hear you're almost healed! Keep up the great work. :)