I'm a 40 year old male from Australia. I promised myself I would post my advice on this website if I ever got free of my AF, so here goes...

After a bad bout of diarrhoea on holiday I developed an AF 4 years ago. After much ongoing pain and misdiagnosis, then research, trial and error on my part (and finding a great CRS) this is what I found. This is based on my experiences, I don't have any medical training.

An AF is a tear in the anal canal, that is problematic because (a) healing is difficult since the blood supply to this area is poor, especially the back-midline which I think is where most AFs occur and (b) you obviously need to use the area regularly to pass waste, injured or not, and can't take it Out Of Service while it heals.

My AF felt like a tiny, red hot razor blade cutting into the exact same spot and varied from no pain at all (for a brief, wondrous time when I awoke, before I stood up) to severe (when the bowel was full or soon after emptying and when sitting on hard surfaces).

I think the two key things that need to be addressed to heal an AF are:

(a) Don't re-tear it! It took me a long time to work out that red meat was the culprit here, specifically steak or lumps of meat that can't be chewed right down to a fine paste. This depends on how good your teeth are and what meat you eat but my advice is don't eat red meat at all (or at least any meat that you can't chew very finely before swallowing). If you're not sure, don't risk it: play it safe. If you re-tear you start the healing process from the beginning again. The more chronic it gets the longer it will take to heal. Anything that promotes regular, gentle bowel motions is helpful, by which I mean lots of fibre and water. Also, don't strain or push during your bowels motions, let things happen at their own pace. For some reason, bending forward, raising your feet a bit and taking deep breaths seem to help things - I don't know why.

(b) Get blood flow to the area to promote healing. This best way to do this is use 2% diltiazem paste, prepared by a compounding chemist (this is a prescription drug in Australia). This is applied topically to the AF and dilates the blood vessels in the area which allows more bloodflow and encourages healing. It apparently works for 4 hours at a time, so in theory you could use it every 4 hours, but I found once in the morning and once before bed works fine. Note: initially it makes the pain worse, maybe because of the increased bloodflow it produces, but it quickly helps the situation if you keep at it. I tried Glyceryl trinitrate too, but this wasn't as effective and caused headaches, so I recommend diltiazem.

Lastly, the healing process is SLOW and unpredictable. Keep at it, follow the rules and don't get complacent and eat a big steak or you may end up back where you started again. When you think you're cured, WAIT and play it safe. Continue watching what you eat until you're 3 - 6 months without AF pain just be safe, the last thing you want is a re-tear.

As far as exercise goes, I think anything that promotes bloodflow is probably useful, just avoid straining and also no cycling or anything that puts pressure on the area.

That's my advice, I hope it helps at least one person to avoid the hell I endured for 2+ years!

Good luck, stay positive. To borrow from Forrest Gump: "And That's All I Have To Say About That."

Thank you very much for sharing you story. In most cases you suggestions indeed works and fissure should heal by its own.