I have been dealing with an AF for the last few months, unfortunately self-misdiagnosed as hemorrhoids, which delayed the treatment. I recently saw a CRD who diagnosed the AF, describing it as being app. 1 cm long and fairly deep. He prescribed Diltiazem and was optimistic about the AF healing over time, which certainly made me feel better given I probably should have seen him about 2 month ago. I try to drink at least 4.5 liters of water a day, along with fine psyllium powder, miralax, and several sitz baths daily.

As with many people, pain is manageable until after a bm, after which it becomes excruciating for 2-3 hours. I have been maxing out on Acetamenophen (4000 mg a day) and Ibuprofen (3200 mg a day,) dividing the maximum dose by 4 and alternating each every 3 hours (basically 1,000 mg of Acetamenophen every 6 hours and 800 mg of Ibuprofen every 6 hours.) I am aware these drugs have side effects, especially if taken for long periods of time, but at this point pain relief is the only concern - I skipped a few yesterday after beginning with Diltiazem and was in intense pain after an afternoon bm for about 4 hours - am not doing that again!

Am speaking to CRD again later today, and was wondering what prescription drugs have others taken for AF pain control besides OTC Acetamenophen and Ibuprofen, what were the side effects, and how successful was the pain relief?

Yikes, you do not want to be taking pain meds like that everyday. Using Ibuprofen gave me an ulcer and I was not taking that much (it wasn't for the fissure). NSAIDs like ibuprofen can cause bleeding or ulcers in the stomach and/or intestines (I had a duodenal ulcer which is when there the stomach and small intestine meet). And too much Acetaminophen causes major liver problems or death. It's intended for minor to moderate pain and fever, not severe pain like an AF. You should really stop taking those.

So what are your options?

There are some OTC ointments or creams that might alleviate your pain which you may have tried. Prep H suppositories don't really help initially with severe pain but can make future BMs smoother to have. Those are more of a proactive approach. Only problem is if you don't know when your next BM is going to be.

There is Rectiv (nitroglycerin) which can help with the fissure pain but it's main side effect are headaches that come on instantly. That stuff is strong! Just touching it with your finger will give you an instant headache!

My go to for fissure pain were hydrocortisone suppositories. Unfortunately the price for them went up from $40 to $400 a few months after I started using them so I stopped getting them and was prescribed the hydrocortisone cream which you have to use on your finger and blindly "aim" for the fissure to apply (or you might find one with an applicator tip). It was better than nothing. Oy, the memories of this stuff! So glad I got the LIS surgery! Hope you won't need to as well but it ended my suffering.

Spoke to my doctor yesterday and he refused to prescribe anything beyond ibuprofen and acetaminophen. My plan now is to take 2x 200 mg ibuprofen and 1x 500 mg acetaminophen every 3 hours as needed. Worst case situation this would be a total of 3200 mg ibuprofen and 4000 mg acetaminophen every 24 hours, which is the maximum dose recommended for adults.

Of course it has possible side effects but right now its pain control that matters, especially after a BM. Am taking diltiazem so hopefully that should begin the healing shortly.