Hi folks-
Just joined up recently, I was too frustrated and felt like I had nothing to add except maybe complaining about the pain, which has been awful for about 4 months, until today. If you find my intro post you will see I have been through quite a few different web/home/folk remedies with little or no success and often they made things worse.
I know things are better today because every morning I wake up in pain, and this morning I was pain free, for the first time in 4 months. Will I backslide? Will I have a setback? Is this a fluke? Maybe, I'm willing to accept the possibility. But I am hopeful and will update this post as I go. Ok I am sure you are thinking "get on with it, spill please". So here's what I did.
In a word: Dilate.
Dilate, dilate, dilate.
I've been self-dilating for a few days now, and experienced instant relief as soon as I stared. A few days later I'm doing absolutely fantastic by comparison.
So I start by applying Diltiazem to the area, which loosens everything up and works great for that purpose. Since it is a compounded with Surgilube, it works great as a lube too. It doesn't take a lot, and I understand if you use too much it has side effects but I haven't had any to my knowledge. I use a pea-sized amount on the area, then the same all over my finger. I started with my finger because the area is so sensitive you have to have really good aim to not aggravate things. I figured out since my fissure is posterior (like most as I understand it), I could sort of 'hook in', pushing gently towards the front to open things up. I got good enough at it to where I could avoid touching the fissure at all. trim your nails and round them off if that wasn't obvious.
So once I'm in, I just stay that way as long as I can take it, which wasn't very long at all at first, maybe 10 seconds or so. It still helped, even that little bit. I felt looser, more relaxed, and a tiny bit less pain. After a few days with the finger, getting up to a minute or two, I felt like the relief was still there but it had plateaued at a certain point, and not good enough.
So online there are a number of choices for stuff to buy to help you with this, but I though most of these were too expensive because they came in sets of 4 or 5. I'm trying to heal, not get ready for a date with a porn star... I went to a local "marital aids" store, got my wife (she was pretty cool about this) to pretend we were there for her. I got to look closely at the products and make sure I was getting the right one for me. Better than taking the risk online IMHO. Anyway I picked out a winner- It's called the "Silicone Tee Probe, the 4 1/2 inch model. Clear silicone, no weird seams to scrape the inside, soft enough to not hurt, and not too long. It stretches the inner and outer muscles evenly and gently without the big "bulb" you see on some butt plugs. I would highly recommend this one to anyone. I feel better without feeling violated, and I haven't had any issues with incontinence whatsoever.
So that was yesterday. I dilated with 2 different times yesterday, I just added it to my regimen of hot showers and Diltiazem. I was pain free all night, up late, sitting at my computer. I haven't been able to do that in a long time. Today, like I said, I woke up pain free for the first time ever in 4 straight months. I went ahead and dilated anyway, and it was just barely uncomfortable, stayed in for 2-3 minutes at least. This really is making me a believer in dilation, but I am patient, we will see.
I will keep you updated if you are interested.
Some thoughts:
Using your finger sucks, but I wouldn't recommend going straight to a toy/trainer until you have "felt it out" and made sure you can get in without hurting yourself worse.
A lube covered finger is a very gentle way to "scrub" (I use that term lightly) the AF once you are in, it can feel really good and get the residual yuck out of there. Your finger will come out gross, and I hated that part every time but got over it. If I hadn't done it all that crap would have stayed up there irritating me all day (this could be some of the relief dilation provides besides the relaxed muscles), and you can wash your finger a LOT harder than you can wash your butt.
If you are hesitating because it's gross, get over it or buy some finger cots.
If you are hesitating because it's humiliating, get over it you will get relief from this, maybe relief you haven't felt in forever.
My Regimen (starting January 2013):
Breakfast:
Warm water 20 oz (makes you BM)
Banana
Apple
gluten free cereal, almond milk
Lunch:
20 oz water
Lean meat sandwich
Gluten free bread
NO CHEESE
Celery
Apple
Peanut Butter (not much)
Dinner:
20 oz water
Lean meat 4-6 oz (mostly fish)
Half steamed green veggies (a big pile, at least twice as much as the meat). A little tiny bit of butter (I'm human for crying out loud) and a little lemon juice go a long way when eating large piles of vegetables.
NO STARCH or a little bit of steamed rice.
Dessert:
Go with sorbet or some other mostly-fruit not much sugar solution.
Avoid (as much as possible): Gluten, Dairy, starches, carbs, chips, all the stuff you probably love that probably gave you the fissure in the first place (talking to myself here).
If this diet sounds hard to maintain it is but I am not hungry and I have dropped about 8 pounds this year and down from 37 to 33 inch waist. And I occasionally cheat and eat a slice of pizza here and there or an ice cream sandwich. Go to far off course and you will pay for it in the morning though...
2-3x daily
Tramadol, Advil (with 20 oz water)
Before bed/after dinner (instead of chips and ice cream people). Nightly "safe bm in the morning" cocktail:
2 Senna, 3 Colace, 3 Citrucel washed down with a glass of miralax.
Post BM and/or 3x daily:
Hot Shower+Diltiazem+Dilate=Relief.
Please let me know if you have any success based on mine! Good luck healing folks...

Glad to hear that dilation is working for you too. It is amazing that more doctors do not recommend it, especially as the scar tissue from constant tearing and healing of an anal fissure can sometimes lead to stenosis. It has changed my life.
I started off with dilators that start at a very small size (started at 9mm) and am at 15mm now. These are medical dilators, made especially for the purpose. For lubrication I use Sliquid Organics (the thickest they have, which is for anal use) buying it from their own site. it has Vitamin E, among other things in it and is very good.
Good luck! Long may the pain decrease!

Thanks for sharing your regimen, which is very similar to what I've been doing for some time and can also highly recommend home dilation.
The only other suggestion I have is that I use a gloved finger. actually, I buy a big box of medical gloves and cut the fingers off, which gives me four usable finger gloves for my index finger. It prevents any possibility of a fingernail or hangnail causing any trauma and also provides a slick surface for your finger to easily enter.
Please do keep us posted on how things go for you!

Jr2- I never thought I'd be saying something like "Yes jamming something up my butt is a wonderful lifesaver" but wow, I'm healing naturally, the way I'd prefer to.
So yesterday I had a BM, shower, Diltiazem, Dilation session. The pain lasted only an hour or 2 at the most, and not nearly as intense. The pain from BM was lasting literally 12-15 hours before dilation. I am sitting here at my desk today 15 MINUTES after a BM. Seriously.
I hope people are reading this I had NO HOPE of healing before 5 or 6 days ago. IT'S A MIRACLE. I feel like writing a book.
If you aren't dilating, you are in needless pain that could be gone in a few minutes. I just can't recommend it enough. I'm taking my daughter swimming today, never would have happened without dilation.

butthurt2013 now that my fissure is better, no pain, just minor irritation some times, I am contemplating dilation also, I can tell that my anal muscle has relaxed enough since the fissure is healing and my skin tag is also receding substantially and that was one of the most sensitive area when the fissure was fresh.

I was thinking about dilation in a few months if my fissure continues to heal. It's just scary though. I would be pissed if dilation tore fissure

With all due respect Dela and Marg, I think you should start sooner than later. I was in agonizing pain right when I started dilating, it was post bm and everything was on swollen and fire like usual, I was desperate. Don't wait until you are desperate...Dilation is what started the process of healing for me, not the other way around.
It might hurt a little the first few times (nothing like the pain you have already been going through) and then it doesn't hurt at all after that. It provided me with instant relief the very first time, and it seems the more I do it the less pain I have.
I had almost NO pain all day today after doing what I explain above post bm, I might sleep on my back tonight for the first time in months.
Obviously I'm no doctor, but if it works for you like it is working for me you could be pain free in 4 or 5 days!

Slept on my back, 90% pain free this morning post- BM/Diltiazem/dilation.
Dilation is a miracle. All that's left is the fissure, the hems have cleared (the big external ones slid back in after the 2nd or 3rd dilation and have NOT popped back out). Without the hems or the internal sphincter pressing on the fissure, It barely hurts.

Crs barely spread my cheeks open a couple weeks ago and it made my fissure bleed. I don't dare do dilation yet. That's awesome that its working for you! I'm actually doing pretty good since I started miralax over a month ago. No pain during bm. Just a little pain after bm for a while, especially when sitting. Pain is like a 3 or less and its kinda random.
I don't have hemroids.

You are lucky not to have hems. They make everything worse, if they go external, they take up valuable real estate in a very crowded neighborhood and the residents get angry, if you take my meaning. It sounds like your fissure is way worse than mine. Mine never ever bled, even post probing by multiple docs. The pain was an 11 or 111 for all I care, but once I got the finger up there the very first time, I could feel the tight muscle and where to push to loosen it. Loosening it made the pain more like a 2 or 3 which was heaven by comparison. The tight muscle was preventing the fissure from healing in my case essentially tearing it open after every bm, I can feel a big difference now.
Maybe you could try a pinkie with a well-lubed finger cot once you're brave enough. Hot shower first to make sure it gets soft. Diltiazem on the area 5-10 minutes before if you have it. I use diltiazem and astroglide together on my dilator for maximum comfort.
I wish you well in your recovery.