Well, it could be say that I now understand where the phrase, "A pain in the butt," comes from.
In retrospect, I've been dealing with AF for years, but I thought they were hemorrhoids.

Let's start in the summer, when I had a really bad run of constipation due to stress, which caused some pretty bad food choices. I then traveled, and during that time my stomach was so distended, I had to appetite. Fortunately, I bought Citrucel, and began the process of cleaning myself out.

But months later, I'm still struggling. Going through my cabinet there are tubes of: Hydrocortisone 10%, Preparation H, (2 kinds). I also take Citrucel, but somewhat irregularly.

Sept 30: I go to the colorectal surgeon at USC. I am in pain, but like everyone else here, I've managed. Now, it's just not feasible that this will be how I'll spend my life.
He's a bit odd. Like, you don't necessarily shake hands with someone whose fingers are up your arse, so I find him a bit cold. But maybe that's because of his job --I don't know. He gave me an exam, and it turns out that I have AF. He prescribes some ointment to be made at a compounding pharmacy, and asks me to come back in 6 weeks.

October 2: I finally get the ointment. It took 2 days for the compounding pharmacy to make it. I've started taking Citrucel 2x a day, evening and morning.
October 3 - 9 I've been using this ointment, and the area feels raw, sore, and hot. The only thing that brings me relief is sitting on ice packs.
October 9: I wake up feeling really good, not really noticing my bottom. I have a soft stool, and still I feel okay. I decide to take a Sitz bath, and that's when everything just goes to hell.
Is it the position I'm in...am I actually stretching the tissue area to sit for so long, in that position? Should I take a bath? I put the dreaded ointment on, and also put a dab of aloe cream. I go to sit in bed with an ice pack, and answer emails.

I'm lost. I don't know what to do. I feel awful most of the time.

Had a really great night sleep. Last night, before I went to bed, I combined Nupercainal, Diltiazem ointment, and hydrocortisone. Slept with an icepack under my bum.
Woke up this morning feeling okay. Took at long warm bath, to which I added a few drops of essential lavender oil
The moisturized, including the rectal area with almond oil.
I'm not crazy about the Diltiazem ointment. It burns.

Hi, you could switch to nifedipine ointment or nitro ointment. Lots of people have trouble with diltiazem. It can cause some nasty itching too. Also be sure your stool softener doesn't stretch the fissure while it's healing. It's unusual that sitz baths irritate the area. You could try just using a hand held shower to clean off. If ice is helping that's great but cold impedes blood flow to the area and you need that for your fissure to heal. So sorry you're struggling. That pain is the worst. Coconut oil is also very soothing to raw irritated skin. I hope you heal soon. Suzy

Hi,
The ice pack is only for when things get really rough, or if I'm going to be driving. (I live in So Cal, we drive a lot. Also, there is no "cold" season here. So car seats get hot. A disaster for anyone with AF or Hemorrhoids). I have this Relax Wrap, filled with Flax, that goes into the freezer. While it gets cold, it doesn't get freezing. Sometimes, I'll use it at night as I fall asleep. It's always room temp by the time I wake up.

This weekend:
Saturday was terrible. My skin raw and sore from the various creams I was using in an attempt to try to get around what damage the Diltiazem ointment had wrought. So it was an on the sofa day, reflecting on what an utterly bad six months it has been. A death, a friend moving away, work challenges, a case of shingles, and the discovery of this AF. Just a lot of uncertainty and stress. Which reminds me, I need to get back to my yoga, but have to be super careful not to do poses that will stretch or tear.

Anyway, my kit from the Optimal Health Network arrived.
-Coconut Oil
-AF Essential Oils
-Reacted Magnesium
-MSM
-Enema bag
-Super Salve
-A book

I used the Super Salve and had immediate relief. It contains Chaparral Leaf, Echinacea Flower, Hops Flower and Usnea Moss.
Then I made the suppositories out of the coconut oil, and AF Essential Oil, and tossed them in the freezer. Before I went to bed, I put one on a plate for 30 minutes, and then inserted it rectally. WOW. Very effective.
However, because I was also very inflamed and had a terrific itch, I also used Nupercainal on those areas, and took a zyrtec. It worked and I slept like a baby.

I continue with my 2x/ Day citrucel and have added 2 capsules of the Reacted Magnesium and 3 capsules of MSM (for inflammation).
I feel like my system is slowing down, and am afraid of getting constipated. The 2x Citrucel might be too bulky, so I'm hoping the Magnesium takes care of it. Though following the protocol of the Optimal Health network package, I should probably do an enema, though will call my doctor first (though honestly, I wasn't impressed with him. He pretty much dismissed me from the office and sent me packing with that awful Diltiazem ointment).

Today: I feel good, but sluggish, though hopeful because I've found some relief. I'm easing back into my daily yoga routine.
I also have a new favorite cookbook. I've been mainly a vegetable/fruit/lean meats eater for years and this has a great collection of recipes.

So, yesterday I was laying on a sofa feeling awful. While I had taken enough Citrucel fiber, I didn't feel as though I was clearing it though. Hence, lots of pressure on the rectal area. So I took Miralax. About 4 hours later..... relief! And I didn't feel any pain.
I went to bed feeling okay, all I had to use was a little bit of the Super Salve and some cream with aloe vera.

This morning, I decided to take Citrucel. Ow! I think it's mildly irritating to my bum. Used my usual treatments, and as long as I didn't sit down for long, I was fine. Sitting is a real problem, fortunately, I have a standing cart which I can use for work. Tonight, will follow up with Miralax. I really want to heal.

Hi Daisy,
You say a hot car seat is a disaster for AF or hemmies, but my experience has been quite different. My hot water bottle saved my bacon. I sat on it for hours every day, nuking it now and again to re-heat. I found a medium-hot bottle extremely soothing AND healing because it promotes blood-flow (as Suzy says).
I'm almost all the way better now - have to take care, but I'm totally pain free almost all the time.

The interior of my car, on a hot California day easily reaches over 120. You can sit on it, but I won't. It's not that "soothing warmth" of a hot water bottle. It's scorching and you can actually burn yourself. And there's a huge difference between a blazing car seat and a hot water bottle. I'm very tired of discussing this with you.