So I've read all of the info about stool softeners, fiber and laxatives helping on the HARDNESS of stools, which of course makes total sense...however, I've not seen anyone broach this subject which to me is as equally an issue (apologies if this is posted somewhere else, I am new and did not find the subject).

That is, the overall DIAMETER of Stools - while my stools are SOFT (I think, I don't actually touch them) due to the steps above, it seems that when the diameter is large, and after going on fiber and Metamucil they are larger, it hurts as much or more than a hard stool. In fact, the larger diameter makes it feel as though the fissure is tearing open again and again, and then comes the bloody stools and tissues on top of the pain.

I work all day in an office with people reporting to me, so taking additional supplements that create a "Diarrhea" situation is not practical. Anyone have advice on STOOL DIAMETER REDUCER and not just "Softener???"

I think finding the right balance of foods and supplements is what you need for the right consistency, diameter, and number of BMs. Unfortunately, it's trial and error. I never took actual softeners. I relied on 150mg magnesium citrate 2x/day, 500mg vitamin C, drinking about 90+ oz water, and eating about 30g fiber from food each day. Some of the best foods for me are an oat bran porridge, sweet potatoes, pecans, salads, watermelon, rice and quinoa, cucumbers, and hummus. Once I'd healed enough that BMs weren't excruciating, I added a tiny amount of metamucil at lunch and dinner. This helped bulk up my stool enough that everything moved through nicely and cleanup was really easy. I found that having too soft stool was just as bad as too hard, just for different reasons.

Interesting! I have a follow-up based on your experience - my CRS told me to start taking Metamucil daily, along with more fiber, warm baths and the compound gel that works miracles...ever since I've gone on the Metamucil, that's when I noticed the much wider girth of my BMs. You are saying you added it back in AFTER the pain subsided, but he had me start in the middle of my agony. Are you saying Metamucil adds bulk to the stools? If so, I may drop it and find a pill stool softener.

Metamucil will definitely bulk up your stool. Many on here, myself included avoid the bulking fiber and go for stool softeners like PEG 3350 (aka Miralax, Movicol, Restoralax...). This forum can give you so much better info than Doctors a lot of the time.

As mmklinemm says, different foods work for different people. When I first got my fissure I was advised by doctor to increase fibre and take lactulose stool softener.

This produced soft but large stools which were painful to pass due to the stretching.
After months of this and taking large amounts of lactulose whilst eating less and less I was referred to a dietician who introduced me to low residue/low fibre foods. I changed to Laxido as a stool softener and life became much easier. I now have loose stools with no bulk to them at all and have managed to stop losing weight.

I would not recommend this diet long term as it is high in refined White flour and sugar (I eat lots of croissants, cake, biscuits, ice cream, some cheese and eggs etc)

If I ate the foods that mmklinemm has on their list I would be in trouble so you can see we are all different and experimentation can be required. I would try mixing some fibre and some low fibre foods and see what works for you :)

Best of luck with it :)

Forgot to say, I am vegetarian and you can also eat lots of fish on a low residue diet - but that's not an option for me.

You can eat some fruit and veg if it's well cooked with no skin but I found I was still a bit sensitive to it so don't risk that often

Yes, metamucil adds bulk. Search on here for info about insoluble vs. soluble fiber. Benefiber is another brand of fiber, but it doesn't add bulk. Doctors always say, "Add more fiber." But really, men need about 35g/day and women need about 30g/day. I chose to get mine all from food rather than supplements. My stools were soft, but small. I started to worry about stenosis and not being able to pass larger more normal stools. That's why I added metamucil. It helped me so much! My stools became larger and more formed, but not painful. The best part is that they pass so cleanly. Clean up is so much easier and less irritating. I hope this helps you!!

As with many on here, my individual situation is more complex when it comes to diet. My fissure actually resulted from a large, hard stool (I still shudder from the pain) following a lithotripsy procedure for kidney stones as I am and have been a recurrent stone former for 25 years...and am now an expert in that area, but that's a discussion for another day and board. My Urologist has been trying to control my stone formation for years, and I try to avoid excess sodium and anything with oxalate as my stones are calcium-oxalate. Wouldn't you know, foods high in fiber are typically high in oxalate, so not a good option for me to get it from food. Since I produce excess calcium, I take prescribed allopurinol, indapimide, & potassium citrate, plus OTC calcitrate pills everyday to prevent stone formation.

I guess you could say that with the fissure, I now have it coming and going! That said, I am concerned about these pills contributing to the fissure, but I think the Stones have to take precedent based on history. I worry about adding fiber supplements that will contribute to stones or counteract the meds for them I'm already on, so it's really challenging for me to determine what to take or change. Thank God the gel is working or I don't know what alternatives would be left for me.

Diz, have you tried miralax? It won't bulk up, just make things soft. It's a miracle for a fissure and safe for long term use. I don't mess with fiber or diet anymore. Miralax is the only tried and true success for me.

No I haven't tried it - but I think I will based on your advice, the Metamucil is bulking me up so much it's become ridiculous and painful, it's not for me...thanks! And request that Diltiazem next time, it REALLY is working miracles for me from the second I used it forward...