I first thought I had hemorrhoids about 18 months ago (not really understanding what that was or how large they were) and was using Preparation H (I since realized that was counterproductive). I thought this because of regular bleeding and discomfort from wiping. Anyway, that provided relief, but nothing seemed to get better, so I asked my doctor about it about a year ago. He said it was probably an anal fissure, to take some laxatives and use soft wipes and it'd be fine.

Over the last year, I feel like I've tried so many different things, and nothing seems to be making it better. I seem to always be constipated (despite taking Dulcolax daily), so I know that's making it worse. I use a bidet toilet seat at home, which helps, but the last week I was traveling and had only moist wipes. Coming home, it's so bad it burns like fire to use the bidet. I bought a sitz bath, and that feels pleasant, but as soon as it comes next bowel movement, I almost let out a scream from the pain.

Current regimen is:
1. Daily laxative (dulcolax), about 3 servings of fruit, and about 80 oz of water daily
2. Cold-water-only bidet attachment (can't afford one with a heater right now), use moist wipes when I have to go out and about
3. Twice-daily sitz bath with epsom salts. I've tried applying different things before after. Right now I'm trying Emu oil or Jojoba oil.
4. I've also tried lubricating my anus with vaseline to prevent abrasion as I pass a movement, but I can't do that all the time. In any case, the stretch on the anus seems just as painful as the abrasion.

Any suggestions would be very welcome!

Sorry to hear about your situation. The doctor I went to prescribed me nifedipine 0.5% ointment for anal fissure. It doesn't kill the pain or anything but it promotes healing by improving blood circulation in that area (from what I understand). But really if the last time you saw a doctor about it was a year ago you should see one again and tell them your current symptoms, that it's lasted a year etc. and see what he recommends from there. I get the impression that these things can sometimes heal with the methods you're using, but if they decide they don't want to heal like that then they just won't (or they will but at a snail's pace)

Thanks for the info! It's good to know that's out there. I know, I need to go back to the doctor. I just feel awkward, because he's a family friend, and it's such an embarrassing problem. I'm almost tempted to go to somebody else just to deal with this particular issue.

In the meantime, since that post, I've tried using Aquaphor healing ointment, which seems to at least help better than anything else so far at stopping abrasion.