Katie -
So glad you found this forum...but sorry you had to. Also -- apologies from all of us for not responding to you sooner.
11 years is a long time to deal with pain, discomfort and the not knowing what is going on down there. I am glad you are tackling this head on now and hopefully over time you will deal with it once and for all.
I am not sure I got what caused the recent flare up -- the autocorrect may have caused some misspelled words. Anyways...no matter.
We can all totally relate to the pain and the distress of dealing with a fissure. Great that you got a prescription for cream -- you should be using it 3x a day and after any bowel movement. Use a pea sized amount and just spread around the anus...it will be absorbed and is supposed to help reduce the resting pressure of the internal anal sphincter. Basically what we all need to do to help the healing process is allow for more blood flow to the anal sphincter area -- and reducing the pressure allows for this. So does heat applied to the area -- that is why sitz baths or regular warm baths a couple times a day are great for both reliving some of the pain but also for stimulating blood flow to the area...baths were a huge help for me. They were a time where i could find some respite from my pain. Sitz baths are also a great way to stay clean down there -- super important for healing.
Taking a softener is a good idea -- most on this site swear by Miralax -- I would highly recommend it. Also, some add a magnesium supplement to help soften stool -- a magnesium citrate often works well (stay away from the kind blended with calcium...it does not help soften stool).
It is important to get a good amount of fibre in your diet -- but make sure it is a combo of soluble and insoluble. One mistake some of us make (me included) is you start out eating only insoluble fibre because you think that is the best...it isn't for this condition. You want some fibre that absorbs water -- again, to help make things soft and to help with peristalsis. In my early days when pain was acute i avoided metamucil and the like because it bulked up my stool and really caused more pain -- now i swear by it and use every day as a way to ensure i am regular.
Please keep the questions coming...others will chime in. Sending you a ton of support and encouragement.
All best,
Canadabum