So had been dealing with this since June 2018. July and September were the worst months by far. Pain was an 8 in those months, very brutal. I went to work through it all and didn't tell anyone at work. Came very close, but talked myself out of it at the last minute.
Survived with hot baths every morning, much fiber, dieting, only going once a day in the morning, drinking half gallon of water per day, sodium acetate packs (sat on them every day, especially in the car, extremely necessary and helpful), and colace.
I had a fissure with overlapping internal hemarrhoids. The fissure would cause pain as high as an 8, but the internal hemarrhoids were more like a 5. But for most of it, I could not tell what pain was attributed to the fissure, and what pain was attributed to the hemarrhoids. The nature of the pain seems to change on a weekly basis. One week its burning, next week throbbing spasms, next week it feels like a hot knife, extreme nerve pain, then it feels like a twisting wrench. Very confusing.
Since I had healed myself twice before since 2015, I remained very optimistic that it would go away on its own. I put off going to the surgeon because was not looking forward to the scope and whatever else. Finally, after five months, I went. The scope was painful, but worse was the DRE. There was blood (hadn't actually bled in a long while) and I asked him about it. He would not tell me why he did such an aggressive DRE, but he explained "there was no frank blood, though". He also told me that it didn't hurt that much because he has had patients that actually fly off the examination table. He said that the fissure is healed and all you have is hemorrhoids. I could swear he was trying to pop all those roids with his DRE, but sure as heck can't prove it. Anyway, he sent me home with two weeks worth of corticosteroids and that was it.
Hopefully, it is all behind me now. Being very careful not to fall back into the bad habit of pooping too forcefully that I have had all my life.