So I'm new to the forum, but as a lurker here when I was suffering I figured it would be good to give back to the community and speak to my own healing story...

I had a long-term anal fissure for 9 months - it started off as a rather benign thing, but of did not seem to heal and only get worse. Like many people here, I had anxiety and tension that somaticized itself into the body. Unfortunately this included some "IBS"-symptoms, as well as tightness of the sphincter probably also related to my psychosomatic suffering. I saw a total of three doctors and two separate proctologists. No doctor could 100% give me some universal advice that would improve my condition - my last proctologist, and the one who helped the most, communicated this to me. Each person is different, and this includes how you respond to treatments that aren't as standard (e.g. twice a day Diltiazem cream - pretty standard and easy to follow). I also switched proctologists because the first one recommended I do surgery, specifically in Germany a fissurectomy (LIS are never suggested given the possible long-term ramifications). After reading things here, checking out The Friendly Proctologist, I didn't want to risk surgery if there was any possibility of conservative recovery, so I switched to a much better proctologist. After three months with him, I experienced one month that was a game changer. I'll describe below what happened, changes I made, and what worked for me.

- Continued with Diltiazem cream twice a day (I am still on it weening off, but I was lucky to not experience long-term side effects... I've been on it for six months now)

- I ate one banana a day, and focused my diet on foods with soluble fiber in it (not insoluble.. it prevents constipation, but stool won't be soft). Spelt bread, spelt pasta, carrots, peas, broccoli, etc. The diet can be very helpful for stool consistency, IBS-contributing factors, etc. This and husk done correctly may in fact be enough vs. going on a laxative

- Psyllium husk twice a day, taken with a meal (either shortly before or directly after)... for lunch I had the metamucil fiber thins (two thins), and for dinner I would drink a tablespoon of the husk power itself. There really is no prescribed dose, my proctologist made it clear it really depends on your body, even what foods you eat, etc. Trial and error to find what works for you! I did not need any laxatives.. when the fissure is live many suggest laxatives and advise against psyllium husk etc. because the stools bulks. I never tried this, but adapted my approach to going to the bathroom accordingly

- Yes the stool bulks with psyllium husk, but the stool should also be quite soft too! When the fissure is live, stretching the sphincter can be hard, even as scar tissue tries to heal - so I didn't simply let it fall out with my abdominal breathing. It was about how I went to the bathroom when the fissure was live. I personally found applying lube, using a foot stool, abdominal breathing ("pushing" with your stomach), and pushing from the anal muscles only a very light-moderate amount helped "squeeze"/"shrink" the bulky stools down enough it was not difficult at all to pass, nor did I overly strain

- Anxiety sucks and is a contributing factor, maybe go to a therapist who specializes with the body, etc. I find most of us struggle mentally. This helped me a lot. The month I healed I stop fixating on solutions, and sort'of accepted my fate. I focused more on life, relaxing, but not overly pushing myself either. I also suffered from "IBS-D" that would burn the chronic fissure sometimes, so this was crucial!

- Anal dilation WITH kegels. All I can say is this worked even better than the cream, but less than getting the stools consistent. Some of the above helps with the stool consistency (husk, diet, anxiety/stress, etc.). I realize when its so fragile you really need the consistency. However that can be very difficult to get right every single day (I only managed it for 3 weeks, which got me over the hump you could say). Therefore anal dilation is a must support. My proctologist prescribed me a medical dilator, and suggested I do it 5-15min a day, and when its dilated to perform slow-graded kegels on the dilator, holding the firmest grip for 3-5 seconds each "rep". Not only would this relieve my pain or tightness sometimes, almost immediately after, it helped the muscle around the wound and eventually scar tissue to remember flexible and strong.

Currently it has been one month since my fissure has closed! I had a small relapse with the scar tissue "bursting" once (getting carried away with my healing), but no re-opening since. I continue with the dilation and cream, but I think in a couple more months I won't even need to do that. Although I do have some discomfort once and a while connected to the hardness of the scar tissue, or the remaining skin tags, it still feels like a new lease on life, and I'm basically no longer in chronic pain.

Good luck to you all! It is possible to heal from a chronic anal fissure without surgery!

Thanks for your story....I cant mentally do dilation cause anoscopy injury traumatised me for life also some doctors warn against it... do you think that only with PT reverse kegels tight sphincter could also loosen with time?