I've been dealing with a (or, multiple?... still not sure I fully understand the definition of chronic in this instance) fissure for about 7 or 8 years. That does not mean I've had an acute fissure ALL of those years.... the first one lasted probably 2 months or a bit longer, the other acute phases have lasted varying lengths.

I still get them, but maybe 1 or 2x year, and I've learned how to shorten the acute phase, reduce the pain a tiny but, and I've actually been able to stop a developing fissure in its tracks a few times.

I have seen multiple docs, almost had the botox intervention (it got better 2 days before) and been on every ointment available.

Mine are very painful as expected but the hardest for me is I get a very significant muscle pulsing nerve reaction that shoots pain down my legs and causes my anal muscles to just flex and pulse all day long. It means the actual bathroom trip is the easy part for ME, painful as it is. The deep pain from the nerve reaction is hellish.

For me, management all comes down to reducing pressure on my bum from digested food in the colon (which just tells my anal muscles and nerves all day long to fire away):

Immediately taking milk of magnesia when I'm remotely backed up. Heavy dose. Stop eating. If a fissure forms anyway:

1. Immediate enema to clear it all out.
2. Stay on the milk of magnesia. And stool softener. For me, going to the bathroom more frequently is better as long as it's very loose.
3. Go to as close to a liquid diet as I can stand, 2-3 days seems to be enough.
4. Apply ointments, of course.

As I said, it's imperfect. It's hard to starve yourself basically (broth, a handful of chips to feel sane, coffee, gummy bears) but it seems to help for me. Once I start to feel a little better I just stay on the mom and start to eat a little more. I have not eaten red meat for 8 years bc I know it's a serious trigger for me.

Still here looking for others tips and solutions.
Good luck everyone, this is terrible condition I wouldn't wish on anyone.