Hello all!
First I'd like to congratulate everybody for the level of support offered in this forum... This is a really nasty condition which isn't well understood by everybody, but those who have it certainly know how hard it is...
So here's for my condition...
I'm a married man with a child and a supportive wife in my late 30s. I had an AF 10 years ago, when I was in a late 20s. Thankfully, it was't really a huge deal and it cured itself with the normal high fiber diet, cleaning, care etc... After a couple of weeks there would be no bleeding and very little pain. I had no spasms at all back then, and while I kept paying attention to my food intake and regular BM, it was a painful, but short experience. And I thought I had said AF bye bye...
Comes 2012 and after some bad weekend food that caused a lot of constipation, the AF reopened again. My current status:
1. I've been bleeding in pretty much every BM in the past 10 days. It's not a lot of bleeding, but it's generally enough to make the toilet water red and leave the baby wipes covered in bright red blood.
2. Most of the days, I have pain when sitting and discomfort while walking, but I only had really painful spasms a couple of times (I mean, that burning sensation that lasts a long time). I have BM twice a day.
After a BM, it usually takes 20-30 minutes before I'm "okay" (that is, pain-free enough for working and basic domestic chores). I was able to have 3 bloodless BM in the past 4 days, but most of them are bloody - I haven't been able to have 2 BM in a row without blood.
3. I went to a doctor 4 days ago. He didn't really think it was a big deal, and told me that the main course of action is "not be afraid of BM". He said it could be AF or a thrombosed hemorrhoid, but I'm 99% it's AF given that this feels exactly like the one I had 10 years ago. So he gave a prescription for Hydrocortisone suppositories and kicked me out of his office without further ado. I didn't like how dismissive he was, but maybe he's used to more serious stuff (? :( ). He said "call me later if it doesn't improve", but I'm not too hopeful he will help me all that much!!
So that's it... I'm in week 2 and looking forward to get over this (duh :) ). I'm eating tons of fiber, drinking tons of water, using boudreaux's butt paste after BM (zinc oxide) and these precautions seem to be reducing the pain, but not bleeding.
At this point, I'm looking for information mostly, so I'd really appreciate if anyone knows the answer to the following question:
Let's assume for now I have an acute case, not a chronic one... What is the normal progression of these AF, not assuming the worst? When I have bloody BM after non-bloody BM, does it mean that "it's 100% open again, and it's all back to the beginning?". Or, if I'm lucky, this will bleed sometimes, not bleedy other times but bleed less and less until it's gone? In my previous time, it bled for 3 days or so and just stopped... This time, it seems to be slowly bleeding less, but I just had a "full bleeding" BM. I have no idea how this is supposed progress! :-O

Dan,
Sorry you've found yourself in this position, once again. It's quite a physically/mentally challenging condition, and many times comes down to much trial and error before we find what works for us as an aid towards healing.
May I ask what type of physician you saw? If it wasn't a crs, I'd highly recommend seeking one out for a proper exam/diagnosis/treatment plan.
You should have received a prescription for a muscle relaxing ointment, such as nifidipine or dilitziem, which are part of the treatment plan a crs
will start you on.
Regarding the normal progression of healing, I'm really not sure. My gut would tell me that as long as there is blood, you've still got a somewhat "active" fissure. But, if it isn't continuous bleeding/blood, possibly some of the fissure is healing but part of it is not. Like closing on one end and not the other. I hope someone on the forum has a better opinion or in-sight regarding this....I'm just really unsure.
I hope you'll consider finding a crs...I do believe aside from being properly diagnosed/treated, they'll be more understanding and not so likely to dismiss you knowing how discouraging/painful this condition is. You'll also be able to have a specialist on hand to call and follow-up with throughout the treatment and healing process.
Best wishes for healing....
Angel

Hello Angel, thank you for your information and quick response. I saw a GI, actually I thought that a CRS would be needed only if surgery was needed, but I learned better in the past couple of days by reading this forum. This is a good piece of advice, I'll certainly ask for my doctor to get rid of me for good and refer me to a CRS :-).
On a separate note, I'm one of those weird engineering types. So what I'm doing to track my progress is to evaluate the amount of blood on a 0-5 scale (0=no blood, 1=some blood on stools but not on wipe etc) and write down on a spreadsheet. Using this method, there is a very clear improvement when I draw a trend line, but I know how difficult this condition is and that it keeps going back and forth:-/
By the way, I just had a big bloodless BM (0 on my scale), which is great! And my average for the last 5 BM is 1.4, which is great too :) (sorry, I'm really geeky, hehe).
One trick that is helping me pass gas, cough and helped me just now with my BM is to hold the back of my buttocks together with my hand, like if you were pinching the back of your buttocks. This is helping because I have a fissure on the back, and it's helping more than I thought it would.

Hi Dan,
I agree with Angel that if you aren't seeing improvements in two to three weeks of self care that your best bet is a colorectal surgeon. But I think from what you're saying you already have found that out :)
As a general guideline, fissure healing isn't too hard to track because less bleeding and less pain are very good signs. Of course, without knowing if you also have hemorrhoids (which are really commonly found together with a fissure) the bleeding can be a little confusing because even painless internal hemorrhoids can bleed.
Keeping stools soft and easy to pass with no straining in whatever way it requires you to achieve that with your body is key. There is a lot of information on this forum about how people approach that if you need some tips. Keeping the area clean and taking sitz baths to relax the sphincter (especially after bowel movements) and promote circulation will also aid in your healing.
Oh, and the support you are providing by holding your buttocks together actually has merit. By supporting the surrounding muscles like you are doing you are taking some of the forceful pressure off the sphincter area so that it doesn't stretch as much. Since you're an engineer you might be interested to hear there is a guy who has invented a toilet seat support device specifically for posterior anal fissure sufferers that achieves what you're doing with your hands. Here is a link to the study.
http://www.ncbi.nlm.nih.gov/pubmed/19288250?dopt=Abstract
Best wishes for speedy relief and healing of your fissure!

Thank you jr2!
This link you sent me is interesting, it seems the same thing I'm doing but I couldn't find a way to read the pdf to confirm...
I must say that, for me, the "holding buttocks together" technique has been nothing short of miraculous. Since I started doing that yesterday morning, I had NO BLEEDING and almost NO PAIN - after 6 BM using the technique. I'm feeling a very minor discomfort for around 5 minutes after BM and that's it... I'm sitting normally, it's like I don't have this condition any longer... Of course I know it's still there, but it's pretty obvious that it's improving.
I've never found this recommendation in any of the articles or forum posts I read - probably because it doesn't help most people. But for me, this pretty much solved the problem. From hours of pain, anxiety and bleeding to nothing by just holding the buttocks together during BM.
There is still a long road ahead, but after 36 hours of no bleeding and no pain, I feel that this has a chance to be cured after 2-3 months like it did 10 years ago... I hope! :D
I will keep you all posted, and I will write a full writeup when this is over. Thank you again for all the support!!

I would also recommend you check out this post which I've shared several times on this forum:
http://anal-fissure.org/t4752-what-worked-for-me-what-didn-t-work

Alright, I've been out for a few days and now it's time for an update... Bill, thank you for the information, I made some tweaks on what I'm eating based on it.
I was able to stay 2 more days with no bleeding with my trick, but it stopped working on Wednesday. I haven't had a lot of pain since then until this morning, when I had 3 BMs in 4 hours and after the last one I had a lot of pain. It's likely that I also have an hemorrhoid because the pain I'm feeling isn't the same as the fissure...
I don't really know why I'm going to the bathroom so often, my best theory is the Miralax I've been taking since last Sunday.
In the beginning, I thought Miralax was helping me but now I feel it's making things worse by sending me to the bathroom more often than ideal... My normal is 1 BM per day, when I started eating fibers I went to 3 BMs per day (after each meal), but now I'm going 5-6 per day which is WAY too much. I will discontinue the miralax and see whether my high fiber diet will be enough for 3. In the past days, as long as I didn't have more than 2 BMs in a 4 hour interval, I was really fine, but now it's hurting quite a bit... :-(

Dan,
I find that as I take miralax, the longer I take it the less I actually need to use for the same softening effect, otherwise I run into the same prob. So you can back off the miralax or take half your normal dose for a bit. See how that helps.