Please some one help me, I'm so confused.  My bm's are smooth and easy, most if not, every time, even if I spot bleed, only about every three weeks, in fact I haven't for a long time.
I still am tight, a little down there, again sometimes, but regardless my BM"s are painless, about 2 to 3 hours later the pain starts and then intensifies. The pain starts as a 1 to 2 and some times can reach up to a 5.
My stools on the bristle scale are a 4 to 5, smooth and easy to pass even if a little larger at times. I do it all, fibre..and of course water, water, water. I find if the pain increases to much then I can't walk, it hurts too much. It can last a little over 3 hours followed with soreness afterwords..it ruins my hole day so I try to get in a oatmeal flax with fruit breakfast so I can get it over with..Its so predictable.
I'm so upset..I don't get it..after breakfast, later for lunch I had a vegetable quinua with a splash of pure olive oil.  I'm just not very hungry, Getting a little depressed over it, and just want to cry:( 
I'm seeing my Gastro, Doctor on the 8th of July. Maybe she can increase the xylacaine. 
I use a heating pad and it soothes it, But I'm so sick and tired of it and has totally taken over my life.
Does any one else have the same problem and how do they handle it?

It sounds like you have a nasty case of anal spasms.  Are you using an ointment?  (nifedipine or ditalezam?)  Those specifically relax the muscle.  I use the ointments but still have spasms at times and they are SO annoying and sometimes miserable.   I'm glad you are going to see your specialist to see what they might have to offer.  They pain reliever (lidocaine or such) or such helps, but the muscle relaxer really helps.  I sometimes have to use ointment plus heating pad to get spasms to chill.  I hope you get relief soon!

Yes the ointment is a 0.25 nitroglycerine and Xylocaine 5%, I don"t get headaches or dizzy or racing heart, so should I ask for a stronger compound..Ugh more money, even in Canada, not working, (no benefits or plan)
I know we are not Doctors, I just want to know why, the pain increases(spasms) and then slowly dulls down to a sore dull ache..what gives, I'm sorry for Barking. Just so tired..Going to have Breakfast and hope for the best today.
Thanks,  

Personally I need to have BMs like bristol 6 for a week or two, to get close to painfree. If they are formed, I will be in pain. I find it strange my CRS tells me to aim for bristol 4, cause that will keep retearing me.

I agree JHH, how the hell is a monster 4 not going to tear? I get that I need to start stretching it, but a 6 or 5 for the rest if my days sounds like heaven.
Stick to it pleasegoaway, it should get easier with time.

Hi Please,
Soft stools are excellent and something you need to strive for, every BM, but unfortunately if your fissure is still relatively new, you are going to get that pain every time you go to the toilet at this stage, even with the softest of stools. This is due to your internal sphincter muscle being in a constant state of spasm and the severe pain is caused by the muscle spasm as it pulls on the wound edges of the fissure and the concurrent stress on the nerves from the muscles tightening. This is where you need to break that vicious cycle and it could be your prescribed medication dosage needs to be stronger - I was prescribed 2% Diltiziam, which was excellent and almost instantly helped calm my sphincter spasms, reducing all that after intensity greatly. I would really go back and state that your current medication is doing nothing and ask for an alternative or higher dosage. I totally relate to this as I too could simply not figure out why a nice soft BM would still lead to an aftermath of horrible lingering pain, but like I said, this was in the early days before I was prescribed my cream and that cream was my life saver. Please go back, be brutally honest and demand an alternative!
Valium is extremely helpful as a muscle relaxant if you can get hold of this and as Pain advises, a heating pad/ hot water battle. You are doing all the right things yourself - you just need a little more medical help here

Please go-away!, so sorry to hear of the discomfort, but remember most of us knows very well what you are experiencing with your fissure.
It took for me about 4 months of horrible daily pain and spams before I felt any relief, but once you get better the spams will ease.
Depression, anxiety some times comes bundle with the fissure as we experience hopelessness because we have not control.
But things get better, they actually do, with proper care and medical help.
Hang in there and keep doing what your doctor tells you and  something that help me a lot in my sleepless nights when the pain was so unbearable, was this board success stories, that gave me hope.
I also learned to do pelvic floor exercises that did wonders for the tightness in the sphincter muscle.
After a BM, a sitz bath help me a lot, I know it feels like a fissure take over our lives and in a way it does.
But is always light at the end of the fissure pain.
I hope you feel better.

It is the muscle tightness and spasming that is causing this to happen. As the others suggest, even if you achieve the perfect stool consistency you still are passing stool by a wound and it will be irritated by that and the muscle will respond by tightening. Keeping up with your same regimen, achieving the softest stools you can short of diarrhea, using the nitro., and making sure you are able to get the anal area very clean after a BM will assist your healing process.
In addition, there are some stretches and relaxation techniques you can try to promote greater relaxation in the pelvic area. Even though the internal anal sphincter is not under your control, you can stretch other muscles in the pelvic floor area that you might be clenching in response to the pain. Deep breathing, very deeply into your lower abdomen is one easy way to release tension in the pelvic floor. Fill your lower abdomen like a balloon and feel yourself let your pelvic floor muscles drop. There is also a series of stretches I do 3 times a day that I find really help with the excess tension in my pelvic floor. They are found in Amy Stein's book on physical therapy for pelvic pain syndromes.
As far as stool consistency and what doctor's recommend... well, easy for them to say. They aren't the ones in agony. Everyone needs to find the best size and consistency that works for them, and then stick with it. Thee are no hard and fast rules about that. Some people do better with more formed stool, some better with fluffier mushier stool. No two fissures are alike. Regardless of what anyone else says, you have to be your own tester. For example, your diet sounds like it's got way too much fiber in it for me, especially insoluble fiber. I'd be tearing myself deeper to shreds with the bulk. For me, lower levels of fiber, mostly soluble, mostly from fruits and vegetables, keeps stool size small but soft. But that's just me.
Don't give up trying and experimenting. And we're here whenever you need to vent. 

I'm going to chime in again about stool consistency.  I became a student of the Bristol scale as well.  For a long time I took a stool softener (sodium dosucate, if I've got that name right) along with diet changes.  Magnesium as well.  As my pain levels have gone down, I have been able to tolerate bulkier stools.  I take Metamucil in the morning and no other stool softener.  Just watching diet and being able to pass without such high pain levels I personally believe it is heading toward normal BM's to have formed stools.  At this point I think I am stretching without retearing.  It is still difficult to start the process but they pass without excruciating pain.  Some days the 'post-pain' is better, sometimes worse.  It is a LOT of work and experimenting to try and help yourself heal.  Fasten your seatbelt for the long run!  I agree about going back and asking for something stronger.  I think the 5 % lidocaine IS strong (the other ointment I have is 1.5 %) but I don't know about the strength of the nitro.  I found ditiazem (?sp) to be a little more effective in controlling spams than nifedipine.  But I like the nifedipine/lido combination ointment for before and after BM's.  So, pros and cons.  If I had had more severe spasms I probably would have opted for botox or LIS.  Keep on keepin' on...it can and will get better!!!!:D

Thank you every one, you have been so helpful, Oh no, my diet has increased in soluble, Oatmeal, quinoa, sweet potatoes, turnips, barly and carrots (carrots are ins, and sol), plus other fruits and vegetables with digestible proteins, I'm just sounding like a big baby, I know its going to take time,
I'm going to concentrate on those pelvic floor exercises.
And lighten up on my breakfast meal, smaller quantities.
Thank you all...much hugs, this has got to be the greatest place to talk it out.

There's a funny story to that, j.p.t," I think the 5 % lidocaine IS strong", because in my family, with my sisters and me,  pain killers rarely work or if we ever need surgery, the surgeon really has to put us out.lol.
I have a friend where half a baby aspirin knocks her out..me it has to be an extra strength, two or a script.
Years ago, when I had my gallbladder removed, I woke up, even with the anaesthetic,(before the operation,of course) lol. The surgeon, knew of my body's intolerance.)Sorry to go off topic.
 I will try to be patient..thank you again.