So here's my quick, fun, gist of a story regarding my AF.
On April 6th I delivered my son. Bam, my first ever AF. After weeks of trying to treat it with nitroglycerin and then anusol, I was still crying from pain and having to care for a newborn and it has just been three months of a nightmare, as you all know and understand.
Anyway, in the beginning of July, my doctor finally said we'd done enough creams to know that it was time to try Botox. I scheduled an appointment that isn't until the 31st.
Here's where I need opinions, fellow AF sufferers. As of last week, suddenly, for no apparent reason, my symptoms got better tenfold. It still hurts during a bowel movement. That pain has not stopped, though I don't scream or shake like I had ~8 weeks ago. But there's been no burning following a BM, only the occasional spasm if at all, and I'm not constantly thinking about it (though my life is still - and I think always will be - consumed by how to care for this problem via diet etc). So... Do I go through with Botox? It's obviously not HEALED but I'm also on the fence of canceling the Botox because, if it is suddenly attempting to heal naturally (I stopped all creams a couple weeks ago as the side effects were not worth it, and the dr approved stopping) I'd prefer to go that route.
What are your opinions? Any thoughts? Thanks everyone!

Hi Newmomproblems
Congratz on your new baby but its unfortunate it came with an anal fissure. You'll soon discover here that your in good company being a new moon with more than just a baby to tote.
Just hearing of your story personally I would wait it out. You must be doing something right to have your symptoms to make an "about face". Is it possible  your bm's of late were nice and soft thereby cutting the spasms. Is it possible you applied the creams a little differently than before. (you may want to try Nifedipine as it does not cause the headaches).
Anyway, it sounds as if there's a good chance for your AF to heal naturally, this being your first AF ever. Although you may be teetering on the edge when it comes to chronic vs acute, I'm wondering during that time was there a retear from a hard bm or not. Knowing this would give me more confidence as to your success in treating it naturally.
So number 1 for you now no matter what, keep your stools soft. A couple more natural weapons we love here is to pre-lube that fissure before each bm and to hop in the tub or showers after each bm (when practical), as this will sure cut down on the burning, spasming, re-tears and enhance healing. And please do not strain on the toilet.
We hope you ultimately make the right decision for yourself and the baby as it must be hard for you to concentrate on both your baby and your bottom.
Always factor in any sound advice that your Dr may give you in regard to doing this or that. And the same Qs that you ask here don't be afraid to ask them.
hope this helps & good luck...

Thanks buttastic! I should have gone into more specifics but I wanted to be brief. Essentially, I had AF-like pains the first couple weeks after delivery but my OB said that was normal. Around week 3 or 4, I had a hard BM and the pain lasted almost 24 hours and I was in complete agony. I assume this is when it truly tore.
As for care, I've been eating a high fiber diet (between 25-30g) with lots of water. My BMs have been soft and regular since around week 7 or 8 when I saw a GI doctor for the first time and she diagnosed it as an AF. I was still naive and thinking it was internal hemorrhoids. That's when we started nitro. But I had a reaction to it that wasn't pleasant so I stopped. Anusol seemed to make matters worse - it felt tighter during BMs and so I stopped. So, for the last three weeks, I've been cream free. I've just been managing my diet (which includes a glass of Metamucil in the morning) and taking a hot bath immediately after a BM for 15 minutes, give or take (aka - whatever my son will allow).
So that's my story, really. Pain started about 15 weeks ago. Got bad around week 3/4, hit its worst peak around week 6/7, and suddenly around week 13/14 it's improved immensely but still not healed.
I want to work out so badly. I miss running. We're also planning for baby number two early next year and I'm fearful of the hold this AF has put on my life!

Yeah, that hard bm of week 3-4 may have reopened the original fissure you may have gotten during childbirth.
That 24 hour pain may have indeed been spasming, which will make it nearly impossible for the AF to heal, hence the botox. So again, if your saying you've been cream free and are not experiencing the  prolonged spasms, thats a good sign that you can heal naturally to me.
So at around week 6/7 when you say the pain hit its worse, why do you think that is? Is it possible it could have re-tore during this time??
Did you have a firmer than normal bm,(as you said bm did not become soft until week 7/8 ) were you straining more so around that time. Not that there's a definite reasons as AF are pretty hard to figure sometimes.

Anyway still, personally I would wait it out and see if this latest improvement continues with some added TLC. But you sure are at least a close candidate for botox.
If I were you I would try another cream that does not cause the headaches if this last turn of success backfires. If that does not work, then I would seriously consider the botox. Just one opinion though, weigh in what other will have to say.
HTH

Thank you! I plan to see my GI on Thursday to further discuss canceling the Botox appointment so we'll see.
I think the pain being the worst at 6/7 weeks is because, after the fissure truly occurred that one painful day, each BM thereafter got rougher and rougher to pass. They weren't necessarily hard, but rubbed against an open wound so that in two weeks time I was in complete agony for upwards of 8 hours after a BM, and during the BM I was in enough pain to feel like I could pass out.
Due to my body's responses to both cream attempts, my doctor wasn't keen on another topical ointment but I definitely agree with what you're saying - if I have a step back I will head back to the doctor.
I just want to avoid anything "surgical" if I can. I'd like to see this heal naturally in hopes of preventing a recurrence. Not sure if that even makes a difference!

Not sure if that even makes a difference!

Yeah, thats a tough call. It could or could not. With some the only thing that will control those spasm is botox or LIS. You and your Dr. will have to figure this out.
All of my AF's healed the natural way, but they also all re-occurred naturally i.e. from being constipated. The only thing that stopped that cycle was mostly a diet thing for me, keeping stools soft.
Lets hope your next upcoming pregnancy fairs better for you with no fissures. Just wish there were more opinions here for you. But while we are waiting, heres some good info here on dealing with AF post childbirth...
http://anal-fissure.org/search?search_keywords=pregnancy
HTH